{"doi":"10.1093/cid/ciad598","title":"Serologic Immunity to Tetanus in the United States, National Health and Nutrition Examination Survey, 2015–2016","abstract":"BACKGROUND: 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 11-12 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 ≥6 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. METHODS: Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015-2016 National Health and Nutrition Examination Survey (NHANES) aged ≥6 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as ≥0.10 IU/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression. RESULTS: Overall, 93.8% of the US population aged ≥6 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial/ethnic categories, sex, and poverty levels. By age, ≥ 90% had protective sero-immunity through age 69 years, but prevalence of sero-immunity declined thereafter, with 75.8% of those aged ≥80 years having protective sero-immunity. Older age (adjusted prevalence ratio [aPR]: 0.89, 95% confidence interval [CI]: .85-.92) and being born outside the United States (aPR: 0.96, 95% CI: .93-.98) were significantly associated with lower prevalence of sero-immunity. CONCLUSIONS: The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program.","journal":"Clinical Infectious Diseases","year":2023,"id":330522,"datarank":0.3958585994422889,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.0,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9595,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":511259,"name":"Nicole Brown","orcid":"0000-0002-3184-0550","position":1,"is_corresponding":false},{"id":625906,"name":"Li Deng","orcid":"0000-0003-3174-8989","position":2,"is_corresponding":false},{"id":243251,"name":"Jarad Schiffer","orcid":"0000-0003-3193-2700","position":3,"is_corresponding":false},{"id":1054735,"name":"Lily Jia","orcid":null,"position":4,"is_corresponding":false},{"id":256481,"name":"Monica Epperson","orcid":"0000-0003-1125-5247","position":5,"is_corresponding":false},{"id":257366,"name":"Yamini Gorantla","orcid":null,"position":6,"is_corresponding":false},{"id":256483,"name":"Sohee Park","orcid":"0000-0001-8513-5163","position":7,"is_corresponding":false},{"id":727884,"name":"Jingning Ao","orcid":null,"position":8,"is_corresponding":false},{"id":422026,"name":"Anna M. Acosta","orcid":"0000-0001-9234-9493","position":9,"is_corresponding":false},{"id":422027,"name":"Susan Hariri","orcid":"0000-0002-5977-0259","position":10,"is_corresponding":false},{"id":792017,"name":"Valerie D Bampoe","orcid":"0000-0002-0682-2430","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:09:10.120703Z","pmid":"37787062","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}