Tetanus and diphtheria immunity among females in the United States: Are recommendations being followed?

Objective The purpose of this study was to examine prevalence and factors associated with tetanus and diphtheria immunity among women in the United States. Study design Sera from 9411 female participants from the third National Health and Nutrition Examination Survey were tested for diphtheria and tetanus antitoxin. Interview information for adult women was analyzed to examine associations with immunity. Results Fifty-seven percent of the female subjects who were ≥6 years old were positive for diphtheria, and 64% of the female subjects for tetanus anti-toxin. Among women ≥20 years old, only 41% of the women were protected against both antigens. Older age, birth outside the United States, and less education was associated with lower immunity. Markers for contact with the health care system were not related to higher immunity. Conclusion More than one half of US women ≥20 years old who were tested were not protected fully against diphtheria and tetanus. All physicians, including obstetricians and gynecologists who may be the sole medical providers for women, should be familiar with the current Advisory Committee on Immunization Practices recommendations regarding tetanus and diphtheria toxoid booster vaccines.