Immunisation does not rule out tetanus

doi:10.1136/bmj.320.7231.383

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David R Vinson, staff physician (drvins@netscape.net)

Department of Emergency Medicine, Kaiser Permanente Medical Center, Sacramento, CA 95825, USA

EDITOR—Shimoni et al illustrate a needed caution to clinicians: do not exclude a diagnosis of tetanus in a patient who has been fully immunised.1 Their report adds to the list of rare cases of tetanus that have occurred despite complete immunisation. Although the authors state that all reported cases of tetanus in the United States have occurred in people who have not been immunised, this …