Effecting factors of tetanus antitoksin levels among adults over 40 years of age in Trabzon, Turkey

Tetanus is a disease that has a high mortality rate and which can be prevented by vaccination. Although it is not commonly encountered in developed countries it is still an important concern for public health in developing countries. In developing countries tetanus is common in young adults, newborns and children. In developed countries it is more frequently seen in adults who have not been immunized or in individuals who have been inadequately immunized. The goal of this study is to determine levels of tetanus antitoxin in adults over 40 years old who live in Trabzon.This cross sectional study was carried out in Trabzon and its 9 provinces between August 2007 and August 2008, in adults over 40 years old. Sample size was 1067 with %50 prevalance, %95 confidence interval and %3 deviation. 1320 individuals who were grouped according to age, sex and lcoation were planned to be included in the study with anticipation of refusing to take part in the study, not appearing for blood sampling and incomplete questionnaires. The study was carried out in 1292 individuals over 40 years old (Percent of participation %97.9). The questionnaire was filled in face to face with participants. Age, sex, marital status, level of education, occupation, income, residence, vaccination status were questioned. Blood samples were acquired and IgG levels were determined. People with tetanus anticore levels over 0.1IU/ml were considered immune. Chi square test was used to compare anticore levels according to sociodemographic properties and tetanus prophylaxis. Logistic regression analysis was done to determine factors that affect having protective levels of anticores and no need for immunization.1292 individuals were included in the study with median age of 55.3±11.5. 673 of them (%52.1) were females and 619 (%47.9) were males. Anticore levels in participants were calculated to be nonprotective in %48.3 and protective in %51.7. Anticore levels were above 0.1IU.ml in %46.5 of females and %57.4 of males and the difference inbetween was found to be statistically significant (p<0.0005). When age groups were evaluated, %86.0 of individuals between 40-44 years old had protective anticore levels while this percentage decreased with increasing age, especially over 50 years old, regressing to %23.0 in individuals over 75 years old (p<0.0005). Statistical significance was present in comparison of protective levels of tetanus anticores regarding level of education, marital status, occupation and income (p<0.0005, p<0.0005, p<0.0005, p<0.0005). No difference was found regarding residence (p= 0.825). Protective levels of tetanus anticores were found in %66.3 of individuals with history of vaccination, in %34.1 of those with no vaccination and the difference between these groups was statistically significant (p<0.0005). Levels of protective anticores were 1.6 times more in males, 3 times more in individuals with vaccination history.As a result, decreasing levels of tetanus anticores was found with increasing age. Most effective means of protection against tetatnus is vaccination, therefore in individuals over 40 years old who present to medical facilities with any health concern, history of vaccination must be questioned and those with inadequate immunization status must be included in vaccination program.