Tetanus Immunity as a Surrogate for Past Diphtheria-Tetanus-Pertussis Immunization in Migrant Children

Background: Data on vaccination coverage in recently arrived refugee children are essential to formulate catch-up recommendations. "Overimmunizing" is costly and associated with risks of hyperimmunization, whereas assuming up-to-date immunizations may be misleading. Methods: We retrospectively collected data from 92 migrant children referred to our hospital between January 2009 and May 2010. Results: According to our guidelines, 68 (73.9%) children without evidence of up-to-date immunizations received a booster dose of an age-appropriate tetanus-containing vaccine. As a surrogate for diphtheria-tetanus-pertussispoliomyelitis immunity, tetanus antibodies were measured by enzyme-linked immunosorbent assay 1 month later in 55 of 68 (80.8%) children 6 months to 16 years of age (median, 7 years) from 23 countries. All but 2 children (3.6%) had reached high antibody titers (>1.0 IU/mL) and required no further booster. Unnecessary additional tetanus immunizations thus were avoided in 53 of 55 (96.4%) patients. Conclusion: Assessing antitetanus antibody responses in migrant children allows individual vaccination schedules and avoids the risks of hyperimmunization.