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Placental transfer of tetanus-specific immunoglobulin G in Iranian mothers.

OBJECTIVES: To investigate placental transfer of anti-tetanus immunoglobulin (Ig)G antibodies in Iranian mothers. METHODS: Sera collected from 209 pregnant women and their paired infants were evaluated for tetanus-specific antibodies by a commercial enzyme-linked immunosorbent assay. RESULTS: In total, 15 (7.2%) out of 209 mothers and 12 (5.7%) out of 209 newborns were negative for anti-tetanus IgG. A highly significant correlation was observed between maternal and fetal anti-tetanus IgG (r = 0.80). The mean cord/maternal blood ratio of anti-tetanus IgG was 1.22 +/- 0.97. The mean cord/maternal blood ratio of anti-tetanus IgG in mothers with blood groups B+ and AB+ was lower than in mothers with other blood groups (p = 0.027). In addition, among mothers who had more than 0.5 IU/ml anti-tetanus IgG, a higher percentage of cases with cord/maternal blood ratio of < 1 was observed in carriers of blood groups B+ and AB+ compared to those with other blood groups (45.2% vs. 41.8%). Parity of more than 4 had a significant negative effect on both frequency of high positive sera and the mean of anti-tetanus IgG level in maternal and neonatal sera. CONCLUSIONS: A relatively high percentage of pregnant women were not immune against tetanus. It was also found that the main factors that affect infants' tetanus-specific IgG are maternal concentration of this immunoglobulin, parity and maternal blood group.

ABO Blood-Group System↗

Epidemiology of tetanus in Denmark 1920-1982.

Tetanus is still a major health problem in developing countries and still occurs in countries with a high medical standard. To guide planning of future prophylactic programs, incidence and mortality from tetanus in Denmark previous and present prophylactic efforts have been studied. Incidence and mortality from neonatal tetanus decreased in the thirties probably consequently to social and hygienic improvement, and a very marked decrease coincided with the introduction of vaccination against tetanus in 1947. Since 1970 no case of neonatal tetanus has been observed. Mortality from non-neonatal tetanus was reduced markedly in 2 steps, coinciding with an increased use of tetanus antitoxin around 1930 and the introduction of vaccination respectively. The effect of routine vaccination in childhood from 1950 was especially prominent. Tetanus in childhood is now nearly eradicated. A survey of all hospitalized cases of tetanus 1978-1982 showed that the majority of patients were incompletely or never vaccinated, but 10% had a history of complete vaccination. The majority of cases developed from minor posttraumatic lesions, of which only 41% had been professionally treated, and 13% developed from non-traumatic lesions. It is concluded that vaccination programs offering continuous protection are needed for a complete eradication of tetanus. Fatality remains high, in the present series 9.4%, and is mostly due to cardiovascular manifestations.

Adult↗

Tetanus surveillance--United States, 1989-1990.

During the period 1989-1990, 117 cases of tetanus were reported from 34 states, for an average annual incidence of 0.02/100,000 population. Fifty-eight percent of patients were > or = 60 years of age, while seven (6%) were < 20 years of age, including one case of neonatal tetanus. Among adults, the risk of tetanus in those > 80 years of age was more than 10 times the risk in persons ages 20-29 years. The case-fatality rate increased with age, from 17% in persons 40-49 years of age to 50% in those > or = 80 years of age. Only 11% of patients reported having received a primary series of tetanus toxoid before disease onset, while 31% lacked a history of tetanus vaccination. Tetanus occurred following an acute injury in 78% of patients. Of patients who sought medical care, only 58% received tetanus toxoid as part of wound prophylaxis. Tetanus remains a severe disease that primarily affects unvaccinated or inadequately vaccinated older adults. Increased efforts are needed to reduce the risk of tetanus among the elderly. Health-care providers should take every opportunity to review the vaccination status of their patients and provide tetanus vaccine when indicated.

Adolescent↗

[The tumor-tetanus assay--experimental studies on the biological differentiation between carcinogenesis and organ regeneration of the rat (author's transl)].

The characteristic clostridial growth which is testable, after systemic administration of tetanus spores, as a positive tumour tetanus - correlation, was manifested by a highly selective tetanus lethality of rats with progressive hepatomas following induction with dimethylaminoazobenzene and diethylnitrosamine, respectively, as well as with methylcholanthren-induced fibrosarcomas of the rat. Control tumours with transplantable Walker carcinoma cells anYoshida sarcoma cells also developed tetanus most frequently whereas healthy tumour-free rats did not show any signs of tetanus for the period of observation. There was strict time-dose-relationship of tetanus after partial hepatectomy, using the same injection technique of the spores, in sofar as the spores injected 24 hours postoperatively caused tetanus as opposed to the completely negative results following spore administration 4 days postoperatively. The mean tetanus survival time of the rats with regeneration of the liver roughly corresponded to that of the wound regeneration assay using pregant rats post partum. The interpretation of these results allows for demonstrating a fairly good agreement between the growth capacity of tumour cells on the one hand and the permanently strong tetanus reactivity on the other, as compared with the time-limited "take" and course of tetanus following regeneration of the liver.

Agglutination Tests↗

Determination of low tetanus or diphtheria antitoxin titers in sera by a toxin neutralization assay and a modified toxin-binding inhibition test.

A method for the screening of tetanus and diphtheria antibodies in serum using anatoxin (inactivated toxin) instead of toxin was developed as an alternative to the in vivo toxin neutralization assay based on the toxin-binding inhibition test (TOBI test). In this study, the serum titers (values between 1.0 and 19.5 IU) measured by a modified TOBI test (Modi-TOBI test) and toxin neutralization assays were correlated (P < 0.0001). Titers of tetanus or diphtheria antibodies were evaluated in serum samples from guinea pigs immunized with tetanus toxoid, diphtheria-tetanus or triple vaccine. For the Modi-TOBI test, after blocking the microtiter plates, standard tetanus or diphtheria antitoxin and different concentrations of guinea pig sera were incubated with the respective anatoxin. Twelve hours later, these samples were transferred to a plate previously coated with tetanus or diphtheria antitoxin to bind the remaining anatoxin. The anatoxin was then detected using a peroxidase-labeled tetanus or diphtheria antitoxin. Serum titers were calculated using a linear regression plot of the results for the corresponding standard antitoxin. For the toxin neutralization assay, L+/10/50 doses of either toxin combined with different concentrations of serum samples were inoculated into mice for anti-tetanus detection, or in guinea pigs for anti-diphtheria detection. Both assays were suitable for determining wide ranges of antitoxin levels. The linear regression plots showed high correlation coefficients for tetanus (r(2) = 0.95, P < 0.0001) and for diphtheria (r(2) = 0.93, P < 0.0001) between the in vitro and the in vivo assays. The standardized method is appropriate for evaluating titers of neutralizing antibodies, thus permitting the in vitro control of serum antitoxin levels.

Animals↗

Transfer rate of transplacental immunity to tetanus from non-immunized and immunized mothers.

Tetanus antitoxin was quantitatively measured in 912 pregnant women by indirect hemagglutination test. The mothers who received no dose, one dose and two doses of tetanus toxoid were 64.6%, 10.1% and 25.3% respectively. The percentage of mothers with protective antibodies in the groups receiving none, one, and two doses of tetanus toxoid were 95.4, 100 and 100. The level of protective antibody in the newborn and the magnitude of transfer rate of passive immunity to tetanus depended directly upon the level of tetanus antitoxin in maternal serum. Mothers who had tetanus antitoxin of 1.28 IU/ml or more could transfer protection to almost all of the newborns (97%-100%) irrespective of doses of tetanus toxoid administration. However, mothers who had received two doses of tetanus toxoid during pregnancy not only confer good protection but also transfer a high tetanus antitoxin levels to their newborns.

Adult↗

Temperature dependence of enhancement and diminution of tension evoked by staircase and by tetanus in rat muscle.

1. The effect of temperature (20-37.5 degrees C) on the potentiation of twitch tension was examined during and after the staircase (250 stimuli, 5/sec) and after the tetanus (188 stimuli, 125/sec) in the extensor digitorum longus muscle of adult Lewis rats.2. During the staircase at 20 degrees C the twitch tension decreased (negative staircase) by 10-20%. At 25-30 degrees C the staircase was initially negative and later positive. At 37.5 degrees C the staircase was positive throughout the train. Both at the end of the staircase and 2 sec after the tetanus the potentiation increased linearly with increasing temperature.3. After the staircase and the tetanus at 20-30 degrees C the twitch tension increased initially rapidly and later after the staircase at a slower rate. Maximal potentiation at 20 degrees C was attained 3 min after the staircase (+ 30 +/- 3%, n = 10, s.e. of mean) and 1 min after the tetanus (+ 16 +/- 1%, n = 10, s.e. of mean). At 37.5 degrees C the potentiation decayed rapidly after the staircase and the tetanus.4. During the staircase the time course of the twitch was shortened twice as much at 20 as at 37.5 degrees C. At the end of the staircase and 2 sec after the tetanus the contraction time was the more prolonged the greater the potentiation. At maximal potentiation the contraction time was prolonged three times as much at 20 degrees C (+ 19 +/- 3%, n = 10, s.e. of mean) as at 37.5 degrees C (P < 0.005). The half-relaxation time at the end of the staircase was prolonged 10 times more at 20 than at 37.5 degrees C (P < 0.02).5. When extrapolated to time zero after the staircase and the tetanus the potentiation at 20 degrees C was still marked (20-50%). The rate of decay of potentiation (time constant, 20 degrees C, 561.2 +/- 37.4 sec, n = 20, s.e. of mean) increased with increasing temperature (Q(10) = 2.6). The event of potentiation with a fast rate of decay, present after the tetanus but not after the staircase at 37.5 degrees C, was abolished below 30 degrees C.6. The increase in twitch tension after the staircase and the tetanus at 20-30 degrees C was taken to indicate the recovery of events that diminished the twitch, occurring simultaneously with potentiation.7. (i) One process of diminution, present after the staircase but not after the tetanus, increased on cooling and was assumed to be due to fatigue. The rate of recovery of the process (time constant, 20 degrees C, 79.6 +/- 7.4 sec, n = 10, s.e. of mean) increased with increasing temperature (Q(10) = 1.9). The half-relaxation time of the last twitch in the staircase was the more prolonged the greater the process. (ii) Another process causing diminution was present after the staircase and the tetanus at 20-30 degrees C. It recovered at 20 degrees C with a time constant of 14.9 +/- 2.2 sec (n = 10, s.e. of mean). This process, possibly responsible for the initially negative staircase, was not thought to be due to fatigue. It may reflect a diminished depolarization of the transverse tubules by repetitive stimuli.

Action Potentials↗

Booster effect of low doses of tetanus toxoid in elderly vaccinees.

In order to improve the immunity to diphtheria, the recommended booster dose of diphtheria/tetanus vaccine for adults in Sweden was changed in 1986 from 0.5 ml of tetanus vaccine with a small diphtheria dose to 0.25 ml of a diphtheria/tetanus vaccine containing 7.5 Lf tetanus toxoid and 30 Lf diphtheria toxoid/ml. This change resulted in an increase in the dose of diphtheria toxoid from 0.5 Lf to 7.5 Lf, but a decrease in the recommended booster dose of tetanus toxoid from 3.75 Lf to 1.9 Lf. The aim of the present study was to investigate whether this lower dose of tetanus toxoid was also sufficiently protective for elderly people. Two hundred adults (median age 76 years, range 60-92 years) with no history of tetanus vaccination during the past 10 years volunteered for the study. One hundred two vaccinees were inoculated with 1.9 Lf tetanus toxoid (0.25 ml) and 98 with 3.75 Lf tetanus toxoid (0.5 ml). Paired serum samples were analysed by the toxin-binding inhibition assay. Side effects were few and mild, without significant differences between the groups. Response rates were similar, with the 3.75 Lf dose eliciting a marginally higher antitoxin response. The prevaccination geometric mean titre was the same for both groups: 0.03 IU/ml. Postvaccination geometric mean titres were 1.18 IU/ml for the 3.75 Lf group and 1.93 IU/ml for the 7.5 Lf group, respectively (difference not significant). Forty-seven percent of the vaccinees had a prevaccination titre of < or =0.01 IU/ml. Postvaccination, 85% had a titre >0.01 IU/ml. Booster vaccination with tetanus vaccine containing only 1.9 Lf of tetanus toxoid was thus found to induce an excellent immune response in elderly people, with few side effects resulting.

Aged↗

Tetanus: pathophysiology and management.

OBJECTIVE: To review the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of tetanus and its complications. DATA SOURCES: MEDLINE and Iowa Drug Information Services databases were searched for literature pertaining to tetanus. Additional literature was obtained from the references of selected articles identified in the search. Information from all articles was considered for inclusion in the manuscript. STUDY SELECTION AND DATA EXTRACTION: Articles selected were those considered by the authors to assist in providing the reader an understanding of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of tetanus. DATA SYNTHESIS: While the number of tetanus cases has decreased markedly since data reporting for the disease began in 1947, mortality among those who acquire the disease remains high. Elderly patients are particularly susceptible to tetanus and its complications. Prevention of tetanus focuses on primary immunization and scheduled boosters. Management of tetanus involves initial stabilization of the patient and protection of the airway, prevention of tetanospasmin absorption by administration of human tetanus immune globulin 3000-6000 IU, and eradication of Clostridium tetani with antimicrobial therapy (metronidazole 500 mg q8h). Supportive measures include the administration of neuromuscular blocking agents such as pancuronium in patients requiring artificial ventilation, as well as benzodiazepines (midazolam 5-15 mg/h) for sedation and muscle relaxation. Autonomic dysfunction should be managed with beta-adrenergic blockers such as propranolol or labetalol. CONCLUSIONS: Despite the relative infrequency of tetanus cases, mortality among untreated patients remains significantly high. Clinicians should become knowledgeable in the pathophysiology, clinical manifestations, and management of this potentially fatal disease.

Humans↗

Otogenic tetanus in Zaire.

Sixty-seven patients with tetanus of otogenic origin were hospitalized at the Mama Yemo hospital, Kinshasa, Zaire over the two-year period from 1975 through 1976. The care of these patients was the same as that for all 620 tetanus cases admitted during this period. No otologic surgical procedures were performed on this group; nor were any special ear procedures utilized. The survival rate in the otogenic tetanus group was 83%. The survival rate in the 620 tetanus admissions was 79%. All 67 patients had evidence of chronic otitis media. None of these patients had evidence of otologic complications before, during or for one month after developing tetanus, other than uncomplicated otorrhea. Tetanus antitoxin of 10,000 or 50,000 IU did not appear to affect survival rates. Mortality rates were not increased in the 18% of patients who did not receive tetanus antitoxin. Sedation sufficient to eliminate muscle spasms and maintain the patient sleeping seems to be important in increasing survival rates in tetanus. The need for tracheotomies appeared to be reduced with the increased sedation. Mortality rates increased among the patients who had tracheotomies. Otologic surgical procedures do not appear to be indicated in the management of patients with otogenic tetanus.

Adolescent↗

Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.

OBJECTIVES: Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. METHODS: A randomized, double-blind cholera vaccine trial of 41,571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. RESULTS: Children of women who received either 1 or 2 injections of tetanus toxoid experienced 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. CONCLUSIONS: The data demonstrate that a limited-dose regimen of maternal tetanus toxoid provides significant and extended protection against the risk of neonatal tetanus death.

Adolescent↗

Serologic immunity to diphtheria and tetanus in the United States.

BACKGROUND: Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups. OBJECTIVE: To provide national estimates of immunity to diphtheria and tetanus by measurement of serum antibody levels. DESIGN: Examination of data from the Third National Health and Nutrition Examination Survey, a representative cross-sectional sample of the U.S. population. SETTING: 89 randomly selected locations throughout the United States. PARTICIPANTS: 18 045 persons 6 years of age or older who were examined from 1988 to 1994. MEASUREMENTS: Serum samples obtained at a single time point were tested for diphtheria and tetanus antitoxin. RESULTS: Overall, 60.5% of Americans 6 years of age or older had fully protective levels of diphtheria antibody (> or =0.10 IU/mL) and 72.3% had protective levels of tetanus antibody (> 0.15 IU/mL). Ninety-one percent of Americans 6 to 11 years of age had protective levels of both diphtheria and tetanus antibody; this proportion decreased to approximately 30% among persons 70 years of age (29.5% for diphtheria and 31.0% for tetanus). Adult Mexican-Americans were slightly less likely to have protective levels of antibody to both toxins. Only 47% of persons 20 years of age or older had levels that were protective against both diseases, and only 63% of adults who were protected against tetanus were also protected against diphtheria. CONCLUSIONS: A substantial proportion of adults in the United States do not have antibody levels that are protective against diphtheria and tetanus. In addition, although the recommended vaccine is a combination of tetanus and diphtheria, only 63% of adults with protective antibody to tetanus also had protective antibody to diphtheria.

Adolescent↗

Incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in Pakistan.

OBJECTIVE: This study aimed to estimate the incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in the Loralai district of Pakistan. The supplemental immunization activities were carried out in two phases during 2001-03. METHODS: A state-transition model was used to estimate the effect of routine vaccination with tetanus toxoid as well as vaccination with tetanus toxoid during supplementary immunization activities. The model follows each woman in the target population from birth until the end of her childbearing years, using age-specific fertility data and vaccination history to determine the number of births at risk for neonatal tetanus. Recently published data on the incidence of neonatal tetanus from Loralai were used to determine the number of cases occurring with and without supplementary immunization activities. Data on the costs of the activities were collected from the UNICEF office in Balochistan and from the Provincial Health Department. FINDINGS: Using base-case assumptions we estimated that the supplementary immunization activities would prevent 280 cases of neonatal tetanus and 224 deaths from neonatal tetanus between 2001 and 2034. Implementation of the supplementary activities was relatively inexpensive. The cost per tetanus toxoid dose delivered was 0.40 U.S. dollars. In the base-case analysis the cost per death averted was 117.00 U.S. dollars (95% confidence interval (CI) = 78-205 U.S. dollars) and the cost per disability-adjusted life year (DALY) averted was 3.61 U.S. dollars (95% Cl = 2.43-6.39 U.S. dollars). CONCLUSION: Compared with similar analyses of other interventions, the cost per DALY averted is a favourable cost-effectiveness ratio. However, if routine diphtheria-tetanus-pertussis vaccination coverage in the Loralai district had been higher (at a coverage rate of about 80%) the cost-effectiveness of the intervention would have been even more favourable, at 2.65 U.S. dollars per DALY averted.

Cost-Benefit Analysis↗

[Investigation of the immunity status towards tetanus of a population of mechanics at the car-factory "Renault" (author's transl)].

Tetanus immunity has been studied in a population of mechanics working at the car-factory "Renault". For the study, 283 individuals were divided into 3 groups. The first group consisted of non-vaccined individuals, the second of vaccinated individuals and the third of individuals who had been boostered. The influence of different parameters on tetanus immunity status was considered, i. e. the age of the subjects, the time at which boostering was given, the serotherapy (when it was administered) and the contact with machine lubricating and cooling fluids. Clostridium tetani bacilli and spores were frequently found in aqueous machine fluids. Their presence is a potential hazard for non-vaccinated mechanics coming to contact with the fluids. Tetanus antibody levels in the sera of the tested population were determined in vivo by the toxin neutralization test. The influence on tetanus immunity of the different parameters considered in this paper was subjected to statistical analysis. From the whole population, 27% of the individuals were found to have no protection against tetanus. When age was taken into account, 53% of the individuals over 45 years old and 10% of those under 45 years old were shown to be devoid of tetanus immunity. It could be shown that younger individuals were better protected than older ones, because the formers had been immunized with adsorbed tetanus toxoid and most of the latters with fluid toxoid. Of the individuals in the third group who had received a booster injection within 15 years after primo-vaccination, 98% showed protective tetanus antibody levels in their sera in contrast to 25% when boostering had occurred more than 15 years after primo-vaccination. Contact with machine fluids was found to influence the degree of immunity of only those individuals whose boostering dated back to more than 25 years. Unexpectedly, 3 mechanics seemed to develop immunity after coming into contact with machine fluids. From the results reported here, it is concluded that tetanus immunity in vaccinated individuals should be renewed by a compulsory booster injection given every 5, 10 or, at the minimum, 15 years. Moreover, high-risk populations such as that represented by the mechanics should be immunized or boostered on commencing employment.

Adult↗

[Tetanus following an abrasion injury].

HISTORY AND CLINICAL FINDINGS: A 80 year-old woman contracted an abrasion of her right forearm while gardening. 5 days later, dysphagia, trismus and a cramp of the right hand developed. On admission (8 days after the injury) cramps of the platysma and pharyngeal muscles were observed. A tetanus vaccination had not been carried out for years. INVESTIGATIONS: Electrophysiologically a pathological masseter inhibitory reflex with a missing "silent period" was observed. The level of serum anti-tetanus-toxoid IgG antibodies was 0.03 IU/ml (definitively protective above 0.1 IU/ml). Free tetanus toxin was not detectable in the serum upon mouse challenge. The diagnosis of tetanus was made based on the typical symptoms and the serological susceptibility. TREATMENT AND COURSE: On admission the wound was antiseptically cleaned and a bandage was applied. On the next day a debridement was performed. After taking a serum sample the patient was immunized against tetanus (active and passive). On the following two days the patient received a further dose of tetanus-antitoxin. The patient was treated with metronidazole for 8 and with penicillin G for 10 days. Within the first days after hospital admission laryngospasms, tachycardia and tachypnoe occurred. From the 7 (th) day in hospital the trismus and the cramp of the hand improved. 4 weeks after admission the patient was discharged; the trismus had completely disappeared, but a slight cramp of the hand was still present. CONCLUSION: Minor superficial injuries can lead to acute tetanus, if the level of anti-tetanus toxin-antibodies is non-protective and a disinfective wound cleaning and a postexpositional vaccination are not performed.

Aged, 80 and over↗

Elevated antitoxin titers in a man with generalized tetanus.

Vaccination programs have significantly reduced the incidence of tetanus in the United States. The disease develops almost exclusively in those who have been inadequately immunized. This report describes severe, generalized tetanus in a 29-year-old man who had received a primary series as a child and two booster injections. Serum obtained before administration of tetanus immune globulin showed antibody titers to tetanus greater than 100 times the level considered protective. Aggressive supportive care can usually prevent serious consequences. Since most physicians have never seen a case of tetanus, however, the diagnosis can be difficult. Many disorders that exhibit signs and symptoms similar to tetanus must be carefully considered during the evaluation of these patients. Tetanus is a preventable disease. Prevention, however, requires both appropriate immunizations and prompt wound care. While controversy exists regarding the most effective policy to adequately immunize all individuals, this case shows that vaccination alone does not preclude the possibility of tetanus.

Adult↗

Tetanus toxin inhibits the evoked outflow of an inhibitory (GABA) and an excitatory (D-aspartate) amino acid from particulate brain cortex.

In order to elucidate the mode of action of tetanus toxin, particles from rat forebrain were preloaded with tritiated GABA or D-aspartate, pre-incubated with tetanus toxin and then depolarized with K+, either in a batch procedure or by superfusion. The toxin depresses, but does not abolish, the evoked outflow of both amino acids in either system. Omission of Ca2+ decreases the outflow in the batch procedure by about 40%. The remaining outflow of either amino acid is insensitive to tetanus toxin, whereas the Ca2+ dependent outflow is completely inhibited. Antitoxin neutralizes the toxin but does not reverse its in vitro effects, once manifest. The toxin effects increase with time and temperature of pre-incubation. Pretreatment of the particles with V. cholerae neuraminidase, which is known to convert the long-chain gangliosides quantitatively into GM1, does not decrease the sensitivity to tetanus toxin. Besides particles from rat brain, those from chicken, but not those from frog brain, are toxin-sensitive when tested for GABA outflow in the batch procedure. Frog brain does not yield the typical ganglioside pattern, and also does not measurably bind 125I-tetanus toxin. The homoexchange diffusion of GABA, but not of D-aspartate, is slightly facilitated by tetanus toxin. We confirmed that tetanus toxin slightly inhibits the uptake of GABA, whereas that of D-aspartate is not measurably influenced. The accumulation, driven by a Na+/K+ gradient, of GABA into membrane vesicles from rat cortex is not affected by tetanus toxin. The present data support the hypothesis that tetanus toxin influences a process involved in the outflow of many transmitters, both excitatory and inhibitory.

Animals↗

Protection against tetanus in the aged people in the Czech Republic--cross-sectional study.

The aged people belong to most vulnerable group for tetanus infection in terms of their vaccination history, frequency of injuries, which may serve as gate of entry for this infection and declared decrease of general as well as specific immunity. The examinations of the aged people for antitetanus antibodies have been done to assess the immunity against tetanus in this particular group of people in the Czech republic. Blood samples were collected from people living in hostels for senior citizens on the bases of signed informed consent. The study focused on people older than 60 years of age. TETANUS ELISA Genzyme Virotech GmbH kit was used for detection of IgG antibodies against tetanus. The level of >0.1 IU/ml was used as protective level of antibodies. Total number of 341 samples was investigated for antibodies against tetanus. Nonprotective (<0.1 IU/ml) titer of antibodies was found in 9.1% of subjects and 90.9% of people possessed protective titers of antibodies against tetanus. The interval between the last vaccination (or revaccination) against tetanus and collection of blood sample was ascertained in 257 subjects and this interval was 10 years or less in 89.9% of subjects. Geometric mean of titers was calculated for different intervals between the last vaccination and collection of blood sample. There was an increasing trend of geometric mean values found with decreasing interval from the last vaccination. But there were also good values of geometric mean of titers found in subjects vaccinated long before collection of blood (intervals up to 27 years). Due to completely different situation in the Czech Republic, where adult people were repeatedly revaccinated in military service (males), in the employment with higher risk of tetanus infection, in context with treatment of injuries and finally during mass vaccination campaigns, organized in the Czech Republic for all adult people in 1974-1976 and in 1984-1986, even the aged people can reach acceptable immunity against tetanus.

Aged↗