Immunization Programs for Adults

To the Editor.— The points made by Hickman and Barness in their commentary "Immunization Program for Adults" (237:129, 1977) are well taken but deserve some amplification. First, physicians considering administration of tetanus toxoid as part of wound prophylaxis would be well advised in most cases to use tetanusdiphtheria toxoids (adult). No tetanus booster is needed following most wounds where the last booster was given less than five years previously. Thus, since diphtheria toxoid alone is not generally available and most adults never receive any boosters unless they are confronted with this need after a wound, updating against diphtheria at that time is also in order and will not cause excessive reaction to the diphtheria component. Second, when an adult has never been immunized against diphtheria, physicians should regard the booster dose of adult diphtheria-tetanus toxoids as an integral part of the immunization series and establish a reminder system to get