Agnew医生问:1例以往在部队中接种过破伤风类毒素的病人在加强接种后上肢出现疼痛和红斑,伴有发热和无力数日。如果以后出现穿透伤,该怎么办? Sutter医生（美国疾病控制和预防中心国家免疫接种计划）答:尽管该病例接种菌苗后出现不良反应的详细情况尚不清楚,但是,一般说来,破伤风类毒素的不良反应可能受到下列因素的影响:以往接种次数、类毒素剂量、接种途径和方法、所用制剂中含有佐剂和/或其他抗原（如白喉类毒素）。破伤风类毒素加强接种后最常见的不良反应是注射部位疼痛和触痛（50％～80％）,较少见的不良反应是水肿和红斑（20％～30％）,极为罕见的是明显肿胀（<2％）。几项研究发现,血液中破伤风抗毒素水平与局部反应程度直接相关。一些报告指出,大块的局部反 Dr. Agnew asks: In one patient who had previously received tetanus toxoid in the army, pain and erythema occurred in the upper extremities following vaccination, accompanied by fever and weakness for days. What to do if there is a penetrating wound in the future? Dr. Sutter (National Center for Disease Control and Prevention Immunization Program) A: Although the details of adverse events after vaccination in this case are not known, in general, Adverse reactions to tetanus toxoid may be affected by the number of past vaccinations, the dose of the toxoid, the route and method of administration, and the adjuvant and / or other antigens (such as diphtheria toxoid) contained in the preparation. The most common adverse reactions after tetanus toxoid booster vaccination were pain and tenderness at the injection site (50% to 80%) and less common adverse reactions were edema and erythema (20% to 30%), which were extremely rare Swelling (<2%). Several studies have found that tetanus antitoxin levels in the blood are directly related to the extent of local reactions. Some reports point out that large chunks of local anti