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PubMed1992

Immunization in children with HIV seropositivity at birth: antibody response to polio vaccine and tetanus toxoid.

OBJECTIVE: To evaluate the humoral response to routine childhood immunization of HIV-infected children. DESIGN: Response rate, antibody titres and persistence after polio and tetanus vaccination were compared in 72 children with HIV seropositivity at birth and divided according to HIV infection status as determined by clinical and laboratory tests. METHODS: Polio antibodies were titred in a microneutralization test (positive titres, > or = 1:4), and antibody to tetanus toxoid with a passive haemagglutination method (protective titres, > or = 1:1024). RESULTS: The response rates to polio and tetanus vaccination (> 80 and > 75%) were similar in the HIV-infected and non-infected children, as were antibody levels. In the subgroup with sera obtained some months after the last dose of vaccine, polio antibody levels decreased in all four HIV-infected and in three of the seven non-infected children; protective tetanus antitoxin levels were detected in three of the six infected and in all three non-infected children. CONCLUSIONS: This study demonstrates the ability of children with HIV infection to respond adequately to the two vaccines considered, although tetanus antitoxin levels were inferior, compared with those in the seroreverted children. The unsatisfactory antibody levels observed in the admittedly few HIV-positive children studied some months after the last vaccination could be the result of a lower initial protective level and not necessarily an expression of severely impaired immunocompetence. The administration of booster doses in addition to the traditional immunization schedule could be useful in children with HIV infection.

Antibodies, Bacterial↗

PubMed2004

Community-based seroepidemiology of tetanus in three selected provinces in Turkey.

The aim of this study was to assess immunity levels against tetanus in the areas of 26 health centers in Samsun, Antalya, and Diyarbakir in Turkey in 2000 - 2001. The study group consisted of 2,465 healthy subjects aged 6 months old or above, randomly selected from each age group in the area. Of these, a total of 2,094 (85.0%) serum samples were assayed for tetanus antibody; 716 were from Antalya, 706 were from Diyarbakir, and 672 were from Samsun. The surveys were implemented in three steps: physical examination, interview, and blood collection. ELISA-in-house was used as a screening procedure and a particle agglutination test was used to reassess antibody titers of 1.0 IU/ml or below. It was revealed that 73.5% subjects had the full protection level (>/=0.1 IU/ml) of antibody in Antalya, 59.9% in Diyarbakir, and 75.0% in Samsun, indicating that protection against tetanus was significantly lower in Diyarbakir than in Antalya and Samsun. The results also showed that the percentage of protective levels decreased with increasing age in three provinces and was higher in rural areas than urban areas in Diyarbakir. The study indicates that the immunity levels against tetanus can be considered as satisfactory among children and adolescents but that it is necessary to increase immunity against tetanus among adults through effective vaccination of pregnant women and those in military service and also among people older than 40 years of age.

Adolescent↗

PubMedDate not supplied

[Coverage of anti-tetanus vaccinations in adults in Canada-year 2002. ].

INTRODUCTION: The rare cases of tetanus that have occurred in Canada were in adults whose vaccination was not up-to-date. The objective of this study was to estimate the vaccine coverage in Canadian adults. METHODS: 1,002 individuals 18 years of age and older selected by random digit dialing were interviewed by telephone in February 2002. Information was collected about their vaccination status, the circumstances of their vaccination, and their opinion about the duration of the protection of the tetanus vaccine and the recommended interval between booster doses. RESULTS: The participation rate was 38%. Overall, 54% of participants reported having received one dose of tetanus vaccine during the last 10 years: 58% for men and 51% for women. The vaccine coverage was lower in adults > or =60 years of age than in those under 60 (38% vs. 59%). Most doses (57%) were administered as part of treatment for a wound. 30% of participants thought they were protected for life by their childhood immunization against tetanus, whereas 52% knew they had to receive a booster dose each 6-10 years. CONCLUSION: Vaccine coverage against tetanus is insufficient in adults, especially those > or =60 years of age. As most doses are administered as part of wound treatment, it is not likely that this situation will improve without developing specific interventions.

Adult↗

PubMed1991

Lectins from Triticum vulgaris and Limax flavus are universal antagonists of botulinum neurotoxin and tetanus toxin.

Lectins from Anguilla anguilla, Artocarpus integrifolia, Canavalia ensiformis, Datora stramonium, Glycine max, Limax flavus, Ricinus communis and Triticum vulgaris were tested for their abilities to antagonize the binding of botulinum neurotoxin and tetanus toxin to rat brain membranes and to antagonize the ability of these toxins to block neuromuscular transmission in mouse phrenic nerve-hemidiaphragm preparations. Lectins from Limax flavus and Triticum vulgaris, both of which have affinity for sialic acid, were antagonists of the various serotypes of botulinum neurotoxin and tetanus toxin. When tested against the high affinity binding site for botulinum neurotoxin type B, the lectin from Limax flavus had a Ki of 3.1 x 10(-7) M and the lectin from Triticum vulgaris had a Ki of 3.75 x 10(-7) M. When tested against the high affinity binding site for tetanus toxin, the lectins from Limax flavus and Triticum vulgaris had Ki values of 1.5 x 10(-7) and 1 x 10(-6) M, respectively. In all cases the lectins behaved as competitive antagonists. In reverse experiments, neither botulinum toxin nor tetanus toxin was a very effective antagonist of lectin binding to brain membranes. Studies on isolated neuromuscular preparations showed that the lectin from Triticum vulgaris did not affect transmission at concentrations of 10(-6) to 10(-3) M, but at a concentration of 3 x 10(-5) M the lectin produced highly statistically significant antagonism of the neuromuscular blocking properties of botulinum neurotoxin types A, B, C, D, E and F as well as tetanus toxin. The lectin did not antagonize beta-bungarotoxin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Tetanus in Ethiopia: analysis of 55 cases from Addis Ababa.

Fifty five cases of tetanus in patients over age 11 years from 6 Addis Ababa hospitals over several years are analyzed. No patient had been immunized. Mean age was 30, male:female 39:16, 34 patients were admitted from April through August (P less than .05). Most common causes of wounds were metal objects, thorns, and nails. There was no history of trauma in 8 patients. Mean incubation period was 11.9 days (range 1-90 days), mean invasion period was 38 hours (range less than 1 day-9 days). All cases were generalized tetanus, clinically diagnosed. Laboratory data was not helpful in management. Patients were treated with tetanus antitoxin, antibiotics, and sedatives. 15 patients (27%) died, there was no correlation between treatment and outcome. Deaths correlated with short incubation and invasion periods, and presence of abdominal rigidity, tachycardia, sweating, and fluctuating blood pressure. Only 3 patients received tetanus toxoid prior to discharge. Comparison is made with African and western studies. Tetanus remains a significant problem in Ethiopia, and vaccination is highly recommended.

Adolescent↗

PubMed1989

Cell-mediated and humoral immune response to tetanus vaccinations in onchocerciasis patients.

In order to assess the possible suppression of immune responses to non-specific antigens in patients with generalized onchocerciasis, a vaccination study was conducted among the population of eight Liberian villages. Hundred and eighty-four persons infected with Onchocerca volvulus and 142 non-infected individuals were tested for delayed cutaneous hypersensitivity to tetanus antigen using the Multitest Mérieux. Prevalence of malaria and infections with intestinal nematodes with larval migration to the lung were much the same in all the villages examined. Other parasitic diseases had no significant influence. Persons aged 2-29 years with onchocerciasis had a significantly lower prevalence of positive tetanus reactions (p less than 0.05). Hundred and eighty persons showing a negative skin test were vaccinated twice with 75 i.u. tetanus toxoid and cell-mediated as well as humoral immune responses were recorded three months later. Analysis of sera collected before vaccinations indicated that 56% of the vaccinees had tetanus antibody levels of 0.01 i.u./ml or more and had, therefore, received a booster vaccination. Rates of seroconversion or booster were the same in persons with or without onchocerciasis (81% and 82% respectively). The conversion rate in the delayed cutaneous hypersensitivity test, however, was significantly lower in those infected with O. volvulus (67%) as compared to the controls (92%, p less than 0.001). These results demonstrate a diminished cell-mediated immune response to tetanus toxoid vaccinations in patients with generalized onchocerciasis. Considering the unimpaired humoral immune response, no changes in vaccination schedules are recommended.

Adolescent↗

PubMed1989

[Epidemiological and immunological features of tetanus under conditions of long-term planned vaccine prophylaxis].

The introduction of mass immunization against tetanus has resulted in the decrease of morbidity rate (5.2 times), the leveling of morbidity rate among the urban and rural population and among males and females, though no essential effect on the seasonal distribution of tetanus morbidity has been observed. Persons over 50 years of age (housewives and pensioners) have become the main groups of risk at the post-immunization period. Mass immunization against tetanus over a period of many years has ensured the existence of a sufficient immune stratum (89.9 +/- 3.0% to 100 +/- 3.0%) and a sufficient level of antitoxic immunity (means geom equal to 6.72-9.6 I.U./ml) among children. Among adults, the proportion of persons protected from tetanus decreases in older age groups from 82.1 +/- 1.3% in persons aged 31-40 years to 22.1 +/- 2.0% in persons over 60 years. The observed differences between the coverage of the population with immunization and the proportion of persons having protective titers of tetanus antibodies require constant control of the intensity of immunity and its correction with regard to its initial level, especially in persons of older age groups.

Adolescent↗

PubMed1987

[Development of an animal model of autonomic over-activity in tetanus].

Although present day progressive respiratory management has decreased the tetanus mortality rate, tetanus-related autonomic overactivity remains a lethal condition. The cause, pathophysiology, and treatment of this condition are controversial and no animal model has ever been reported. So we tried to make a rabbit model of this condition. At first we injected 30 micrograms of purified tetanus toxin intravenously. Blood pressure oscillation occurred, but the degree of oscillation was smaller than that was seen in the clinical cases. The degree of oscillation had not changed by addition of 30 micrograms purified toxin 12 hours after first injection. Secondly, 7 days before the experiment we injected 0.5 micrograms of purified tetanus toxin intravenously. On the experiment day, we injected 30 micrograms of purified toxin again. By this method there occurred blood pressure oscillation as same as that was seen in the clinical cases. But no rabbits progressed to circulatory collapse by purified toxin. Then to the last group of rabbits, we injected crude tetanus toxin for purified toxin. The degree of blood pressure oscillation was same as that of cases in which purified toxin was injected, and all rabbits progressed to circulatory collapse.

Animals↗

PubMed1980

[Clinical aspects and therapy of tetanus].

The various clinical symptoms of the tetanus are included by the Authors in three different groups. In the first and the second ones are the localized forms or tetanus, which affects several skeletal muscle groups without involvement of the respiratory apparatus. In the third group, in addition to the tetanus of the new-born babies, are the most severe forms of tetanus, the dangerousness of which is due to a respiratory involvement or to the persistence of a severe hypertensive-hypotensive syndrome, associated with hyperpyrexia and an ingravescent uncontrollable circulatory failure, in the completely sedated patient. An encephalopathic coma may also occur. The highest mortality (55-70 per cent) is observed in the tetanuses of the third group. The therapy is based on the triad seroanatoxins, antibiotics and sedative drugs. Tracheotomy and assisted mechanical ventilation are essential in the patients of the third group in order to be allowed to administer curare-like drugs as choice remedy. But, in spite of all these heroic treatments, the mortality is still high.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Tetanus immunity in old age].

Among 1546 elderly persons (above 60 years of age) from a large town the immunity against tetanus was tested. 1043 persons (66.18%) had no antibodies against tetanus-toxoid in their serum. Almost half of the remaining positive sera (33.82%) showed antibody titers between 0.01 and 0.1 IU/ml. It is open to discussion if these titers warrant complete protection against the disease. On the contrary, children or young men serving in the army showed good immunity with high antibody titers. Tetanus has become a rare disease in the western countries, but cases still occur. The disease affects nowadays mainly adults. The older the patient the higher is its mortality. According to our study, many old people are not protected against tetanus. The risk of infection is widespread. It is strongly recommended to immunize also elderly persons at regular intervals. The vaccination against tetanus is cheap, well tolerated and yields a good immunity even in old age.

Aged↗

PubMed1980

[Current trends in the use of combined serum and vaccine in tetanus prevention].

There is evidence that when plain tetanus toxoid is given at the same time as antitoxin, the response to the toxoid is inhibited. Good responses can be obtained when absorbed tetanus toxoid is used with non-human antitoxin, but there is evidence of an interval (10-15 days) between the end of passive immunization and the beginning of the active one. Using absorbed tetanus toxoid at the same time as human antitoxin there is complete absence of interference. Therefore simultaneous active and passive immunization (only using absorbed tetanus toxoid and human immunoglobulins) can be a practicable procedure in the treatment of persons liable to contract tetanus as a result of injury.

Humans↗

PubMed1995

Immunologic response of extremely premature infants to tetanus, Haemophilus influenzae, and polio immunizations.

OBJECTIVE: To determine whether extremely premature infants have immunologic responses to tetanus toxoid, Haemophilus influenzae type b polysaccharide and polio vaccines similar to those of full-term infants. INFANTS AND METHODS: Sixteen extremely premature (< 29 weeks, < 1000 g at birth) infants received separate diphtheria-tetanus-pertussis and H influenzae type b oligosaccharide-CRM197-conjugated (HbOC) vaccines at 2, 4 and 6 months of chronologic age, enhanced potency inactivated polio vaccine at 2 months, and oral polio vaccine at 4 months. Serum was obtained for anti-tetanus toxoid (TT), anti-Haemophilus b polysaccharide (HbPs) and polio neutralizing antibody assays before the 2-month vaccination and 4 to 6 weeks after the 6-month vaccination. Comparison sera were obtained from full-term infants immunized with the same lots of diphtheria-tetanus-pertussis (n = 46) and HbOC (n = 66) vaccines or the same sequence of polio vaccines (n = 10). RESULTS: Preterm and full-term infants had similar geometric mean titers of anti-TT antibodies, anti-HbPs antibodies, and neutralizing antibodies to polio serotypes 1, 2, and 3 after the completion of the primary series of vaccines. After vaccination, similar proportions of preterm and full-term infants had protective levels of antibody to TT (preterm 100% vs full-term 100% with levels > 0.01 IU/mL), HbPS (82% vs 87%, > 1.0 microgram/mL), and polio serotypes 1 (85% vs 80%, > or = 1:8) and 2 (100% vs 100%, > or = 1:8). Preterm infants were less likely than full-term infants to have protective levels of neutralizing antibody to polio serotype 3 (31% vs 90%, > or = 1:8). CONCLUSIONS: Extremely premature infants have adequate antibody responses to tetanus and HbOC antigens but may have diminished responsiveness to serotype 3 polio vaccine.

Antibodies, Bacterial↗

PubMed1995

Neonatal tetanus mortality in Veracruz, Mexico, 1989.

This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.

Case-Control Studies↗

PubMedDate not supplied

Objective verification of tetanus immune status in an apparently non-immune population.

Patients who are not known to be immunised to tetanus are considered to be non-immune. The appropriate treatment is the commencement of active immunisation with a course of three tetanus toxoid inoculations; if the wound is considered to be tetanus-prone, 250 IU of human anti-tetanus immunoglobulin is given concurrently. This study determined the true immune status of 166 patients who were considered to be non-immune on the basis of the available history. The majority (90 of 166) had protective levels of immunoglobulin (greater than 0.06 IU/ml) and further treatment was not indicated. Only two patients were non-immune. The remainder had protective levels (between 0.01 and 0.06 IU/ml) and required a tetanus toxoid booster.

Aged↗

PubMed1996

[Effect of administration of blood products on the course of tetanus antibody concentration in immuno-incompetent patients].

OBJECTIVE: Collecting of data for immunoprophylaxis of tetanus in immunodeficient patients via administration of blood products. DESIGN: Prospective single case studies. SETTING: Clinical therapy in a department of hematology with continuous determination of tetanus antibody concentrations in patients' sera and administered blood products with an enzyme immunoassay. PATIENTS: 3 patients with acute myeloid leukemia (FAB classifications M1, M3, M4). INTERVENTIONS: Regular administration of blood products due to clinical therapy. RESULTS: After administration of about 4,000 IU tetanus antitoxin i.v., serum concentration is increasing by 1 IU/ml. Half life in serum amounts to 7 days. Protection lasts therefore up to 6 weeks. CONCLUSIONS: Immunodeficient patients may receive a medium-term effective protection against tetanus after selection of suitable blood products. This method is interesting also for prophylaxis of postoperative tetanus in immunocompetent patients.

Antibodies, Bacterial↗

PubMed1995

Tetanus in Singapore: report of three cases.

Three cases of tetanus in Singapore are presented. One local resident had cephalic tetanus most likely secondary to otitis media and the other two, residents from surrounding Asean countries, had generalised tetanus. The portal of entry was a puncture wound on the foot in one patient and the ear in another. No portal of entry was identified in one patient. All three patients required tracheostomy, ventilatory support and intensive care management for periods ranging from 11 to 22 days. One patient died from complications of nosocomial septicaemia and one patient required prolonged rehabilitation. There was a questionable history of tetanus immunization in the Singapore resident whereas the other two patients who were foreigners had never received any immunization. Tetanus is an uncommon but important disease in Singapore. In spite of the availability of intensive care management, it continues to be a disease with significant morbidity and mortality. Early recognition and treatment of the disease are critical factors in determining the prognosis. This is a disease that may be largely prevented by adequate immunization.

Abdominal Pain↗

PubMed1997

Antibody levels to diphtheria, tetanus, and rubella in infants vaccinated while on PD: a Study of the Pediatric Peritoneal Dialysis Study Consortium.

To determine whether infants who receive routine childhood immunizations while on chronic peritoneal dialysis (CPD) develop protective antibody levels/titers, we measured antibody levels/titers in infants vaccinated with diphtheria/tetanus/pertussis (DTP) and measles/mumps/rubella (MMR) while on CPD. Eight CPD patients (median age 19 months, range 9-39 months) had measurement of antibody to diphtheria and tetanus toxoids. Seven of the 8 (88%) had protective levels of IgG antibody to both toxoids. The single patient who did not have protective antibody to either diphtheria or tetanus had a low total serum IgG. However, 3 other patients who had low IgG had protective antibody levels. Serial measurements of antibody to tetanus and diphtheria were obtained in 3 of the 8 patients. All maintained protective levels to both diphtheria and tetanus toxoids for as long as 24 months postvaccination. Antibody to rubella was also measured in 5 CPD patients (median 29 months, range 19-39 months), and all had protective antibody titers despite the fact that 3 had low total serum levels. In conclusion, most but not all infants immunized while on CPD have protective antibody levels/titers to diphtherial, tetanus, rubella. Alteration of the routine schedule for immunizations does not appear to be necessary. However, periodic measurements of antibody may be indicated, particularly to live vial vaccines, prior to transplantation.

Antibodies, Bacterial↗

PubMed1998

[A patient with tetanus without an obvious point of entry].

A 59-years-old man with oesophageal cancer (T3NXMo) presented with trismus, dysarthria and diaphoresis. Later, he developed opisthotonus and generalized spasms. Despite negative blood cultures and sufficiently high anti-tetanus-titres, tetanus was suspected, on clinical grounds. He was intubated and treated with tetanus toxoid, human antitetanus immunoglobulin, benzylpenicillin, propofol, benzodiazepines, vecuronium, and sufentanil, and recovered gradually. Tetanus is caused by Clostridium tetani, a Gram-positive rod capable of remaining present latently in the body for years. Absence of a visible external wound suggests that the oesophageal mucosal cancer lesion could have served as portal of entry or that endogenous reactivation of latent tetanus bacteria had taken place.

Clostridium tetani↗