tetanus toxoid reported in the former East Germany from 1963 to 1976. The average latency was 14 days. Two of the eleven cases that fulfilled all diagnostic criteria of brachial neuritis reported by Beghi and colleagues (1985) listed tetanus toxoid as an antecedant event. One of those two patients also had an antecedent influenzal illness. The latency from vaccination to onset of symptoms was not described for either case. Four separate case reports of brachial plexus neuropathy have also been described (Baust et al., 1979; Bensasson et al., 1977; Gersbach and Waridel, 1976; Kiwit, 1984) in adults (ages 20-48), all following receipt of booster doses of tetanus toxoid, with latencies ranging from 4 days to 3 weeks.
Other cases of probable or unclassified neuropathies are on record as occurring after tetanus toxoid vaccination, sometimes in association with other vaccines (Deliyannakis, 1971; Dieckhoefer et al., 1978; Ehrengut, 1986; Paradiso et al., 1990). The significance of these cases is uncertain.
Three case reports of possible neuropathy following tetanus toxoid or Td administration were found in VAERS (submitted between November 1990 and July 1992). The documentation of the clinical and laboratory findings from these cases is sketchy at best: therefore, the correct diagnosis was difficult to determine. One report described a 47-year-old man who developed a probable brachial neuritis 1 year following receipt of tetanus toxoid. The long latency prior to the onset of symptoms makes this case unlikely to be related to tetanus toxoid. Another report described a 37-year-old man who had pain in his hand immediately after injection of Td into the deltoid muscle; this is probably a case of direct injection into the radial nerve. The last report described a 41-year-old man who developed what was probably brachial neuritis 12 days following receipt of Td.
Tsairis and colleagues (1972) reviewed 99 patients with brachial plexus neuropathy seen at the Mayo Clinic in Rochester, Minnesota, between 1954 and 1968. Of the 99 patients. 14 had immunizations in the month prior to the development of brachial plexus neuropathy (4 patients had received tetanus toxoid alone. 1 had received tetanus toxoid and influenza vaccine, and a 3-month-old had received DPT). Latencies for the group that received tetanus toxoid alone ranged from 6 to 21 days. The authors indicate that some of the affected limbs were contralateral to the injection.