Issue Number 459            May 10, 2004


  1. Reminder: Spring is the time to encourage adult patients to get a tetanus-diphtheria booster
  2. New edition: "International Travel and Health 2004" now available on the WHO website


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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.

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May 10, 2004

Springtime finds people of all ages heading outside to garden, picnic, and have fun in the sun. Outdoor recreation can create problems, however, and one of them is potential tetanus exposure. According to CDC, 31% of reported tetanus-related injuries occur in yards, gardens, and farms, and another 23% occur in other outdoor locations.

Given the popularity of gardening and other outdoor activities, it's important that health professionals make sure patients, particularly older patients, are fully and currently immunized against tetanus (and diphtheria). According to an MMWR surveillance report, in 1998-2000, only 40% of persons 65 years and older reported receiving a booster dose of tetanus toxoid in the previous 10 years, and 75% of reported tetanus deaths occurred among patients 60 years of age or older. Clearly, many older adults are not adequately immunized against tetanus and some are suffering and dying as a result. Other at-risk populations include persons of Hispanic ethnicity, older diabetics, injection-drug users, pregnant women, persons with philosophical objections to vaccines, and persons who might not have received a primary series (e.g., immigrants). (Source: "Tetanus Surveillance--United States, 1998-2000." MMWR, June 20, 2003, Vol. 52[SS03].)

An array of free tetanus information for patients and professionals is available from the following sources:

For a variety of materials, including a patient-education brochure that can be downloaded or ordered free of charge, visit the National Foundation for Infectious Diseases website at

For professional resources, including a clinical information slide set, international travel information, and excerpts from the "Pink Book," visit the CDC website at

For journal articles, recommendations, state laws, case histories, photos, and other resources, visit the IAC website at

For VISs for tetanus and diphtheria vaccine (Td) in 28 languages, go to:

For VISs for diphtheria, tetanus, and acellular pertussis vaccine (DTaP) in 28 languages, go to:

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May 10, 2004

Newly available on the WHO website, "International Travel and Health 2004" offers guidance on the full range of health risks likely to be encountered at specific destinations and associated with different types of travel--from business, humanitarian, and leisure travel to backpacking and adventure tours. The information is intended to help the medical profession be fully aware of potential risks and to provide appropriate advice regarding vaccinations, protection against insects and other disease vectors, and safety in different environmental settings.

To allow for regular updates, the 2004 edition is available online only. To access it, go to: and click on the chapter titles at the top of the screen.

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IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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