Archives of Clinical Infectious Diseases
A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48-72h and 7-9 days after the injection.
Twenty-eight (64%) patients had induration =5mm in 48-72h, classified as non-responsive, whereas 16 (36%) had induration =5mm that was classified as positive test (NS). There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis , history of tetanus-diphtheria vaccination and cutaneous anergy test. Of 44 patients, 34(77.3%) had antibody level of <0.01 IU/ml, 8 (18.2%) between 0.01-0.1 IU/ml and 2 (4.5%) had an antibody level of =0. 1 IU/ml . There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis , history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations (48-72h and 7-9 days after the test) (p<0.05).
Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required.
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