Lack of Tetanus Immunity in Neonates in a Developed Country

Objective: Our study was performed to evaluate the tetanus vaccination status of newborns and their mothers in a developed country. In Austria, a nation-wide routine screening program for pregnant women exists. Expecting mothers are regularly seen by their physicians and data are collected in the so-called mother-child-passport. Due to vaccination programs in industrialized countries, immunity against tetanus of expecting mothers and their offspring should be assumed.

Methods: A total of ninety-nine delivering women were enrolled in our study. Neonatal immunity against tetanus was investigated using cord blood samples. Antibody titers were measured by ELISA. According to international standards, weak immunity, requiring an immediate booster, was defined as an antibody concentration of 0.01–0.1 IU/ml, and adequate protective immunity was classified as ≥0.1 IU/ml.

Results: In five of ninety-nine individuals (5.1%) no tetanus antibodies could be detected in cord blood samples, while two of the samples represented borderline values (0.01 IU/ml). Thus, seven serum samples revealed the need for an immediate booster vaccination (>0.01-<0.1 IU/ml). Eighty-five women (85.9%) presented with adequate tetanus immunity having a protective antibody concentration ≥0.1 IU/ml. The median antibody concentration was 0.95 IU/ml.

Conclusion: Our data demonstrate a lack of adequate tetanus immunity in 14% of newborns in an Austrian tertiary care university hospital. This investigation stresses the importance of stringent regimens concerning prenatal vaccination care. Programs called “getting prepared for pregnancy“ should include the evaluation of vaccination histories even in countries where generalized immunization programs are established. If indicated, maternal immunization during pregnancy should be initiated for protection of newborns against a life-threatening infectious disease.