Tetanus in the Elderly

To the Editor.—  Preventive health care is a relatively ignored discipline of geriatric medicine, consequently I applaud the publication of the article on tetanus in the elderly by Richardson and Knight.¹ Although rare in the general population, most deaths secondary to tetanus occur among older persons, augmenting the importance of preventive immunization. However, Table 3 in the article by Richardson and Knight is not what the Advisory Committee of Immunization Practices guidelines suggest for tetanus prophylaxis in wound management; rather, the Committee advises that patients with an unknown history of tetanus immunization or less than three doses of tetanus toxoid and a wound that is not clean receive an injection of tetanus toxoid and tetanus immune globulin (Table 1).Prophylactic immunization is an elemental component of geriatric care; however, several studies^2-5 suggest that tetanus immunization is lamentably inadequate. Accordingly, clinicians must become cognizant of the potential for tetanus