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PubMed1993

Control of neonatal tetanus in southern Thailand.

Prior to 1989, Krabi and Satun, two neighbouring provinces with similar socioeconomic background and health service coverage, had the highest reported incidence rates of neonatal tetanus in Thailand (3 per 1000 livebirths). A control programme was conducted between 1989 and 1991. The objective of this study was to examine changes in prevalence of risk factors among the population and changes in incidence rates of this disease due to this programme. Two 30-cluster surveys to measure prevalence rates of risk factors were conducted in Krabi, before and after the campaign. Information on incidence was obtained from routine surveillance. The intervention in Krabi consisted of mass immunization and intensive education for traditional birth attendants (TBA) whereas only the latter was carried out in Satun. The incidence of neonatal tetanus in both provinces declined dramatically to less than 0.4 per 1000 livebirths in 1990 and 1991. From 1989 to 1991, in Krabi Province, the coverage of at least two doses of tetanus toxoid injections at any time prior to delivery, delivery by trained health personnel, acceptable sterile technique for umbilical cord cutting and correct method of dressing the umbilical stump rose from 70 to 88%, 55-80% cent, 80-94% and 40-74%, respectively. Reduction in the incidence rate of neonatal tetanus was achieved by strengthening of routine health services with or without additional mass immunization. Considering that the coverage of immunization has not yet been completed and the prevalence rates of different risk factors are still high, further attempts to improve the problem of neonatal tetanus are necessary.

Adult↗
PubMed1978

Antitoxin responses in the elderly to tetanus-diphtheria (TD) immunization.

A high per centage of reported cases of tetanus and diphtheria in the United States occurs in persons over 60 years old. The sera of 69 elderly persons, mean age 80 years, were tested for prevalence of tetanus and diphtheria antibodies, and only 51% and 59%, respectively, had protective levels (greater than or equal to .01 AU/ml). In a prospective study 27 elderly volunteers were given 0.5 ml tetanus-diphtheria (Td) toxoid twice, seven months apart. Before toxoid 26% and 59% of persons had protective antitoxin levels against tetanus and diphtheria. After one dose the per cent protected rose to 42 and 88. After the second dose all persons immunized had protective levels. No subjects had significant side effects after either dose. These data demonstrate that many elderly persons lack protection against tetanus and diphtheria and document that two doses of Td toxoid would confer immunity to virtually all such persons.

Aged↗
PubMed1996

The effect of immunization against tetanus during pregnancy for protective antibody titres and specific antibody responses of infants.

The protective effect of immunization against tetanus during pregnancy was examined by determining the serum antitoxin titres in 28 infants of twice immunized mothers and in 39 infants of non-immunized mothers during pregnancy. In addition, it was also determined whether transplacentally passive immunization of infants exerts a suppressive effect on active immunization with DPT vaccine. Before primary immunization with DPT, serum tetanus antitoxin (IgG) titres higher than protective level of 0.1 IU/ml were found in 100 per cent of infants of mothers immunized during pregnancy. Thirty-one per cent of infants born to non-immunized mothers had serum tetanus antitoxin titres below the protective level. In the sera obtained 1 month after the third dose of DPT vaccine, no significant difference was observed between the infants of both groups of mothers. It was concluded that specific antibody responses to three doses of DPT vaccine in infants who had received passive immunity from their mothers were not suppressed, and administration of two doses of tetanus toxoid to women during pregnancy provided passive transient protection of the infant against tetanus before administration of first dose of DPT vaccine.

Antibodies, Bacterial↗
PubMed1987

Revaccination against tetanus 17 to 20 years after primary vaccination: kinetics of antibody response.

In 24 military recruits vaccinated against tetanus 17-20 years earlier antibody responses were studied 4, 11, and 24 days after revaccination. Antitoxin concentration in serum showed a sigmoid increase with titres at day 4 only just above protective level, corresponding to a risk of susceptibility to be expected even 4 days after revaccination (2.0%, 95% confidence limit). Only after 7 days the risk of unprotection was less than 1%. As the incubation period of tetanus can be as short as 24 hours, revaccination only may not be regarded sufficient if more than 17-20 years have elapsed since primary vaccination and conditions favoring rapid development of tetanus are present. The findings may explain some of the cases of tetanus which have occurred in spite of primary vaccination supplemented by emergency booster. The statement that prophylactic tetanus immunoglobulin is never indicated to persons completely vaccinated earlier should be considered for revision.

Adult↗
PubMed1994

Antibodies against Haemophilus influenzae type b and tetanus in infants after subcutaneous vaccination with PRP-T/diphtheria, or PRP-OMP/diphtheria-tetanus vaccines.

In an open randomized study, serum antibodies against Haemophilus influenzae type b capsular polysaccharide (PRP) and tetanus toxoid were determined in 146 Swedish infants; 75 of them received PRP conjugated to tetanus toxoid (PRP-T) concurrently with diphtheria toxoid vaccine, and 71 received PRP conjugated to an outer membrane complex of Neisseria meningitidis (PRP-OMP) concurrently with diphtheria-tetanus toxoid vaccine. Injections were given subcutaneously at ages 3, 5 and 12 months. One month after the second injection, the PRP-T recipients had a geometric mean (GM) concentration of 0.38 microgram/ml and only 69% had PRP antibodies > or = 0.15 microgram/ml (considered a protective level). In the PRP-OMP group the GM concentration was 0.44 microgram/ml and 85% had PRP antibodies > or = 0.15 microgram/ml. One month after the third injection, 99% of the infants in both groups had PRP antibodies > or = 0.15 microgram/ml, but PRP-T recipients had significantly higher GM concentration than infants vaccinated with PRP-OMP, 10.21 micrograms/ml vs. 1.90 micrograms/ml (P < 0.001). After all three injections the diphtheria-tetanus toxoid vaccine elicited higher GM concentrations of tetanus toxoid antibodies than did the PRP-T vaccine, but both vaccines induced antibodies above the proposed protective level, 0.01 IU/ml. The reason for the lower than expected immunogenicity of the two Haemophilus influenzae type b conjugate vaccines has yet not been established. For PRP-OMP the most probable explanation is the use of a lot of low immunogenicity, but the route of administration also has to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Bacterial↗
PubMed1978

A rapid automated latex screen for tetanus toxoid antibodies.

This report describes the sensitisation of latex particles and the use of this reagent on the Autotape system to select blood donations containing greater than or equal to 4 IU/ml of tetanus toxoid antibody. Plasma containing tetanus toxoid antibodies is processed to provide immunoglobulin for passive protection against tetanus. The techniques used for screening include immunoelectrophoresis [3], tetanus toxoid sensitised latex particles [5], haemagglutination [1] and automated haemagglutination [6]. The technique used by the Sheffield Regional Transfusion Centre until recently, was immunoelectrophoresis, selecting donors with 4 or more IU/ml. The Autotape system, previously described for brucellosis [4] and syphilis testing [2], provides a system for automated slide testing and a 5-min tetanus toxoid coated latex test has been developed to select suitable donations for the production of specific immunoglobulin.

Agglutination↗
PubMed1993

Tetanus of immunized children.

Five children aged five to 15 years contracted tetanus in Finland between 1969 and 1985, together with 101 adults. Four of the five had been adequately immunized against tetanus. The clinical picture of tetanus was mild or moderate, and none of the children needed respirator treatment. Epilepsy, meningitis and psychogenic symptoms were considered in the differential diagnosis. The course of tetanus in immunized patients is atypical and often benign, but the diagnosis is problematic--in contrast to affected children in developing countries, whose populations are not adequately immunized and where neonatal tetanus is common and often fatal.

Adolescent↗
PubMed1999

Quantitation of commercial equine tetanus antitoxin by competitive enzyme-linked immunosorbent assay.

In the USA, the potency of commercially prepared equine tetanus antitoxin is determined by the method outlined in the Code of Federal Regulations, Title 9, Part 113.451. In the current test, commercial equine tetanus antitoxin is tested by a toxin neutralization test in guinea pigs. The in vivo test measures antitoxin content through effectiveness of protection of guinea pigs injected with diluted mixtures of antitoxin and a standard toxin. A competitive enzyme-linked immunosorbent assay, designed as an in vitro alternative to the in vivo test, measures antitoxin content based on a competitive reaction between standard or unknown serum and murine monoclonal antibody specific for tetanus toxin. The monoclonal antibody used in the assay delayed death in mouse passive protection studies and reacted with the C fragment of tetanus toxin. No cross-reaction was observed when the antibody was tested with the toxins of Clostridium chauvoei, C. novyi, C. perfringens, or C. sordellii. The in vitro test will measure the antitoxin content of serum samples containing 100-1500 units of antitoxin. Tetanus antitoxin titers obtained by the competitive enzyme-linked immunosorbent assay compared favorably with the toxin neutralization test conducted in guinea pigs. The in vitro assay serves as a feasible alternative to the in vivo test because it can be completed in less time, is reproducible, and eliminates the use of test animals.

Animals↗
PubMed1994

The role of aluminium for adverse reactions and immunogenicity of diphtheria-tetanus booster vaccine.

In a randomized, double-blind clinical trial, 235 schoolchildren aged 10 years received either a regular, aluminium-adsorbed diphtheria-tetanus vaccine or the same vaccine in fluid form, in order to investigate if local side effects could be diminished by exclusion of aluminium. System reactions were rare and local reactions frequent in both groups but larger local reactions were even more pronounced in the non-adsorbed vaccine group. Antibody responses to both vaccines were excellent and even slightly higher to the non-adsorbed diphtheria-tetanus vaccine (p = 0.0135 and 0.0014 for anti-diphtheria and anti-tetanus, respectively). This study has shown that fluid diphtheria-tetanus vaccine does not solve the problem of extensive local side effects induced by the diphtheria-tetanus school booster. Alternative strategies, such as changes in vaccine composition, dosage and spacing, will have to be considered.

Adsorption↗
PubMed1996

Tetanus immunisation in the elderly population.

OBJECTIVE: To emphasise that tetanus still occurs in the United Kingdom, particularly in elderly people-as illustrated by two case reports-and to examine the state of tetanus immunity in elderly people. METHODS: 111 elderly people (over 65 years) were studied: 43 males, mean age 77.7 years, range 67-94; 68 females, mean age 81.3 years, range 67-95. They were either attending the accident service or were hospital inpatients. An attempt was made to obtain an immunisation history and antitetanus antibody titres were measured. RESULTS: Immunisation history was uncertain and unreliable. Measurement of antibody titres showed that they were inadequate to ensure protection in 50% of those studied. Low levels were particularly prevalent in the over 80 age group and in females. Questioning about military service confirmed that this had predominantly involved males. CONCLUSIONS: Elderly people are at risk of contracting tetanus and should be targeted for community immunisation. Extra precautions in the form of passive immunisation with human anti-tetanus immunoglobulin should be used in this age group in addition to the usual wound management measures when the elderly sustain tetanus prone injuries.

Age Factors↗
PubMed1991

The immune response to anti-idiotype antibodies bearing an internal image epitope of tetanus toxin/toxoid. II. Comparison of the primary humoral immune response to xenogeneic Ab2 beta 1 and Ab2 beta 2 internal image anti-idiotype antibodies.

Mouse monoclonal (Ab1) anti-tetanus toxin/toxoid antibodies were used to raise Ab2 beta (tetanus toxin/toxoid internal image bearing) anti-idiotype antibodies in rabbits. Those rabbit serum antibodies (Ab2 beta) that did not bind to mouse serum proteins on an affinity column gave rise to an Ab3 anti-tetanus toxin/toxoid antibody response in mice. Rabbit serum antibodies that did bind to the affinity column, when eluted and used to inoculate mice also gave rise to an Ab3 anti-tetanus toxin/toxoid antibody response. It is suggested that one population of rabbit Ab2 beta anti-idiotype antibodies (unbound fraction) bears a partial or complete internal image of a tetanus epitope (Ab2 beta 1) while others (bound fraction) bear a complete or partial mirror image of a mouse immunoglobulin epitope as well (Ab2 beta 2).

Animals↗
PubMed1983

Transplacental immunization of the human fetus to tetanus by immunization of the mother.

Experimental studies in rats showed that immunization of the pregnant female led to the transplacental immunization of her fetuses. The possibility that this also occurred in humans was explored by immunizing 42 pregnant women with tetanus toxoid (2.5 or 5 Lf) in the fifth and eighth months of pregnancy and comparing the immune responses of their offspring with the responses of the offspring of 25 unimmunized mothers. Only the offspring of the immunized mothers were sensitized to tetanus. IgM antitetanus antibodies were in their blood before immunization with diphtheria, pertussis, tetanus vaccine (DPT), they had a more rapid (P less than 0.01) response to DPT immunization, and they were still highly sensitized (P less than 0.01) to tetanus 13 mo after birth. In addition, pregnancy had no immunosuppressive effect (P less than 0.05) on the responses of the mothers to tetanus toxoid. Thus, transplacental immunization occurs in humans; it enhances the response of the offspring to subsequent immunization, and it could be used to circumvent the necessity for immunization in early neonatal life.

Adolescent↗
PubMed2005

Tetanus immunity in nursing home residents of Bolu, Turkey.

BACKGROUND: Tetanus is a serious but vaccine-preventable disease and fatality rate of the disease is high in the neonates and the elderly. The aim of this study was to detect the tetanus antibody prevalence in the over sixty-year age residents of the nursing homes in Bolu. METHODS: A voluntary-based study was done in the residents of two nursing homes in Bolu, Turkey. Blood samples were taken from 71 volunteers residing in there nursing homes. Tetanus IgG antibodies were measured by a commercial ELISA kit. RESULTS: Among overall subjects, only 11 (15.7 %) had the protective tetanus antibody titers at the time of the study. Totally, 10 subjects were examined in emergency rooms due to trauma or accidents within the last ten years and, four (40%) of them had protective antibody levels. Of the remaining 61 subjects only 7 (11%) had protective antibody levels (p < 0.05) [Relative Risk = 3.49, 95% Confidence Interval 1.24-9.77]. CONCLUSIONS: Tetanus antibody level is below the protective level in the majority of the over-sixty-year-age subjects residing in the nursing homes. Each over sixty-year age person in our country should be vaccinated. Until this is accomplished, at least, nursing home residents should be vaccinated during registration.

Aged↗
PubMed2006

Reduced-antigen, combined diphtheria, tetanus, and acellular pertussis vaccine (Boostrix): a review of its use as a single-dose booster immunization.

Reduced-antigen, combined diphtheria, tetanus, and acellular pertactin-containing pertussis vaccine (dTpa; Boostrix) contains reduced quantities of the same toxoids/antigens found in a diphtheria, tetanus, and acellular pertussis vaccine (DTPa; Infanrix) used for the primary immunization series in children. A single dose of dTpa (Boostrix) is indicated for booster vaccination against diphtheria, tetanus, and pertussis in individuals aged >or=4 years in Europe and Canada, in individuals aged >or=10 years in Australia, and in adolescents aged 10-18 years in the US.A single booster dose of dTpa (Boostrix) was safe and highly immunogenic for all its component toxoids/antigens when administered to adults, adolescents (including those previously unvaccinated), and children aged >or=4 years in clinical trials conducted in various countries worldwide. It was also well tolerated, as was a second (repeat) dose administered to a small number of adolescents who had previously received the vaccine as a preschool booster. Vaccinees generally reported a low incidence of severe/grade 3, solicited, local and general adverse events during the 1-month postvaccination period.Current recommendations for dTpa usage vary from country to country; they include one dose only in adolescence or adulthood (e.g. Australia, Canada, France, Switzerland, and the US), one dose at preschool age and one in adolescence (Germany), and one dose in adolescence followed by regular (10-year) doses during adulthood (Austria). Available data support the use of dTpa (Boostrix) in place of the combined diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) or DTPa booster dose in preschool children and/or the reduced-antigen, combined diphtheria, tetanus vaccine (Td) booster dose in adolescents, as well as in place of a regular Td booster dose in adults who have not previously received the vaccine.

Antigens, Bacterial↗
PubMed2006

Reactogenicity of meningococcal C conjugate vaccines when administered at the same time as, or a month prior to or after, tetanus and diphtheria booster vaccinations.

INTRODUCTION: This single blind study was conducted to address safety concerns regarding coadministration of diphtheria/ tetanus (DT,Td) boosters and meningococcal C conjugate (MCC) vaccines containing diphtheria or tetanus conjugate proteins. METHODS: 1754 subjects (835 preschoolers and 919 school leavers) were randomised to receive one of three MCC products a month before, after or at the same as routine DT or Td boosters. They (or their parents) completed a health diary for 10 days to record local reactions and systemic symptoms after each vaccination. The effect of antibody levels pre and post-vaccination, preexisting allergies and medication taken before and for up to ten days after vaccination on reactogenicity was assessed. RESULTS: No relationship between prevaccination antibody levels and local reactions or systemic symptoms was found. Local reactions were more common after DT/Td than MCC vaccination and were related to post-vaccination diphtheria and tetanus antibody levels in younger children and to the post-vaccination tetanus only antibody levels in older children. Preexisting allergies were not related to reactogenicity. Use of analgesics/antipyretic medication significantly reduced the incidence of local reactions and of some systemic symptoms. In the first three days after vaccination there was an excess of some systemic symptoms including fatigue/malaise and headache for all ages, and crying/ irritability for younger children and nausea/vomiting and dizziness/faintness for older subjects. Eleven serious adverse events were reported, none of which was deemed related to vaccination. CONCLUSION: MCC vaccines can be given under the above schedules and safely in the presence of raised diphtheria and tetanus antibody levels without materially altering reactogenicity profiles of either vaccine.

Adolescent↗
PubMed1975

[Competitive relations between tetanus anatoxin and toxin].

Experiments were conducted on albino mice; it was shown that preliminary injection of tetanus toxoid enhanced the animal resistance to tetanus toxin, this being expressed in increase in LD50. The effect increased the higher doses of the toxoid and their fractional injection. By using protagon and crude mitochondrial fraction isolated from the brain as a receptor of tetanus toxin in the nervous tissue there were established competitive relations for the receptor between the tetanus toxoid and the toxin. The results of investigations confirmed the authors' earlier statement that the molecule of the tetanus toxin contained different functional groups responsible for the toxin binding with the receptor in the nervous tissue, for the pathogenic action of the toxin and for the binding of the toxin with antitoxin.

Animals↗
PubMed2003

[Production of recombinant fragments of the Clostridium tetani neurotoxin for the development of new immune-prophylaxis preparations against tetanus].

Tetanus belongs to dangerous infection diseases, whose effective prevention can be ensured by vaccines. The acting substance of tetanus vaccines, presently in use, is a partially purified and deprived-of-lethal-action Clostridium tetani neurotoxin. The construction of a subunit preparation on the basis of toxin fragments obtained through gene engineering could be a method aimed at promoting the quality of the used tetanus vaccines. With this goal in mind, we built, within the present case study, the expressing genetic constructions and obtained, in the pure form, an extensive tetanus-vaccine chain with its C-terminal (Hc) fragment, hydride peptides, containing the Hc-fragment and C-terminal fragment of toxin B C. difficile, as well as Hc-fragment and S3 collagen-binding domain of collagenase C. histolyticum. The thus obtained proteins can be used in testing their immunogenic and protective properties, while the conducted study could be a basis for further research of a new-generation vaccine against tetanus and other human infection diseases.

Binding Sites↗
PubMed1992

Haemodynamic studies during the management of severe tetanus.

Detailed invasive haemodynamic studies were performed in 27 of 32 patients with severe tetanus. Nineteen had severe uncomplicated tetanus and eight had associated major complications, chiefly infection and pulmonary complications. The results were compared with those obtained from 15 healthy male volunteers who served as controls. There were two deaths in 32 patients (mortality 6.25 per cent). Severe tetanus without major complications was characterized by a high output hyperkinetic circulatory state with tachycardia (heart rate 131 (19.2) beats/minute), increased stroke volume index (43.1 (10.7) ml/m2), increased cardiac index (5.48 (0.94) l/min/m2) and a normal left ventricular stroke work index (60.5 (15.9) g/m/m2). Volume loading demonstrated a significant haemodynamic response and increased vascular capacitance. Even so the maximum percent rise from baseline values of these indices after volume load was significantly higher in controls (p < 0.001). Autonomic cardiovascular disturbances affected both sympathetic and parasympathetic activity. Hypertension and tachycardia alternating with hypotension and bradycardia were related to sudden fluctuations in systemic vascular resistance. Our studies suggested some degree of myocardial dysfunction in patients with severe uncomplicated tetanus. The haemodynamics of severe tetanus were masked and altered by complicating infection, pneumonia, and atelectasis.

Acute Disease↗