DEAR DR. ROACH: I was told by my doctor that I need a tetanus booster shot, but when I was 17, I cut my foot and needed stitches. I was told then that I was allergic to the tetanus shot, so they gave me penicillin instead. Of course, that was a long time ago, since I’m now 81 years old. How could they have determined I was allergic to the shot, and is that even reliable? Can I be tested now? Or do I even need to be tested? — M.N.
ANSWER: Reactions to vaccines are common, but they were much more common 64 years ago, when the purity of vaccines was far less than what it is now. One reaction that was common in the 1950s is called an Arthus reaction, which causes painful swelling at the injection site within a few hours — the worst swelling usually occuring around 24 hours later, and then slowly decreasing. You are unlikely to get that type of allergic reaction because of better vaccines, and because it has been so many years since you’ve taken the vaccine.
Very few people get anaphylactic reactions. Anaphylaxis is a life-threatening condition, which often starts with skin symptoms such as hives or swelling; respiratory symptoms such as nasal congestion, discharge or the sensation of the throat closing; gastrointestinal symptoms such as nausea, vomiting or abdominal pain; and cardiovascular symptoms such as dizziness and fainting. Any history of anaphylaxis prevents you from getting the same trigger (vaccine or medication) again, if it can be helped. Only a careful history of your symptoms at the time of the allergic reaction you had can provide an answer on which type of reaction it was. Blood testing for allergic reactions is not 100 percent reliable.
If you haven’t had a tetanus vaccine in over 60 years, the decision to get one now really is a judgment call based on your likelihood of exposures. If you do a lot of gardening or hiking, it may be worthwhile to give you a vaccine with careful monitoring. If you were to develop a tetanus-prone wound, such as a deep wound that comes into contact with soil or manure, you would be recommended tetanus immunoglobulin as well as a tetanus vaccine. Penicillin alone is not effective in preventing tetanus: Meticulous wound cleaning is critical, in addition to the shots.
DEAR DR. ROACH: How do I know if I’ve been vaccinated for polio? — S.A.
ANSWER: The first U.S.-transmitted case of polio in a decade was reported in Rockland County, New York, in July 2022. The person who contracted polio was unvaccinated: They probably contracted the case from a person who was vaccinated outside the U.S., since it was a vaccine-derived polio case. Occasionally, the weakened strain used for the oral polio vaccine can mutate and cause disease. The oral polio vaccine has not been used in the U.S. since 2000, but it is still used in other parts of the world.
The vast majority of American and Canadian adults are vaccinated for polio, as it is required for school. So, most adults do not need vaccination, but it is routine for those traveling to endemic areas to receive a booster. Unfortunately, many children have not gotten their boosters on time due to the pandemic, and parents in the area of the case are recommended to get their kids’ vaccines up-to-date as soon as possible. Anyone exposed to a known case should get guidance from their physician, who will probably be in contact with the health department.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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