The Potential Development of Tetanus in Wounded Patients With AIDS: Tetanus Toxoid and Tetanus Immune Globulin

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Abstract
To the Editor.—The use of tetanus toxoid (TT) for tetanus-prone wounds has proven effective in preventing tetanus. Failures of TT can be due to (1) agammaglobulinemia, (2) exposure to acute doses of radiation, (3) immunosuppressive drugs, (4) carcinoma of the breast, (5) poor toxoid, or (6) an inaccurate toxoid history.1 Individuals with acquired immunodeficiency syndrome (AIDS) might not respond to an initial injection of TT, so they might not have an anamnestic response to booster TT injections. Recently, Bernstein et al2 assessed specific antibody production in five young children with AIDS. No antibody was found in serum obtained before TT booster immunization. Three patients had no demonstrable antibody after immunization; the other two patients had a diminished response that was less than the lowest titer measured in age-matched controls. It does not seem unreasonable (1) to administer TT (active immunization) to injured patients with AIDS in accordance

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