Simonsen O, Klaerke M, Jensen J E, Kjeldsen K, Hau C, Heron I
Vaccine Department, State Serum Institute, Copenhagen, Denmark.
J Trauma. 1987 Dec;27(12):1358-61. doi: 10.1097/00005373-198712000-00007.
In 24 military recruits vaccinated against tetanus 17-20 years earlier antibody responses were studied 4, 11, and 24 days after revaccination. Antitoxin concentration in serum showed a sigmoid increase with titres at day 4 only just above protective level, corresponding to a risk of susceptibility to be expected even 4 days after revaccination (2.0%, 95% confidence limit). Only after 7 days the risk of unprotection was less than 1%. As the incubation period of tetanus can be as short as 24 hours, revaccination only may not be regarded sufficient if more than 17-20 years have elapsed since primary vaccination and conditions favoring rapid development of tetanus are present. The findings may explain some of the cases of tetanus which have occurred in spite of primary vaccination supplemented by emergency booster. The statement that prophylactic tetanus immunoglobulin is never indicated to persons completely vaccinated earlier should be considered for revision.
对24名17 - 20年前接种过破伤风疫苗的新兵，在再次接种疫苗后的第4天、第11天和第24天研究其抗体反应。血清中的抗毒素浓度呈S形增加，第4天的滴度仅略高于保护水平，这意味着即使在再次接种疫苗4天后仍有易感性风险（2.0%，95%置信区间）。仅在7天后，无保护的风险才低于1%。由于破伤风的潜伏期可短至24小时，如果自初次接种疫苗已过去17 - 20年以上且存在有利于破伤风快速发展的条件，仅再次接种疫苗可能不足以预防。这些发现或许可以解释一些尽管进行了初次接种并补充了应急加强针但仍发生破伤风的病例。对于之前已完全接种疫苗的人永远不需要预防性破伤风免疫球蛋白这一说法，应考虑进行修正。
