To the Editor.—
While Crossley et al (242:2298, 1979) draw proper attention to the low prevalence of protective levels of tetanus antitoxin among those older than 60 years (34%), including the institutionalized elderly (51%),1 it does not seem reasonable or cost-effective to immunize the 2.2 million elderly persons who occupy 1.2 million nursing home beds each year in the United States. An analysis of the epidemiology of tetanus and the demography of the nursing home population sheds light on this issue.The number of cases of tetanus reported to the Center for Disease Control is approximately 130 per year, with 50% of the cases occurring in those older than 60 years. Almost three fourths of the injuries that resulted in tetanus during 1970 and 1971 occurred in the home, while 15% occurred in "other specified locations." The remaining 10% of the cases occurred in the farm, garden, hospital, or factory.