{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:43:15Z","timestamp":1793835795723,"version":"4.6.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"2","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tetanus, a life-threatening infection, has become rare in the United States since introduction of tetanus toxoid-containing vaccines (TTCVs), recommended as a childhood series followed by decennial boosters beginning at age 11\u201312 years; vaccination uptake is high in children but suboptimal in adults. The objective of this study was to estimate the prevalence of sero-immunity to tetanus among persons aged \u22656 years in the United States and to identify factors associated with tetanus sero-immunity. Understanding population protection against tetanus informs current and future vaccine recommendations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015\u20132016 National Health and Nutrition Examination Survey (NHANES) aged \u22656 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as \u22650.10\u2005IU\/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 93.8% of the US population aged \u22656 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial\/ethnic categories, sex, and poverty levels. By age, \u2265 90% had protective sero-immunity through age 69 years, but prevalence of sero-immunity declined thereafter, with 75.8% of those aged \u226580 years having protective sero-immunity. Older age (adjusted prevalence ratio [aPR]: 0.89, 95% confidence interval [CI]: .85\u2013.92) and being born outside the United States (aPR: 0.96, 95% CI: .93\u2013.98) were significantly associated with lower prevalence of sero-immunity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad598","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T10:29:15Z","timestamp":1696328955000},"page":"470-475","source":"Crossref","is-referenced-by-count":15,"title":["Serologic Immunity to Tetanus in the United States, National Health and Nutrition Examination Survey, 2015\u20132016"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-2430","authenticated-orcid":false,"given":"Valerie D","family":"Bampoe","sequence":"first","affiliation":[{"name":"Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Brown","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Deng","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarad","family":"Schiffer","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily Tao","family":"Jia","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Epperson","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamini","family":"Gorantla","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Hee","family":"Park","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingning","family":"Ao","sequence":"additional","affiliation":[{"name":"Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M","family":"Acosta","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hariri","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine Preventable Diseases 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