Thirty-nine per cent of 1,900 randomly selected adult Health Plan members received one or more tetanus injections during a 10-year period of continuous eligibility. Age-specific immunization rates decreased from 47 per cent for 20-39 year olds to 28 per cent for those over age 70. Nearly half of the elderly, age 60+, received a booster of tetanus toxoid rather than tetanus-diphtheria toxoids as recommended by the Immunization Practices Advisory Committee of the Centers for Disease Control. Access to care does not appear to be a sufficient condition for achieving recommended levels of immunization, especially among the elderly.