Seroprevalence of tetanus immunity among noninsulin-dependent diabetes mellitus patients

Tetanus is a preventable disease that continues to affect people in both developing and developed countries. The aim of the present study was to evaluate the immunity profile to tetanus in patients with Type II diabetes mellitus (DM) and to compare them with healthy controls. The tetanus antitoxin levels in 310 diabetic patients (104 males and 206 females) and in 200 healthy controls (72 males and 128 females) were measured by ELISA (Virotech, Germany). The mean antitoxin concentration in patient and control groups were 0.8238±1.61 and 0.9978±1.49 IU/ml, respectively. There was a statistically significant difference between the two groups ( z=−3.520, P=.0001 and odds ratio was 2.367). There was a definitive inverse correlation between the duration of diabetes and tetanus antibody titers (Spearman's correlation analysis, r=−.155, P=.006). A gender-dependent difference in the susceptibility to tetanus was present in the diabetic group with antibody titers being significantly higher in males compared with females ( z=−2.267, P=.023). For both of control ( χ 2=20.207, P=.003) and patient ( χ 2=43.532, P=.0001) groups, there was a significant inverse correlation between the tetanus immunity levels and age. Statistically, a significant drop in antibody titers of both groups was found as the period past from the last immunization increased (Pearson correlation analysis: for patient group r=−.364, P=.0001; for control group r=−.143, P=.044). The tetanus antitoxin levels were significantly increased in individuals who had primary immunization during childhood (for patient group χ 2=17.191, P=.0001; for control group χ 2=9.911, P=.007). A significant reduction in the level of antitoxin immunity to tetanus in association with an increased susceptibility to infections in patients with diabetes may implicate the need for improving vaccination rates in this patient group.