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TETANUS VACCINE In 1960, at the age of 6 years, I was given my first tetanus injectioll after pierctng my leg on a piece of rusted barbed wire. The previous year, the Medical Journal of Australia contained a number of letters on Tetanus Prophylaxis written by concerned doctors. Some excerpts from these letters follow: Dr W. F. Hunter, Medical Journal ofAustralia (18n/1959): "Press (948) also quotes a number of references which testify to what is generally known-that practically any study of the illness reveals many cases ill which tetanus antitoxin failed to prevent tetanus; and this author gives an average of fj,gures quoted 'in the 'literature showing that 33.4% of cases which had developed tetanus had received prophylactic antiserum (the average in non-military cases was 6.8%). Thus it is seen that antiserum is by no means efficacious in the prevention of tetanus in humans; also, in these cases the patient not only has the risk of contracting tetanus, but has the aJlded risk of the complications of therapy. "The complications of horse serum injections range from minor local reactions ~brough reactions of gradually increasing severity such as generalised urticaria, a-rthralgia, signs and symptoms of heart, lung and kidney involvement to neurological complications, some of which are of cons'iderable danger to the patient, with cases of radiculitis, brachial plexus neuritis, polyneuritis, Guil'lain-Barre syndrome, myelitis and cerebral and meningeal reactions (Miller and Stanton, 1954; Woolli ng and Rushton, 1950). "It would seem that if the figures quoted are correct, then a doctor who gives tetanus antitoxin should rather be sued for exposing the patient to unne,cessary risk should s.eri ous complications of therapy arise. In ;fact large sums of money !have been! paid by insurance companies ,to patients suffering from the complications of serum, therapy (Bennett, 1939). Is it possible that ATS, like typhoid vaccine, has been used for so many years with no real proof of its value?" Dr K. D. Murray. Medical Journal ofAustralia (31/10/1959): "I had occasion a few years ago to review a great bulk of literature in the English Ilan guage, and some selected German translations on the subject. "No evidence was found by me to suggest th'at tetanus antiserum had any value as a prophylacHc agent against the development of tetanus following accidentiil traumi} to humans. If any persons, ,or the manufacturers of this dangerous material, have evidence to the contrary, the time is ripe to present that evidence for evaluation. "In the absence of such evidence, tetanus antitoxin should be classed as both danger ous and useless, and its continued manufacture andj prescribing as a Pharmaceutical Benefit for the purpose of prophylaxis against tetanus in humans, a waste of public money." Dr Taylor, MedicalJournal ofAustralia (18/4/1959): "When presented with a break in the skin, recent or old, superficial or penetrating (including impetigo, otitis media, whitlow, etc.) the risk of tetanus infection is explained to the patient-that he has approximately a one-in-2S0,000 chance of contracting the disease from Ihis existing lesion (11 cases per annum in Victoria-population 2,700,00O-assuming each person contracts one potentially tetanic lesion lper year). If tetanus is contracted he would have a 40% to 60% chance of recovery. Now if an ATS injection is -given,. he has a one-in-SO,OOO to 200,000 'cnance of dying of anaphylactic shock. He 'has a three-in-1 00 chance of developing moderately severe urticaria. After this explanation, the patient us.ually has second thoughts about receiving an injection of ATS." JUNE-JULY 1993 NEXUS·21