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PubMed2002

Otolaryngologic aspects of tetanus.

Tetanus is considered a major health problem in the developing and under-developed countries, with approximately 1 million new cases occurring each year. We have evaluated the tetanus patients and their presenting complaints, the clinical findings and their relations to the head and neck region along with the frequency of otolaryngological findings and their correlation to the prognosis of this highly mortal disease. There were a total of 37 patients with generalized tetanus diagnosed and treated between 1991 and 2001. There were 25 women and 12 men with a mean age of 55+/-15.6 years. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscular contractions. Wound evaluation revealed that 72.9% of the patients had tetanus-prone wounds, and 27% had either no obvious wounds or a wound considered to be trivial by the patient. Only 62% percent of the patients had sought medical attention immediately after being injured. Three patients in our series were admitted to the otolaryngology clinic with upper aerodigestive tract symptoms. A comparison of complaints with clinical findings revealed a significant lack of correlation, emphasizing that complete physical examination must be performed when evaluating patients with trismus, dysphagia and neck pain. Tracheotomy was performed in 21 cases. There was a direct correlation between the clinical stage and the requirement of tracheotomy. Wound debridment was performed, and antibiotherapy, tetanus toxoid vaccine and immunoglobulin were administered. The mortality rate was 59.4% (22/37). Shorter incubation periods and periods of onset and a higher grade of disease were significantly related to high mortality rates ( P=0.001). It is important to realize the fact that instead of looking for tetanus-prone wounds, one should be on the lookout for tetanus-prone patients. Consequently, on the part of the otolaryngologist, there should always be a high index of suspicion, and concerning patients with trismus or subacute progressive dysphagia, the possibility of tetanus must be borne in mind.

Adolescent↗

PubMed1985

The use of antibody Fab fragments specifically directed to two different complementary parts of the tetanus toxin molecule for studying the mode of action of the toxin.

The injection of 500 minimal lethal doses (MLDs) of tetanus toxin into mice routinely causes a flaccid-type paralysis and death within 8 h. Non-precipitating antibody fragments (Fab) directed against each of two papain cleavage products of tetanus toxin (Ibc and IIc) were used to study this botulinum toxin-type effect of tetanus toxin. Ibc (100,000 daltons) is a toxic fragment which does not bind to gangliosides but will produce a flaccid type paralysis when injected into mice. Treatment of intact tetanus toxin (500 MLDs) with Fab-Ibc prevents the flaccid type paralysis and such mice will die from a spastic paralysis after about 24 h. IIc (50,000 daltons) is an atoxic fragment of tetanus toxin which binds tightly to gangliosides. Treatment of tetanus toxin with Fab-IIc prior to intracerebral injection converts the characteristic spastic paralysis to a flaccid paralysis. It is proposed that the botulinum toxin-type effect of tetanus toxin complexed to Fab-IIc results from the inability of such complexes to be transported to the central nervous system. Moreover, the ability of Fab-Ibc to prevent flaccid paralysis, but not spastic paralysis, suggests that both types of paralysis may be mediated by the same portion of the tetanus toxin molecule.

Animals↗

PubMed2005

Immunity to tetanus is protective against the development of multiple sclerosis.

Following allegations that Hepatitis B vaccination causes or triggers multiple sclerosis (MS), several epidemiological studies have been conducted to evaluate the association between MS and vaccination. In one study conducted in the US, a significant protective effect on the development of MS was observed for tetanus immunization. We reviewed the medical literature and found two additional recent studies, as well as several older studies, which also observed a significant protective effect of tetanus immunization on the development or progression of MS. Furthermore, decreased humoral and cellular immunity to tetanus toxoid has been observed among MS patients. We postulate that naturally acquired or vaccine-induced immunity to tetanus has a protective effect against the development and progression of MS. We also postulate that this link to tetanus is in part responsible for the gender, age, geographic and socio-economic distribution of MS, as well as its pattern among migrants. The biological basis for this protective effect could be an unspecific boost of bystander suppression of auto-immunity as shown for other infections. Our hypothesis can be tested in several ways. The simplest approach would be to compare tetanus exposure and MS occurrence on a population level. Stronger support would come from the re-analysis of previous studies that have information at the individual level on both tetanus exposure, whether induced or natural, and on the development of MS. Laboratory evidence could be sought by testing the effect of tetanus toxoid on experimental allergic encephalomyelitis, the experimental animal model of MS.

Bystander Effect↗

PubMed2001

BCG vaccination among West African infants is associated with less anergy to tuberculin and diphtheria-tetanus antigens.

To examine risk factors for anergy, delayed-type hypersensitivity was assessed among 884 infants participating in a vaccine trial in Guinea-Bissau. The infants were skin-tested at 7.5 months of age with a panel of seven intradermal antigens. Risk factors for anergy to tuberculin or anergy to both the diphtheria and tetanus antigens were determined in relation to Bacillus Calmette-Guérin (BCG) vaccination, diphtheria-tetanus-pertussis (DTP) vaccination, and measles vaccination. We found sick children to be more anergic to tuberculin and diphtheria-tetanus antigens than healthy children (OR=2.49 (95% confidence interval 1.40-4.55)). There was a higher prevalence of anergy to tuberculin in the rainy season than in the dry season (OR=1.67 (1.25-2.23)). Children who had taken antimalarials within the last week had a higher prevalence of anergy to tuberculin (OR=1.41 (1.02-1.92)). BCG vaccination was significantly associated with less anergy to tuberculin and diphtheria-tetanus antigens (OR=0.42 (0.28-0.63), OR=0.77 (0.60-0.99), respectively). Children vaccinated with BCG before 1 month of age were more anergic to tuberculin than children vaccinated after 1 month (OR=1.61 (1.19-2.19)). DTP vaccination was associated with less anergy to diphtheria-tetanus antigens (OR=0.40 (0.32-0.49)), but not to tuberculin. Children with a positive reaction to tuberculin were less likely to be anergic to diphtheria-tetanus antigens (OR=0.36 (0.26-0.49)) than children with a negative tuberculin reaction. Children who were vaccinated with BCG before they received their last DTP vaccine were less anergic to diphtheria-tetanus antigens (OR=0.40 (0.16-0.88)) than other DTP-vaccinated children. In conclusion, current disease, rainy season, age below 1 month of age at the time of BCG vaccination, and administration of chloroquine or quinimax within the last 7 days were risk factors for anergy to tuberculin among 7.5-month-old infants. BCG vaccination and a positive tuberculin reaction were associated with a lower prevalence of anergy to both tuberculin and diphtheria-tetanus. Thus, BCG vaccination may contribute to better cell-mediated immune responses among infants.

BCG Vaccine↗

PubMed1997

Identification of a ganglioside recognition domain of tetanus toxin using a novel ganglioside photoaffinity ligand.

Tetanus toxin entry into vertebrate motorneurons may involve binding of neuronal surface gangliosides containing the "1b" substructure (a NeuAcalpha2,8NeuAc group on an internal galactose residue). The domains of tetanus toxin involved in ganglioside binding are known to reside within the carboxyl-terminal half of the toxin's heavy chain ("C fragment"). We developed a novel photoaffinity reagent based upon the structure of the 1b ganglioside GD1b (125I-azido-GD1b) to define the ganglioside-binding domains of tetanus toxin. Using this ligand, we observed radiolabeling of tetanus toxin C fragment which could be specifically inhibited by a ganglioside of the 1b series (GT1b), but not by a non-1b series ganglioside (GM3). When tetanus toxin C fragment was proteolyzed with clostripain, whether before or after reaction with 125I-azido-GD1b, a radiolabeled band was observed by SDS-polyacrylamide gel electrophoresis autoradiography, which was selectively inhibited by GT1b. Protein sequencing of proteolyzed tetanus toxin C fragment co-migrating with that band revealed the carboxyl-terminal 34 amino acid residues of tetanus toxin. Matrix-assisted laser desorption/ionization mass spectrometry of a photoaffinity labeled synthetic polypeptide representing the 34-amino acid domain revealed modification at a single residue (His1293). We propose that this domain of tetanus toxin is sufficient for ganglioside binding.

Affinity Labels↗

PubMed2001

Increased levels of specific leukocyte- and platelet-derived substances during normal anti-tetanus antibody synthesis in patients with inactive Crohn disease.

BACKGROUND: Crohn disease is considered a consequence of inappropriate upregulation of immune reactions evoked by the intestinal microflora or luminal antigens. Since the intestinal mucosa is continuously exposed to tetanus toxoid we studied the antibody response to tetanus toxoid booster immunization in patients with Crohn disease and the subsequent release of various inflammatory mediators and growth factors in blood. METHODS: Ten patients with inactive disease and no concurrent medication and 12 age-and gender-matched healthy volunteers with anti-tetanus antibody levels less than 0.1 IU/ml were inoculated with 1 ml (6 Lf units) of tetanus toxoid vaccine. The anti-tetanus antibody levels were determined in serum obtained before inoculation and after 7, 14 and 28 days, respectively. C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), histamine, vascular endothelial growth factor (VEGF), tissue inhibitor of metalloproteinases-1 (TIMP-1), plasminogen activator inhibitor type-1 (PAI-1) and myeloperoxidase (MPO) were determined in serum or plasma obtained on the same days. RESULTS: After inoculation anti-tetanus antibody levels were equally raised in patients and healthy volunteers. Pre-inoculation CRP levels were below the upper level of the normal range (<10 mg/l) in all inoculated patients/volunteers. No differences in IL-6, TNF-alpha, MPO or histamine levels between patients and healthy volunteers were observed. CRP levels were within the normal range and IL-6, TNF-alpha, MPO and histamine levels were unchanged in patients and volunteers during the study period. The levels of VEGF, TIMP-1 and PAI-1 were unchanged in the healthy volunteers during the study period, but were significantly (P < 0.05) increased at day 14 in patients with Crohn disease. At day 28 the levels had fallen to pre-inoculation levels, apart from PAI-1, which was still significantly (P<0.05) increased. CONCLUSIONS: In patients with inactive Crohn disease, booster immunization against tetanus toxoid seems to result in normal anti-tetanus antibody synthesis, but it may cause inappropriate release of certain bioactive substances, which are known to play a major role in modulation of the inflammatory response.

Adult↗

PubMed1990

Response to tetanus toxoid immunization after allogeneic bone marrow transplantation.

An ELISA was used to study long-term immunity and immunization responses to tetanus toxoid in 48 bone marrow transplant recipients. Among patients who were seropositive to tetanus before transplant, 51% had lost their seropositivity 1 year later. All patients who were not reimmunized with tetanus toxoid were seronegative 2 years after transplant. All patients who were seronegative before transplant remained seronegative 1 year later regardless of the donor's serologic status. There was no difference in the ability to remain seropositive to tetanus toxoid between patients with and without chronic graft-versus-host disease. Of 21 patients immunized with one dose of tetanus toxoid 1 year after transplant, 14 were seronegative at the time of immunization (response rate, 64%). At 1 year after immunization, 7 remained seropositive. Ten patients were reimmunized with two doses of tetanus toxoid. All responded and 90% remained seropositive 1 year later. When 21 patients were primarily immunized with three doses of tetanus toxoid, all patients seronegative at immunization responded and all tested patients remained seropositive 2 years later. The immunization responses were significantly superior in patients receiving three doses compared with those who received one. Reimmunization with tetanus toxoid of long-term survivors after marrow transplant seems necessary. A three-dose immunization schedule is recommended to obtain an adequate immune response.

Antibodies, Bacterial↗

PubMed1971

The effect of tetanus toxin in the goldfish.

1. The effects of tetanus toxin have been investigated both on central nervous and peripheral neuromuscular systems of goldfish.2. Tetanus toxin kills goldfish when administered in minute doses. The lethal effect is temperature dependent. Unlike mammals, in which tetanus toxin produces spastic paralysis and convulsions, the tetanus-intoxicated goldfish die with an apparently flaccid paralysis.3. Inhibition and excitation were investigated on the Mauthner cells of goldfish which had been paralysed with tetanus toxin for at least 24 hr, and which were subsequently kept alive for up to 3 days by perfusing the gills with oxygenated water. In such fish, antidromically and orthodromically excited Mauthner cells were quite normal, and there was no apparent effect on either the collateral inhibition or the crossed VIIIth nerve inhibition.4. Local injection of sublethal doses of tetanus toxin into the pectoral fin muscles produced local paralysis of the fin. Nerve-muscle preparations were isolated from such goldfish; in tetanus toxin-paralysed fins, the muscle no longer responded to stimulation of its nerve. The nerve compound action potential was still present and the muscle still responded vigorously to direct electrical stimulation.5. It is concluded that the major part of the lethal action of the toxin in the fish must be ascribed to a peripheral effect, the blocking of neuromuscular transmission. The inhibitory neuronal systems acting on the Mauthner cells of the goldfish, in apparent contrast to those acting on mammalian spinal neurones, are highly insensitive to tetanus toxin.

Action Potentials↗

PubMed1971

Simultaneous immunization with B.C.G., diphtheria-tetanus, and oral poliomyelitis vaccines in children aged 13-14.

The simultaneous administration of B.C.G. vaccine, diphtheria-tetanus toxoid aluminium hydroxide adsorbed vaccine, and oral poliovaccine was studied in 628 children aged 13-14 years between 1966 and 1969 in Newham, London. The efficacy of these vaccines was unaffected by administering them at the same time; routine simultaneous administration is considered justified when organizational difficulties prevent the attainment of high immunization rates with the vaccines given separately. No adverse reactions to B.C.G. or oral poliomyelitis vaccines took place, but 8% of children had moderately severe local reactions after diphtheria-tetanus aluminium hydroxide adsorbed vaccine, which were attributed to diphtheria toxoid.Serological studies showed the need for immunization against diphtheria, tetanus, and poliomyelitis at 13-14 years of age. Because of the adverse reactions to diphtheria toxoid, however, simultaneous administration of tetanus toxoid aluminium hydroxide adsorbed, oral poliomyelitis, and B.C.G. vaccines only is recommended at present.An "adult type" diphtheria-tetanus toxoid might overcome the problem of reactions, though in two to three years' time most children aged 13-14 years will have received diphtheria-tetanus-pertussis vaccine in infancy and reinforcement might then be accomplished by a small intradermal dose of the currently available fluid diphtheria-tetanus vaccine.Continued serological studies of diphtheria and tetanus antitoxins and polio antibody are necessary to determine the future need for reinforcement of immunity; such studies should become an essential part of the surveillance of the community immunization programme.

Adolescent↗

PubMed1998

The use of tetanus toxoid to elucidate the delayed-type hypersensitivity response in an older, immunized population.

Tuberculin reactivity decreases with age despite epidemiologic evidence that the elderly are more likely to have been infected. Whether this phenomenon is due to lack of antigenic stimulus or host inability to mount a delayed type hypersensitivity (DTH) response is unclear. In order to determine if the DTH response to tetanus toxoid in an exposed population is a useful tool to understand the phenomenon of lack of tuberculin reactivity in the remotely exposed elderly, a trial of skin testing was undertaken. Seventy-seven residents of a Veterans Affairs domiciliary were skin-tested using solutions of tetanus toxoid, candida and mumps skin test antigen. The 35 subjects who had negative reaction to the tetanus skin test were randomized into two groups: one which received tetanus vaccination before repeat skin testing and one which did not. Positive skin test reactions occurred in 42 patients to tetanus toxoid, 44 to mumps and 37 to candida. Of the 35 randomized, 27 were available for repeat skin tests. None reacted to the repeat tetanus skin test although 5 reacted to other antigens to which they had previously been nonreactive. Tetanus toxoid was equal to other antigens in its ability to elicit a DTH response originally; however antigenic stimulation with vaccination did not elicit positive skin test in nonreactors. Lack of DTH response to tetanus toxoid in recently vaccinated patients implies that nonresponse was secondary to host factors rather than lack of antigenic stimulation.

Adult↗

PubMed2002

Philosophic objection to vaccination as a risk for tetanus among children younger than 15 years.

OBJECTIVES: Although safe and effective vaccines are available to protect against tetanus in the United States and vaccination rates are high, cases of tetanus among children continue to occur. The objectives of this article are to describe reported cases of tetanus in children in the United States and to identify the reasons for lack of protection against tetanus. METHODS: We reviewed all cases of tetanus in children <15 years of age that were reported to the National Notifiable Diseases Surveillance System from 1992 through 2000. Cases were defined by physician diagnosis. We verified the information in the case reports with state and local health departments. RESULTS: From 1992 through 2000, 15 cases of tetanus in children <15 years of age were reported from 11 states. Twelve cases were in boys. Two cases were in neonates <10 days of age; the other 13 cases were in children who ranged in age from 3 to 14 years. The median length of hospitalization was 28 days; 8 children required mechanical ventilation. There were no deaths. Twelve (80%) children were unprotected because of lack of vaccination, including 1 neonate whose mother was not vaccinated. Among all unvaccinated cases, objection to vaccination, either religious or philosophic, was the reported reason for choosing not to vaccinate. CONCLUSION: The majority of recent cases of tetanus among children in the United States were in unvaccinated children whose parents objected to vaccination. Parents who choose not to vaccinate their children should be advised of the seriousness of the disease and be informed that tetanus is not preventable by means other than vaccination.

Adolescent↗

PubMed2002

A mechanism of the thearubigin fraction of black tea (Camellia sinensis) extract protecting against the effect of tetanus toxin.

The aim of the present study was to elucidate the mechanism of the protective effect of black tea extract's thearubigin fraction against the action of tetanus toxin. The effects of thearubigin fraction extracted from a black tea infusion were examined for neuromuscular blocking action on tetanus toxin in mouse phrenic nerve-diaphragm preparations and on the binding of this toxin to the synaptosomal membrane preparations of rat cerebral cortices. The interaction between tetanus toxin and thearubigin fraction was also investigated. Tetanus toxin (4 micrograms/ml) abolished indirect twitches in mouse phrenic nerve-diaphragm preparations within 150 min. Thearubigin fraction mixed with tetanus toxin blocked the inhibitory effect of the toxin. Mixing iodinated toxin with thearubigin fraction inhibited the specific binding of [125I]tetanus toxin to the synaptosomal membrane preparation. The effects of thearubigin fraction were dose-dependent. The elution profile of [125I]tetanus toxin on Sephadex G-50 column chromatography was different from that of toxin mixed with thearubigin fraction. These findings indicate that thearubigin fraction protects against the action of tetanus toxin by binding with the toxin.

Animals↗

PubMed1989

Changes of tetanus specific IgG, IgM and IgG subclasses after DPT vaccination.

We evaluated tetanus specific IgG, IgM, IgG subclasses after DPT vaccination in infants and children. Tetanus toxoid specific IgG, IgM IgG subclasses were measured to characterize the isotope profile of antibody against tetanus toxoid. The values of the tetanus specific IgG in the positive group were significantly increased compared to those of the control group, and were significantly increased after two inoculation. Tetanus specific IgG was very low in adults and neonates. In our tetanus specific IgG subclasses study, forty-five of 56 cases (80%) showed predominantly IgG1 antibody responses to tetanus toxoid, while twenty-five of 56 cases (45%) showed IgG4 responses. Both IgG1 and IgG4 responses were demonstrated in 17 cases (30%). So we suggest that IgG was mainly involved in humoral immune response after DPT vaccination, and IgG1 may play an important role among IgG subclasses. IgG4, alone or together with IgG1, can also play a role in immune response to tetanus toxoid.

Antibodies, Bacterial↗

PubMedDate not supplied

[Epidemiologic features of tetanus in adults form Yucatan, Mexico].

OBJECTIVE: To describe epidemiologic features from tetanus in adult patients (TIAP) treated at hospital general O'Horan in Merida, Yucatan, Mexico and compare them with another Mexican series analyzed 25 years ago. MATERIAL AND METHODS: From 1985 to 1999, 121 TIAP cases aged 13 years or older were identified from which 112 were analyzed. Diagnosis of TIAP was made just in a clinical basis. To analyze information inferencial statistics were used. RESULTS: People affected by tetanus averaged 43 +/- 21, 95% CI 39 to 47. A 3:1 male to female ratio was documented. Eighty two (73%) patients come from the rural area; 43 (38%) did work as peasants. Sixty two cases (55%) were diagnosed during the Fall and Winter seasons. In 91 patients (81%) no anti-tetanus vaccination was documented. In 89 cases (79%) incubation period averaged 5.4 +/- 4 days, 95% CI 5 to 6. According to this 89 cases (79%) with incubation period < 10 days were graded as severe tetanus and 23 (21%) with incubation period > or = 10 days were graded as non-severe tetanus. Tetanus-prone wounds were documented in 95 (85%) cases, 59 (62%) of which (62%) were localized in the lower extremities. Final outcome dichotomized either as death patient (group one) or surviving patient (group two) was documented in 103 cases of whom 67 (65%) were in group one and 36 (35%) were in group two. By comparing them, differences were seen in mean age (P = 0.004, 95% CI 3.9 to 19.8), age categories (< 50 vs. > or = 50) (chi 2 P = 0.001, 95% CI 0.6 to 0.60), severity of tetanus (Fisher exact test P = 0.0009, 95% CI 2 to 53) and mean hospitalization time (mean difference 14.8, P = 0.0001, 95% CI 11 to 18) but not in sex (chi 2 0.69, P = 0.40). CONCLUSIONS: In the State of Yucatan, Peninsula de Yucatan, Mexico, TIAP is still an endemic process with high mortality rate specially among young productive people. Secondary preventive measures as routinely tetanus toxoid booster vaccination are still not enough, at least in adulthood.

Adolescent↗

PubMed2003

[Missed opportunities for tetanus immunization of pregnant women in Juiz de Fora, Minas Gerais, Brazil].

OBJECTIVE: To estimate the missed opportunities for tetanus vaccination and to determine the immunization coverage at the end of pregnancy in women living in the city of Juiz de Fora, which is in the state of Minas Gerais, Brazil. METHODS: A cross-sectional study was carried out of 430 women who were randomly selected from all the maternity hospitals in the city, from February through August 1996. The women were interviewed regarding prenatal care, their knowledge of tetanus, and tetanus immunization before or during the latest pregnancy. RESULTS: The age of the participants ranged from 14 to 45 years (mean = 26.4 +/- 6.9 years); 420 women lived in urban areas and 10 in rural areas. Prenatal care was from the Brazilian public Unified Health System in 69.5% of the women (299 of 430); 27.6% (119) received prenatal care through other types of providers; and 2.8% (12) did not receive prenatal care. Of the 430 participants, 352 of them (81.8%) had their prenatal care card with them during the interview; 85.6% (368) had four or more prenatal care visits. Regarding their knowledge of tetanus, 92.1% (396) knew about the disease and its severity. Out of the 430 women, 359 of them (83.5%) started the latest pregnancy without having had a tetanus vaccination; 104 were vaccinated during the latest pregnancy, so 255 had not been vaccinated by the time of delivery. This was in spite of the significant increase in the opportunities for being vaccinated with an increase in the number of prenatal visits. The odds ratio for pregnant women with four or more prenatal visits being vaccinated by the end of the pregnancy was 2.7 times that of the women with zero to three visits. Seventy percent of the opportunities for tetanus immunization were missed in the study population. The overall tetanus immunization coverage was 40.6% by the end of pregnancy. CONCLUSIONS: The low immunization coverage was below the level recommended by the World Health Organization. In combination with the high rate of missed opportunities for vaccination, this points to the need to implement a tetanus vaccination promotion strategy directed at health professionals in general but especially at those who provide care for pregnant women, in both public and private health clinics. In addition, the vaccination practices in Juiz de Fora should be strengthened.

Adolescent↗

PubMed1992

Use of reminders to increase compliance with tetanus booster vaccination.

OBJECTIVE: To assess the effect of three computerized reminder systems on compliance with tetanus vaccination. DESIGN: Prospective randomized controlled trial. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8069 patients 20 years of age or more who were not in a hospital or institution 5589 were randomly assigned, by family, to a control group, a physician reminder group, a telephone reminder group or a letter reminder group. The remaining 2480 patients were not included in the randomized portion of the study but were monitored. Results are presented for the 5242 randomized patients and the 2369 nonrandomized patients for whom there was no up-to-date record of tetanus vaccination at the start of the trial. INTERVENTIONS: For the patients in the physician reminder group the physician was reminded at an office visit to assess the patient's tetanus vaccination status and to recommend vaccination; those in the other two reminder groups received a telephone call or letter enquiring about their tetanus vaccination status and recommending a booster dose. MAIN OUTCOME MEASURE: Proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years. MAIN RESULTS: The rate of recorded tetanus vaccination in the randomized control group was 3.2%. The difference between that rate and those for the three reminder groups was 19.6% in the physician reminder group (95% confidence interval [CI] 17.1% to 22.2%, p less than 0.00001), 20.8% in the telephone reminder group (95% CI 18.3% to 23.5%, p less than 0.00001) and 27.4% in the letter reminder group (95% CI 24.8% to 30.2%, p less than 0.00001)). The letter reminders were more effective than either the telephone reminders (p = 0.00013) or the physician reminders (p less than 0.00001) in improving compliance. The cost to the practice per additional vaccination recorded was 43 for the physician reminders, $5.43 for the telephone reminders and $6.05 for the letter reminders. CONCLUSIONS: Although all three reminder systems increased the rate of recorded tetanus vaccination they fell far short of achieving complete population coverage. More intensive interventions would be required to approach that goal. However, such interventions do not appear to be justified given the rarity of tetanus.

Adult↗

PubMed2005

Knowledge about tetanus immunization among doctors in Delhi.

BACKGROUND: In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus. AIMS: 1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. SETTING AND DESIGN: It was a cross-sectional study conducted in Delhi. MATERIALS AND METHODS: After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma. STATISTICAL ANALYSIS: Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied. RESULTS AND CONCLUSION: As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

Adult↗

PubMed2003

Knowledge regarding tetanus toxoid immunization among persons attending health mela in Delhi.

Although vaccine against tetanus has been in use for more than two decades, often people are not aware of tetanus immunization schedules and its significance in preventing tetanus. The current cross-sectional study was carried out to (1) assess knowledge about tetanus immunization (in relation to injury) among persons attending a health mela and (2) To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. Every tenth person above 15 years of age, who came to health post in the mela was interviewed. A total of 231 persons attending a health mela in Delhi in October 2003 were interviewed. About two third of them were males. Majority (55%) were graduates or above. Only half of them indicated that they would give tetanus immunization after an injury, two fifth indicated it after animal bite and only one fourth indicated it after burns. Knowledge was higher among females and with higher education. However, knowledge regarding correct immunization schedules, prevention of tetanus by DPT and when to give booster in case of injury after primary immunization was poor. There is need to create greater awareness among people about immunization against tetanus, duration of immunity and disease prevented by it. This is to ensure immunization when it is needed and avoid unnecessary repeated immunization.

Adolescent↗