[Tetanus vaccination--tolerance and prevention of side effects]

Data collected over a 15-year period concerning the side effects directly reported following administration of Tetanol were evaluated and it was found that the tetanus vaccination exhibited an extremely high degree of tolerance, with only 27 cases of side effects for 1 million doses. In over 80% of those cases with side effects the intolerance took the form of a painful reddening and/or swelling at the site of injection. This reaction to the vaccination, though not uncommon, was thus greater than is to be expected. General reactions, particularly malaise and an increase in body temperature, accounted for 10% of the cases reported; 3% involved skin reactions beyond the injection site. Symptoms involving the cardiac, circulatory, respiratory, locomotor, or nervous system occurred in fewer than 3 cases per 1 million doses, i.e., in fewer than 5% of the reported cases. It proved highly improbable that an allergic-anaphylactic or anaphylactoid reaction was involved and the complete picture of anaphylactic shock was never observed. Young and middle-aged adults with several tetanus pre-vaccinations accounted for the majority of side effects reported and in most cases hyperimmunization was suspected as a cause. As they were mainly restricted to the site of application and in 75% of cases occurred within 2-48 h, they can be interpreted as type III reactions (Arthus type). Furthermore it can be assumed that other causes of the reactions will have included unintentional intravascular and subcutaneous administration.(ABSTRACT TRUNCATED AT 250 WORDS)