Sadly, I’ve managed to lose my draft of this page twice in two days, so for now, I suggest 1) reading the opening chapters of Tetyana Obukhanych’s Vaccine Illusion and 2) checking out my markup to the CDC’s document on tetanus here.
There is no good evidence that the tetanus vaccine works. (1 EXCEPTION below)
There is circumstantial evidence that it might work.
There is also circumstantial evidence to the contrary.
RCT’s 
are needed, but not likely to be forthcoming.
Review of the circumstantial evidence that it might work:
- von Behring-Kitasato discovery of a treatment for tetanus in humans by using antiserum from horses infected with the tetanus toxin
— but there were serious side effects
- 1924 discovery that toxoids (produced by treating toxin with formaldehyde) did not induce the disease in humans but did induce antibody creation
— these toxoid antibodies were lab indistinguishable from toxin antibodies
- Vaccination with toxoid begins on the theory that the antibodies produced would protect from acquiring tetanus when infected, TIG
also used to treat the disease. - Best evidence for that protection comes from comparing WWII incidence of tetanus in soldiers with WWI incidence. (But see this from WHO.)
One good study showing the vaccine does work:
- I am surprised at how little referenced this study was in the literature I consulted (it took me a long time to stumble onto), but it nevertheless impresses me as a solid and persuasive study.
This study is NIH funded and the lead author is professor of epidemiology at Tulane University, K W Newell. Newell and his group found a remote area of Columbia where neonatal tetanus was common. (It is widely thought that the cause of this is poor birthing practices, particularly the unhygienic treatment of the umbilical cord. The thinking was that it would be easier to change vaccination practice than birthing practice.) Here is a link to the study, K. W. Newell, A. Dueñas Lehmann, D. R. Leblanc, N. Garces Osorio. The Use of Toxoid for the Prevention of Tetanus Neonatorum. Bull World Health Organ. 1966; 35(6): 863–871.
The researchers registered a group of almost 3,000 women, ages 13-45, in this remote area, and divided them randomly into a control and a study group. About a thousand women refused to accept vaccination, so that left control and study groups of, eventually, about 800 women each. The study was randomized and double blind. No changes were made in birthing practice except for the vaccination. The basic result was that for women who had received two or three shots during pregnancy there were no children born with tetanus (fatal in all but one case, I believe, so the study works with mortality rates), but for the control group, there were 27. The women who received only one shot also did better, 9 versus 20. In the 2 or 3 shot comparison, the 27 cases (and deaths) amounted to 7.8% of the births and was five times the standard error. There were 341 and 347 women in the 2-3 shots group versus the control, which actually received a flu shot.
I am quite impressed by the quality and results of this study. It is true that it only applies to pregnant women, but it’s hard not to believe that it would also work for the rest of us.
Caveat 1: see below for indications the shot may not work well for adults (28% of a properly up-to-date innoculated group were not protected; no actual studies done on the effectiveness of the shot in children and adults).
Caveat 2: with proper hygiene in birth and wound treatment, there appears to be very little chance of acquiring the disease at all. I have not studied (yet) what negative side-effects to the shot itself there may be.
Review of the circumstantial evidence that it might not work:
- The horse serum treatment may have actually worked
, but tests were never done (and never have been) to show that it was the antibodies in that antiserum that countered the toxin in patients. - In addition, no tests have ever been done to show that the vaccine itself works (“Efficacy of the toxoid has never been studied in a vaccine trial,” CDC, page 297 here.) While this doesn’t show that it doesn’t work either, it does make you wonder.
- However, the generally vaccine skeptical Randall Neustaedter (in The Vaccine Guide) feels confident that it does work:
There is no question that a series of tetanus toxoid injections is highly effective at preventing tetanus (Edsall, 1959). This has been documented in several large studies during World War II, and with studies of large groups of horses. The fact that nearly all recent tetanus cases in the United States occurred in individuals who had not received the recommended schedule of vaccinations provides further evidence that active immunization is extremely effective. (257)
As much as I respect Dr. Neustaedter’s work, and I use it elsewhere, as in regard to smallpox, I must agree with the clear logic of Tetyana Obukhanych (Vaccine Illusion, 2010) when she says this (my emphasis):
Although the reduction in tetanus frequency among wounded soldiers during WWII compared to WWI is apparent {she refers to the widely know statistics}, any conclusion about the role of the tetanus vaccine in this reduction is scientifically invalid. Only an RCT could have established whether the vaccine should receive the credit. Otherwise, we can reasonably speculate that the reduction in tetanus during WWII compared to the previous war was simply due to better wound hygiene and better nutrition of the US soldiers.
In the civilian US population, tetanus mortality had been dropping dramatically during the first half of the 20th century before the vaccine introduction, and it continued to drop further after the vaccine introduction {source omitted}. Therefore the vaccine’s role in tetanus reduction in the US population cannot be inferred from the tetanus mortality statistics either.
Sadly, too, I have to point out that Dr. Neustaedter’s claim that “nearly all recent tetanus cases in the United States occurred in individuals who had not received the recommended schedule of vaccinations” is not true according to the CDC’s official Tetanus info sheet. My annotated pdf of this is located here. I urge careful study of their incompletely-reported statistics, out of which at least this can be concluded, as I say there: “Of the [tetanus] cases they want to tell us about with regard to vaccination status (having received 3 or more TT injections) 28% were up-to-date and nevertheless were unprotected.” If Neustaedter has better information than the CDC reports, he does not either say that or report his source.
The one source Neustaedter does give (Edsall, 1959) offers only two sources for its claim of efficacy, first the difference in incidence among US soldiers in the two world wars (offered without discussion of the problems Obukhanych and others mention) and second a quick reference to anecdotal differences between Philippine native residents of Manila in the aftermath of the battle for that city in WWII and American expats there at the same time. No reference is given for this and I was unable to find good info in my Google searching. The Obukhanych objections to comparing WWI to WWII incidences applies with even greater force to this anecdote without even numbers. Notice that Edsall does not even give citations to studies for his two pieces of argument here.
- Since the toxoid that is in the vaccine causes the body to produce the same antibodies that are in the TIG, which is the human version in the US of the horse serum used earlier and still in some parts of the world, and since it is manifest that the TIG itself doesn’t work very well and maybe not at all (same note ), how can we be at all sure that the vaccine works?
- The CDC (reference at top of page and just above) follows up its no-vaccine tests have ever been done statement this way (my emphasis) —
Efficacy of the toxoid has never been studied in a vaccine trial. It can be inferred from protective antitoxin levels that a complete tetanus toxoid series has a clinical efficacy of virtually 100%; cases of tetanus occurring in fully immunized persons whose last dose was within the last 10 years are extremely rare.
Yet it is obvious to anyone who starts to question these authoritative statements that no one has yet shown that the antibodies produced by the tetanus toxoid are in fact useful in preventing the disease. Considering that getting the disease itself does not induce natural immunity (reference (5th ¶ from bottom)) I am really at a loss to see how they can reason this way. So the underlined sentence really does what is called begging the question — it simply assumes as true what it claims is an inference. That’s because the inference is from what are called “protective antitoxin levels.” But the whole issue is whether or not the antitoxin levels found in the blood are in fact protective.
As for the argument from the rarity of fully immunized persons who nevertheless get the disease and so were not protected, it is highly misleading. I work out the details in the commented pdf I’ve linked to already several time (again, here). The assumption evidently that the rarity comes from the vaccination program instituted after the second world war. But the disease had been in dramatic decline since the early 1900’s and simply continued to decline at the same rate after the introduction of the vaccine. No studies have been done to show the vaccine had any effect. In the CDC document the only even slant-wise relevant information we pick up is that 7 of 25 fully up to date vaccinated people nevertheless got the disease. They were not protected.
