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Routine tetanus toxoid primary immunization and postexposure prophylaxis have made tetanus rare in the U.S. and Europe. Worldwide, however, about 1 million cases occur annually, with a mortality rate ranging from 6% to 60%. In a prospective, randomized, intent-to-treat trial, researchers in Brazil recently compared disease progression, duration of hospitalization and of spasm period, respiratory complications, time on assisted respiration, and mortality in 120 patients who received either intramuscular tetanus immune globulin (3000 IU) or this regimen plus intrathecal tetanus immune globulin (1000 IU). The two groups were similar in presentation and prognostic characteristics at the inception of treatment.
Compared with the control group, th…