Tetanus Antitoxin Titers in Women of Childbearing Age from Nine Diverse Populations

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Abstract
The proportion of women with tetanus antitoxin titers adequate to provide protection for themselves and for their newborn infants varied from 96% in New Haven, Connecticut to 19% in Santiago, Chile. Women of childbearing age in five of the nine areas (São Paulo, Recife, and Pôrto Alegre, Brazil; Ecuador; and Gazankulu, South Africa) had an average of 40% immunity to tetanus and did not differ significantly from one another. By comparison with Chile, where vaccination during pregnancy is not current policy, we estimate that 21%–34% of the women in these five areas had received toxoid recently. In general about half the women with inadequate titer had undetectable levels of antibody and may require more than one dose of vaccine to attain immunity.