High tetanus antitoxin antibody concentrations in the Netherlands: a seroepidemiological study

Vaccine. 2010 Nov 16;28(49):7803-9. doi: 10.1016/j.vaccine.2010.09.036. Epub 2010 Sep 25.


We assessed the level and determinants of tetanus-antitoxin (TT)-antibodies in the Dutch population. Additionally, we evaluated the national guidelines for post-exposure prophylaxis. Serum samples and questionnaire data from a cross-sectional, population-based study were obtained from 7903 individuals. Serum antitoxin antibodies were assessed with a multiplex immunoassay. Multivariable linear regression was used to explore factors associated with antibody concentration. The overall seroprevalence was 94% with a geometric mean concentration (GMC) of 0.91 IU/ml. The TT-GMC increased with age in the age-cohorts of 13-23 years, which coincides with the meningococcal C conjugate mass-vaccination in 2002. Lower seroprevalences were found in individuals born before introduction of routine vaccination, first-generation migrants from non-Western countries born before 1984, and conservative Protestants living in the Dutch 'Bible belt'. Only 10% of those eligible for post-exposure prophylaxis were not sufficiently protected against tetanus.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Bacterial / blood*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emigrants and Immigrants
  • Female
  • Humans
  • Immunization, Secondary
  • Infant
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Netherlands / epidemiology
  • Seroepidemiologic Studies
  • Tetanus / blood*
  • Tetanus / epidemiology
  • Tetanus / immunology
  • Tetanus / prevention & control
  • Tetanus Antitoxin / immunology
  • Tetanus Toxoid / immunology
  • Young Adult


  • Antibodies, Bacterial
  • Tetanus Antitoxin
  • Tetanus Toxoid