Immunization against tetanus of patients given injections of antitetanus serum.

The authors report on an investigation conducted in the Netherlands into the best method of active immunization of patients treated with antitetanus serum; the active immunization is conferred by two intramuscular injections of tetanus phosphate toxoid at one month's interval.Trials were carried out on a total of 153 patients to determine the relative value of three treatment schemes: (a) the first vaccination and the serum injection given simultaneously but in different sites, (b) the first vaccination and the serum given in a single mixed inoculation, and (c) the first vaccination given one month after the serum injection. The results show that with simultaneous administration of vaccine and serum in different sites the patient acquires a reasonable antitoxin titre more rapidly than with either of the other schemes. Not only is he quickly protected, but he also receives his first vaccination at a psychologically opportune moment-when he is being treated for an accident.The authors lay special stress on the value of booster injections and discuss the difference in immune response between those under and over 20 years of age.