Tetanus Toxoid, Its Use in the United States Army

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Abstract
The procedure of active immunization against tetanus of American troops was adopted as routine for all military personnel in 1941. The agent selected for this immunization was fluid or plain tetanus toxoid obtained from commercial biol. laboratories licensed by the Natl. Inst. of Health. The decision to use fluid rather than alum-precipitated toxoid was based in part on the satisfactory experience of the British and French with the use of a fluid prepn. The author discusses reactions following the use of tetanus toxoid in 2 main categories. In the first category the reactions caused no concern and were manifested by headache, weakness, general malaise, local soreness of the arm. and occasional chills, and fever. In the 2d category the reactions occurred in the majority of instances within 30 min. of the injn. and were characterized in general by flushing and itching of the skin, local and generalized urtiearial eruptions, and edema of the lips and eyelids. Occasional instances of edema of the glottis and dyspnea have been observed. Reactions in both categories did not occur with great frequency. A study of the length of time required to develop protection after completion of the initial series of 3 injns. indicates that the present practice afforded a maximum of protection. The incidence of tetanus in the army as in the civilian population of this country is very low. Since June 1941 when the present tetanus immunization program was adopted there have been but 4 cases reported from the entire army and none of these were in immunized individuals.