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PubMed1977

Tetanus antibody production in serum and cerebrospinal fluid in the rabbit and correlated histopathological features of the central nervous system.

The histopathological features in the central nervous system (CNS) developing during the active phase of tetanus antibody formation in the cerebrospinal fluid (CSF) as induced in 15 rabbits were studied. The measurement of antibody titres in serum and CSF by electroimmunodiffusion and histological examination were done sequentially at the 1st, 3rd, 5th, 7th and 9th days after cisternal secondary inoculation with fluid tetanus toxoid. Tetanus antibodies appeared in serum after the 1st and in CSF after the 5th day. Decreasing values of CSF total protein were found. The meaning of an elevated Q ratio as observed in this situation of strong antibody formation in the CSF was enhanced. The histopathological features in the central nervous system consisted of perivascular inflammatory infiltration, at first polymorphic and then composed almost exclusively of mononuclear cells with a predominantly leptomeningeal and subpial localization, which might represent the origin of CSF tetanus antibodies. The localization was related to the contact zone between the antigen- and antibody-containing compartments, respectively the subarachnoid space and vascularized structures of the brain and spinal cord. Four control rabbits presented neither tetanus antibodies in the CSF nor perivascular inflammatory infiltration in the CNS. Similarity between the present experimental results and the immunopathological features of the primary demyelinating diseases provides some useful information about the immunological inflammatory events in these diseases.

Animals↗
PubMed1981

Natural resistance against tetanus in patients with lepromatous leprosy.

Tetanus antitoxin levels in the sera of unimmunized lepromatous patients, often suffering from many ulcerations on their limbs due to physical and thermal trauma, but not developing clinical tetanus, were studied. Sera from 40 such patients with no history of immunization against tetanus, 35 unimmunized matched controls and 12 immunized controls were tested for the presence of tetanus antitoxin by the passive haemagglutination technique. 45% of patients, 17% of controls and all the immunized patients showed adequate serum antibody levels. Eight of the 22 leprosy patients, with no detectable antitoxin on their sera, were immunized with a single dose of tetanus toxoid and all showed sero-conversion four weeks later. 2-Mercaptoethanol (2ME) treatment of these sera showed both IgM and IgG classes of specific antibody in all groups but the level of mature antibody of IgC class was higher in the immunized group. Neutralization test further confirmed the presence of protective antibodies in these sera.

Adult↗
PubMed1995

Immunoglobulin E responses to diphtheria and tetanus toxoids after booster with aluminium-adsorbed and fluid DT-vaccines.

Immunoglobulin E responses to diphtheria and tetanus toxoids were investigated in pre- and postbooster samples of 104 children given, at 10 years of age, a DT booster with either an adsorbed (n = 51) or a non-adsorbed, fluid vaccine (n = 53). Vaccination with adsorbed DT is part of a national immunisation programme and represents the first regular booster given to these children, primarily immunised with three doses of adsorbed DT at age 3-6 months. The vaccines, with a content of 30 Lf of diphtheria toxoid and 7.5 Lf of tetanus toxoid per millilitre, were given for booster in a dose of 0.25 ml as a deep subcutaneous injection. In the prebooster samples, 3 and 14% had measurable IgE to diphtheria and tetanus, respectively. These rates rose to 94 and 92% in the postbooster samples, respectively. The median (range) of IgE to tetanus among recipients of the adsorbed vaccine was 0.59 PRU ml-1 (< 0.1-17.5), as compared to 0.27 (< 0.1-8.22) in the recipients of the fluid vaccine (p = 0.027). The median IgE response to diphtheria toxoid in the whole group was 1.8 (< 0.1-17.5), with no significant difference between the two vaccines (p = 0.76). There was no correlation between the IgE and IgG responses (r < 0.07, p > 0.5) but the two IgE responses as well as the ratios of IgG/IgE showed strong correlations (r > 0.7, p < 0.001). The study thus revealed unexpectedly high rates of IgE responses to diphtheria and tetanus toxoids in a regular DT booster vaccination programme, which were associated to high rates of local side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvants, Immunologic↗
PubMed1988

Tetanus following a burn injury.

We report a case of tetanus following thermal injury in an 18-month-old girl who had been immunized with the usual triple vaccine and had received a booster dose for tetanus at 15 months of age. She had been admitted initially to a general district hospital and remained there for 10 days before being transferred to the University Hospital. Despite the unparalleled effectiveness and safety of tetanus toxoid, the administration of antitetanus serum (tetanus antitoxin) for patients with suspicious symptoms or wounds grossly contaminated with soil is often highly desirable. A schema of prophylaxis and management of patients with tetanus is provided.

Burns↗
PubMed1992

Tetanus.

Tetanus is a preventable disease with proper immunization. The marked decline in the incidence over the past several decades has resulted from widespread use of tetanus prophylaxis and improved wound management in the emergency department. Emergency physicians are among the most frequent providers of tetanus vaccination. We can stress the importance of proper immunization and encourage patients to keep accurate immunization records. This can maximize protection of patients from tetanus, and minimize adverse reactions from excessive administration of booster. Tetanus can be fatal even with proper treatment. Vital treatment measures can easily be completed in the emergency department.

Benzodiazepines↗
PubMed2005

Unreliability of reported tetanus vaccination histories.

Our study questioned the reliability of patients' reported tetanus immunization histories. One thousand patients at an urban teaching hospital were queried regarding their tetanus immunization status. Of the 377 patients who initially asserted having had a tetanus vaccine in the last 5 years, 98 (26%) were confirmed, either by further history taking or chart review, not to have received tetanus immunization. It appears that there is a sizeable percentage of patients who falsely report their tetanus immunization status.

Health Knowledge, Attitudes, Practice↗
PubMed2006

Tetanus prophylaxis for diabetic foot ulcers.

The infected or ulcerated diabetic foot is a suitable environment for Clostridium tetani. Tetanus intoxication as a result of foot ulcer has been described in the literature. Immunopathy, vasculopathy, and ulceration place the diabetic patient at risk for developing tetanus. Of diabetic patients who contract generalized tetanus in the United States, foot ulcer or gangrene are responsible for 25% of cases. Patients who have diabetic wounds should receive tetanus prophylaxis. The prophylaxis should follow the "tetanus-prone" wound recommendations as set by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.

Diabetic Foot↗
PubMed2005

[Current aspects of pediatric and adult tetanus in Dakar].

OBJECTIVE: This retrospective study was undertaken to assess epidemiological and clinical aspects as well as outcome of tetanus cases in patients over 28 days of age, so as to issue recommendations. PATIENTS AND METHODS: This study included patients admitted to the Fann teaching hospital in Dakar from 2001 to 2003. Age, sex, portal of entry, clinical signs, delay from onset to admission, stage and outcome of the tetanus were recorded. RESULTS: 410 cases of tetanus were observed. The sex-ratio was 2.41. The mean age was 20 years [range 2 months-89 years]. Sixty-two percent of the patients were between six and 30 years of age. Most of the patients were workers and craftsmen (58%) or pupils (19%). A wound was the most frequent portal of entry (73%). Tetanus was localized in four out of 406 cases. The global mortality rate was 22%; but it was higher when tetanus was stage III and in case of complications. CONCLUSION: According to these results, it seems necessary to include booster doses in the Expanded Immunization Program, and to implement better prevention strategies targeting people not taken into account in this program. In addition, health care providers should check out the immunization status of their patients and accordingly offer an update or a full course of active immunization.

Adolescent↗
PubMedDate not supplied

Tetanus antibody levels among adolescent girls in developing countries.

Neonatal and maternal tetanus infections remain an important cause of death in many countries. Few studies have reported tetanus toxoid antibody levels of adolescent girls. As part of the Expanded Programme on Immunization most girls receive up to 3 injections in early childhood, and many subsequently do not receive booster vaccinations until pregnant. We determined (by ELISA) tetanus antibody seropositivity in adolescent girls from Malawi (in 1996), Nigeria (in 1993) and Pakistan (in 1996), and response to tetanus vaccination in adolescent girls from Pakistan. Geometric mean titres (GMT, IU/mL) were 0.94 in 117 Malawian, 0.32 in 154 Nigerian and 1.08 in 162 Pakistani girls. In Nigeria, 54.7% of adolescents were seronegative, of whom 26.8% had a history of unsafe abortion. In Malawi and Pakistan all girls were seropositive and in Pakistan, following a booster vaccination, titres increased 3-fold, with a lower response in older girls. The results indicated that adequate childhood immunization is likely to provide protective levels through adolescence. Booster vaccination in late childhood/early adolescence should protect the majority of women throughout their reproductive lives. This practice would reduce the risks of girls exposed to infection through unsafe abortions, and may be the best option for countries seeking to improve their vaccination schedule, especially where tetanus vaccine coverage in pregnant women is unacceptably low.

Adolescent↗
PubMed1983

In vitro humoral immune response of human peripheral blood lymphocytes to tetanus toxoid sepharose 4B.

The in vitro immune response of unfractionated human peripheral blood lymphocytes (PBL) from immune donors who had not been re-immunized with tetanus toxoid (TT) prior to donation was investigated. In this study we were able to stimulate PBL with tetanus toxoid coupled to Sepharose 4B (STT) for production of anti-tetanus toxoid antibody (Ab). Soluble tetanus toxoid or STT alone did not stimulate production of specific Ab. Pokeweed mitogen (PWM) and STT were required for optimal production of IgG and IgM antibodies specific to tetanus toxoid. Specific Ab responses were reduced in low and high concentrations of STT. Depletion of monocytes had no effect on either total IgG or specific IgG synthesis, but decreased the synthesis of both total and specific IgM. Depletion of E-rosette-forming cells decreased the production of specific Ab, suggesting T-dependency of the immune response to STT. Simultaneous production of total immunoglobulin and specific Ab by Sepharose 4B was negligible in the absence of PWM. In the presence of PWM, total immunoglobulin production was optimal, and specific anti-TT Ab production was undetectable. The specificity of the anti-TT Ab was studied by absorption of the culture supernates with an STT column which removed all measurable specific Ab.

Antibody Formation↗
PubMed1999

A population-based study on tetanus antitoxin levels in The Netherlands.

We assessed the tetanus immunity of the general Dutch population and of religious groups refusing vaccination by means of population-based study to evaluate the effect of tetanus vaccination. More than 95% of those born after the introduction of routine vaccination had tetanus antitoxin levels above the minimum protective level. After the sixth vaccination, a fall in tetanus antitoxin levels occurred. Nevertheless, immunisation in accordance with the routine programme most likely induces protection for much longer than two decades. Not only many members of religious groups who refuse vaccination, but also many adults born before the introduction of vaccination lack tetanus immunity. These cohorts might benefit most from (re)vaccination.

Adolescent↗
PubMed1995

Structure and function of tetanus and botulinum neurotoxins.

Tetanus and botulinum neurotoxins are produced by Clostridia and cause the neuroparalytic syndromes of tetanus and botulism. Tetanus neurotoxin acts mainly at the CNS synapse, while the seven botulinum neurotoxins act peripherally. Clostridial neurotoxins share a similar mechanism of cell intoxication: they block the release of neurotransmitters. They are composed of two disulfide-linked polypeptide chains. The larger subunit is responsible for neurospecific binding and cell penetration. Reduction releases the smaller chain in the neuronal cytosol, where it displays its zinc-endopeptidase activity specific for protein components of the neuroexocytosis apparatus. Tetanus neurotoxin and botulinum neurotoxins B, D, F and G recognize specifically VAMP/ synaptobrevin. This integral protein of the synaptic vesicle membrane is cleaved at single peptide bonds, which differ for each neurotoxin. Botulinum A, and E neurotoxins recognize and cleave specifically SNAP-25, a protein of the presynaptic membrane, at two different sites within the carboxyl-terminus. Botulinum neurotoxin type C cleaves syntaxin, another protein of the nerve plasmalemma. These results indicate that VAMP, SNAP-25 and syntaxin play a central role in neuroexocytosis. These three proteins are conserved from yeast to humans and are essential in a variety of docking and fusion events in every cell. Tetanus and botulinum neurotoxins form a new group of zinc-endopeptidases with characteristic sequence, mode of zinc coordination, mechanism of activation and target recognition. They will be of great value in the unravelling of the mechanisms of exocytosis and endocytosis, as they are in the clinical treatment of dystonias.

Amino Acid Sequence↗
PubMed1998

Tetanus immunity in autologous bone marrow and blood stem cell transplant recipients.

The aims of this study were to assess long-term immunity and reimmunization responses against tetanus toxoid in recipients of autologous stem cell grafts and to compare immune status in patients who underwent ABMT or autologous blood stem cell transplantation (APBSCT). Ninety patients were included in the study; 52 had received ABMT and 38 APBSCT. Thirty of 52 ABMT patients (58%) and 25 of 38 APBSCT patients (66%) had protective antibody levels against tetanus before transplantation (P = NS). The rate of seropositivity had decreased at 1 year after transplantation; 15 of 52 (29%) ABMT patients and 18 of 38 (47%) APBSCT patients (P = NS) were still positive after 1 year. There were no cases of spontaneous recovery in seronegative patients. Most patients were reimmunized with three doses of tetanus toxoid given at 12, 13, 14 and or 18 months after transplantation. All immunized patients had protective immunity against tetanus at 1 year after vaccination. These results suggest that humoral immunity is defective both after ABMT and after APBSCT and in both cases the loss of immunity seems to be similar. Reimmunization of patients who have undergone ABMT or APBSCT is necessary to obtain protective immunity against tetanus.

Adolescent↗
PubMed2001

A 5-year follow-up on antibody response after diphtheria and tetanus vaccination in hemodialysis patients.

Chronic renal failure is associated with a T-cell-dependent immune defect. In the past, various studies have focused on the insufficient immune response to vaccination of hemodialysis patients. An impaired vaccination response rate has been reported for vaccines against hepatitis B, influenza, tetanus, diphtheria, and others. However, no data exist on the long-term success of vaccination against tetanus and diphtheria in these patients. The aim of the present study is to investigate seroresponse to tetanus and diphtheria vaccination over a 5-year period. Antibody levels were determined by enzyme immunoassay. Antidiphtheria antibody levels of 31 hemodialysis patients were determined 5 years after vaccination. After 5 years, 10 of 31 patients (32%) had a protective antibody level against diphtheria (>/=0.1 IU/mL), whereas 12 months after vaccination, 26 of 71 patients (37%) were protected. Also, mean antibody levels significantly decreased. Furthermore, antitetanus antibody levels of 21 patients simultaneously vaccinated against tetanus and diphtheria were investigated. After 5 years, 15 of 21 patients (71%) were protected compared with 46 of 71 patients (65%) in the hemodialysis collective studied after 12 months. In the interval between 1 and 5 years after vaccination, significantly more patients in the initial nonresponder group had died than in the responder group; therefore, the overall protection rate observed in vaccinated patients increased. Our results provide evidence that during a 5-year period, antibody persistence against tetanus toxoid is better than that against diphtheria toxoid. Therefore, detection of individual antibody concentrations may be indicated to decide on revaccination.

Antibodies, Bacterial↗
PubMed1998

Humoral immune response to tetanus-diphtheria vaccine given during extended use of chloroquine or primaquine malaria chemoprophylaxis.

Immune suppression resulting from prolonged chemoprophylaxis and potential drug-vaccine interaction were investigated within the context of a randomized placebo-controlled trial that compared daily primaquine or weekly chloroquine administration for malaria prevention. After 11 months of prophylaxis, adult male subjects received a tetanus-diphtheria (Td) vaccination. Prophylaxis continued 4 weeks longer. Anti-tetanus and anti-diphtheria antibody levels were measured by ELISA at baseline and at 1, 3, 7, and 14 months after Td vaccination. All groups were comparable at baseline. Immunization triggered significant increases in anti-tetanus and anti-diphtheria IgG levels over each group's pre-Td baseline levels and those of an unvaccinated control group. Geometric mean anti-tetanus titers (GMTs) in the primaquine group were significantly higher than those of the placebo group at 1, 3, and 14 months. Anti-tetanus GMTs in placebo and chloroquine groups declined over 14 months to levels comparable to those of unvaccinated controls, but levels in the primaquine group remained significantly higher than in controls.

Adult↗
PubMedDate not supplied

Botulism and tetanus: selected epidemiologic and microbiologic aspects.

Botulism is rare in both developing and developed countries. During 1980 only 89 cases (18 food borne, 68 infant, 2 wound, 1 unspecified) were reported in the United States. Coproexamination is essential for laboratory confirmation of infant botulism. Botulinal antitoxins of equine origin are used for treating food-borne and wound botulism but are usually not recommended for infant cases. Tetanus is much more common in some developing countries than in developed countries. During 1980 only 95 cases of tetanus were reported in the United States; in 68 (72%) of these cases, the patient was 50 years or older, and in only two (2.1%) cases was the patient younger than one year. Tetanus neonatorum is a major problem in some developing countries. Diagnosis of tetanus is based primarily on clinical findings, but laboratory studies can be helpful, especially in epidemiologic investigations. Human hyperimmune immunoglobulin is now used in the treatment of tetanus.

Adolescent↗
PubMedDate not supplied

Selective primary health care: strategies for control of disease in the developing world. XXII. Tetanus: a preventable problem.

Tetanus, although an eminently preventable disease, remains common and uncontrolled in many developing countries. The persistence of tetanus is attributable to health service policies that ignore the disease because of a dearth of reliable epidemiologic and economic information. In many developing countries there have, as yet, been few public or professional demands for preventive action. For the prevention of neonatal tetanus, the immediate priority is immunization timed to produce and maintain protective levels of maternal antitoxin during pregnancy. This strategy should be accompanied by the extension and improvement of scientific standards of midwifery. To protect the rest of the population from wound tetanus, the strategy of first choice consists of continuous multiple-antigen immunization in infancy and childhood. Such a program should be reinforced by the routine administration of a toxoid booster following all accidental wounds as well as before all ritual procedures known to carry risk. These strategies, which are of proven efficacy and adaptable to local conditions of the large populations still in need of protection, together provide powerful justification for the expansion of primary maternal and child health services. Careful measurement of the incidence of neonatal tetanus would provide a good indicator of the degree of effectiveness such services have attained in many rural communities.

Adolescent↗
PubMed1991

Risk factors of neonatal tetanus in Senegal.

A case-control study for evaluating the risk factors of neonatal tetanus was conducted in a rural area of Senegal under demographic surveillance (Niakhar). Some 45 neonatal tetanus deaths that occurred in the study area between March 1983 and March 1986 were investigated. They were matched with 187 controls. Neonatal tetanus accounted for one-third of all neonatal deaths; mortality from neonatal tetanus was 16/1000 livebirths. The effect of various demographic, socioeconomic, epidemiological and behavioural factors was investigated in a multivariate analysis using linear logistic regression. There was no difference associated with socioeconomic factors between cases and controls. Factors associated with the skill and behaviour of birth attendant and mother were highly significant and were associated with high odds ratio (OR) and included whether the hands of the person cutting the cord were washed with soap (OR = 5.22; p = 0.001); whether the person who dressed the cord was skilled (OR = 4.71; p = 0.012); whether the age of the mother was less than 18 years (OR = 7.03; p = 0.027) and whether the birth attendant arrived before delivery (OR = 4.15, p = 0.023). Conversely, the type of tool used to cut the cord did not have a significant effect (p = 0.239). Data analysis suggests that a main source of Clostridium tetani may be the hands of the birth attendant and that the main mode of contamination may be the dressing of the wound stump. Results suggest that teaching mothers and birth attendants simple hygienic principles and basic techniques may have a significant impact on neonatal tetanus mortality.

Case-Control Studies↗