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Objective: The purpose of this study was to examine prevalence and factors associated with tetanus and diphtheria immunity among women in the United States., Study Design: Sera from 9411 female participants from the third National Health and Nutrition Examination Survey were tested for diphtheria and tetanus antitoxin. Interview information for adult women was analyzed to examine associations with immunity., Results: Fifty-seven percent of the female subjects who were > or =6 years old were positive for diphtheria, and 64% of the female subjects for tetanus anti-toxin. Among women > or =20 years old, only 41% of the women were protected against both antigens. Older age, birth outside the United States, and less education was associated with lower immunity. Markers for contact with the health care system were not related to higher immunity., Conclusion: More than one half of US women > or =20 years old who were tested were not protected fully against diphtheria and tetanus. All physicians, including obstetricians and gynecologists who may be the sole medical providers for women, should be familiar with the current Advisory Committee on Immunization Practices recommendations regarding tetanus and diphtheria toxoid booster vaccines.

After the 1989–1991 rubella resurgence, rubella vaccination efforts targeted children and women of childbearing age. Utilizing National Health and Nutrition Examination Survey data collected during 1988-1994 and 1999- 2004, we assessed whether US levels of rubella seropositivity are consistent with rubella elimination and whether changes are consistent with immunization efforts. Serum samples with rubella antibody levels ⩾10 IU tested by rubella immunoglobulin G enzyme immunoassay were considered to be positive. In 1999–2004, the overall age-adjusted rubella seropositivity level was 91.3% (95% confidence interval [CI], 90.5%–92.1%), a significant increase from 88.1% (95% CI, 86.9%–89.1%) in 1988-1994 (P < .001). Among children, seropositivity was highest in children 6–11 years of age (96.2%), followed by adolescents 12–19 years of age (93.7%). Both groups showed significant increases in immunity levels, in comparison with those in 1988–1994 (P < .001). Among adults, seropositivity among women increased (from 88.9% to 91.5%; P = .015), and there was no change among men (from 87.8% to 88.0%; P = .84). In 1999–2004, population rubella immunity levels were at or above the modeled threshold for elimination of rubella virus transmission. Increases in immunity levels are consistent with vaccination efforts. [ABSTRACT FROM AUTHOR]