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PubMed1998

[Postoperative tetanus after gangrenous ileus].

Tetanus has become an uncommon disease in developed countries. Tetanus is caused by exotoxins from the bacteria Clostridium tetani. This microbe, which is obligate anaerobe, is present in soil, and animal and human faeces. The condition usually appears after contamination of wounds. However, reports have been published of tetanus occurring after both acute and selective gastrointestinal surgery. We present a case of severe postoperative tetanus in a 57 year-old woman who underwent bowel resection after strangulation of the ileum. The patient was treated on an intensive care unit and was artificially ventilated for 64 days. Seven months later she had fully recovered. Clinical presentation, diagnosis, treatment, and complications are discussed in the report. The diagnosis of tetanus is made by clinical observation. Nowadays, lack of suspicion of this condition may cause delay in administering proper treatment. Women and older men are often inadequately immunized. Doctors should therefore examine the immunization status of these groups of patients regularly.

Clostridium tetani↗

PubMed1999

Does concomitant injection of a combined diphtheria-tetanus-acellular pertussis - hepatitis B virus - inactivated polio virus vaccine influence the reactogenicity and immunogenicity of commercial Haemophilus influenzae type b conjugate vaccines?

UNLABELLED: Does concomitant injection of a combined diphtheria-tetanus-acellular pertussis - hepatitis B virus - inactivated polio virus vaccine influence the reactogenicity and immunogenicity of commercial Haemophilus influenzae type b conjugate vaccines? The immunogenic responses and local reactions to four Haemophilus influenzae type b (Hib) conjugate vaccines licensed for primary immunisation (Hiberix, ActHib, Pedvax, HibTITER) when administered concomitantly but in the opposite thigh with a candidate diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus vaccine were studied in 549 healthy infants at 3, 4.5 and 6 months of age. Local reactions were mild, but different between the four groups, a tetanus conjugate Hib vaccine showing the fewest reactions. All local reactions resolved without sequelae. There was no apparent general reaction. The immunogenic response was similar with all four vaccines, geometric mean concentrations ranging from 4.95 to 7.2 microg/ml. All but one subject had antipolyribosylribitol phosphate polysaccharide antibody titres > or =0.15 microg/ml, and 88.0% to 96% achieved high titres (>1.0 microg/ml) generally associated with long-term protection against Hib disease. CONCLUSION: There does not appear to be any interference with the immune response when current commercial Haemophilus influenzae type b conjugate vaccines are concomitantly administered with a candidate diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated polio virus vaccine as separate injections.

Antibodies, Bacterial↗

PubMed1984

Immunity against tetanus and effect of revaccination 25-30 years after primary vaccination.

Fall off in tetanus immunity and the effect of late revaccination were investigated in a randomly selected group of Danes aged 25-30. Routine reinforcing doses of tetanus toxoid are not customary in Denmark except at injury and when there are certain occupational risks. 11% of the total group of 418 had antitoxin titres below that required for protection (ie, less than 0.01 IU/ml, determined by neutralisation technique). In those who had received only primary vaccination an exponential fall off in immunity was seen, and 25-30 years after primary vaccination, 28% had serum antitoxin concentrations below the level of protection. Up to 30 years after primary vaccination, one reinforcing dose of tetanus toxoid adsorbed by aluminium hydroxide was sufficient to induce protective titres of antitoxin. There were no serious side-effects and it was concluded that routine reinforcing doses of tetanus toxoid should be given before the age of 20 in Denmark and other countries where primary vaccination is given in the first years of life.

Adult↗

PubMed2003

Tetanus antitoxin levels among adults over 40 years of age in Central Anatolia, Turkey.

OBJECTIVE: To determine tetanus antitoxin levels in adults and the aged. METHODS: This study was conducted on 249 adults over 40 years of age who applied to a blood-withdrawal unit in Kayseri, Central Anatolia. Tetanus toxoid-specific antibodies were measured in serum by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the research group, only 63 persons (25.3%) were found to have protective levels (>0.1 IU/mL) of tetanus antitoxin. Antibody levels were significantly higher in educated people (30.7%), in those under 50 years of age (38.2%), in those who had been vaccinated at least twice (47.6%), and in those vaccinated not more than 10 years previously (58.3%). There was no association between antibody level and sex, occupation or place of residence. CONCLUSION: Our findings indicated that tetanus antibody values were under the protective level for most adults over 40 years of age, and vaccination programs directed at the adult population should be developed.

Adult↗

PubMed1992

A single human monoclonal antibody that confers total protection from tetanus.

Protective human monoclonal antibodies (HuMAbs) are superior to hyperimmune sera and murine monoclonal antibodies as far as human immunotherapy is concerned. In this report, we describe the successful generation of triomas secreting HuMAbs to tetanus toxin (tt). Lymphoblastoid cell lines secreting anti-tt antibodies were stabilized by back-fusion with a mouse x human heterohybrid myeloma partner, SBC-H20. One of the antibodies so produced, confers total protection of mice from tetanus, unlike a few recent reports where only partial protection (delay in the onset of tetanus) was achieved with single HuMAbs. Experiments to localize the neutralizing epitope(s) of the toxin using the protective monoclonal antibodies revealed that the antibody recognizes a conformational determinant that is destroyed on SDS-treatment. Preliminary studies show that Fab preparations of the protective antibody are capable of neutralizing tetanus toxin, suggesting that it might be possible to clone and express the Fab in a stable vector for large scale production.

Animals↗

PubMed1993

Tetanus and diphtheria immunization coverage in Ecuadorian children after a national vaccination campaign.

Between October 1985 and June 1986, a national vaccination campaign was launched in Ecuador. Between March and November 1986, 7798 Ecuadorian children < 5 years old were enrolled in a representative health survey. According to their vaccination cards, 65% of children had a complete series of three doses of diphtheria-tetanus-pertussis (DTP) vaccination. Serum samples were obtained from a subset of 1400 children; by ELISA, 80% had serologic evidence of recent DTP vaccination and > 80% of the newborns had tetanus antitoxin titers, indicating recent tetanus vaccination of their mothers. For all 1400 children, median tetanus and diphtheria antitoxin titers were 1.0 and 0.6 IU/mL, respectively. These data indicate the possibility of success of such vaccination campaigns if supported by the government.

Aging↗

PubMed2005

Reduced immunogenicity of diphtheria and tetanus toxoids when combined with pertussis toxoid.

The effect of pertussis toxoid on the immunogenicity of diphtheria and tetanus toxoids (DT) was studied during a double blind efficacy trial of an acellular pertussis vaccine. Infants received DT with or without pertussis toxoid at 3, 5 and 12 months of age. Geometric mean concentrations were higher in the DT than in the DT-pertussis toxoid group 1 month (diphtheria toxoid 4.76 versus 3.58 IU/mL, P = 0.009; tetanus toxoid 4.42 versus 2.66 IU/mL, P < 0.0001) and 2 years after the third injection (diphtheria toxoid 0.15 versus 0.10 IU/mL, P < 0.0001; tetanus toxoid 0.38 versus 0.18 IU/mL, P < 0.0001). Pertussis toxoid causes a small but significant reduction of the immunogenicity of diphtheria toxoid and tetanus toxoid.

Animals↗

PubMed1962

A comparison between the effects of a tetanus and the effects of sympathomimetic amines on fast- and slow-contracting mammalian muscles.

The effects of adrenaline and isoprenaline on the tension and time-course of the contractions of the tibialis anterior and soleus muscles of cats and rabbits have been compared with the effects of previous high-frequency stimulation. Like a tetanus, adrenaline possessed a facilitating action on neuromuscular transmission and an action exerted directly on the muscle fibres. Isoprenaline possessed only the second of these two actions. The effect of adrenaline and isoprenaline on the muscle fibres was blocked by dichloroisoprenaline and by 1-(2 naphthyl)-2-isopropylaminoethanol, whereas the effect of adrenaline on neuromuscular transmission was blocked by phentolamine and by phenoxybenzamine. In the soleus muscle, both the catechol amines and a previous tetanus caused similar decreases in maximal twitch tension and in the times to peak tension and to half-relaxation. The muscle action potentials were unaltered or slightly increased in amplitude. In the tibialis anterior muscle, a previous tetanus and the catechol amines caused an increase in twitch tension and an increase in the overall duration of the twitch. The muscle action potentials were either unchanged or were slightly decreased in amplitude. In this muscle the effect of a tetanus differed from that of the catechol amines in that the large post-tetanic change was associated with a marked increase in the rate of rise of twitch tension.

Animals↗

PubMed1986

Revaccination of adults against diphtheria. II: Combined diphtheria and tetanus revaccination with different doses of diphtheria toxoid 20 years after primary vaccination.

Immunity following diphtheria vaccination in childhood is temporary, and recent outbreaks of diphtheria in adult populations evoked interest in the effect of and side-reactions to revaccination of adults. 237 military recruits were randomly allocated to revaccination with 6 Lf tetanus toxoid or 6 Lf tetanus toxoid combined with 2 Lf or 5 Lf diphtheria toxoid. Side-reactions were recorded one week later, and antitoxin response was assessed after 4 weeks. Protective serum diphtheria antitoxin levels were attained by all subjects receiving diphtheria toxoid containing vaccines. Antibody response was related to dose, indicating a safer long-term protection by revaccination with 5 Lf diphtheria toxoid. All vaccinees, except one without documentation for primary vaccination, attained high tetanus antitoxin levels. Interference phenomena between toxoids were insignificant. Mild local reactions were reported by 22% of the vaccinees. More pronounced local reactions were experienced by 5% and systemic reactions by 3%, independent of vaccine. No serious reactions were observed. Reactions were significantly related to tetanus antitoxin response only. It was concluded that combined revaccination of adults, primary vaccinated around 20 years previously, may be performed without immune assessments.

Adult↗

PubMed1975

Prevention of tetanus in the wounded.

Recommendations for the prevention of tetanus in the wounded have been revised to incorporate the use of human tetanus immunoglobulin, which is now available in the United Kingdom. Surgical toilet is of prime importance for all wounds, and is usually sufficient for tetanus prophylaxis in patients with wounds that are less than six hours old, clean, non-penetrating, and with negligible tissue damage. Human tetanus immunoglobulin should be given to patients with more serious wounds sho have had toxoid injections over 10 years earlier, had an incomplete course, or do not know their immunity status. The importance of active immunization is emphasized. The recommendations should be regarded as guidelines as the circumstances in individual cases will differ.

Humans↗

PubMed1996

The management of tetanus 1996.

The three main basic concepts in the understanding and management of tetanus: (1) Tetanus is polysystemic in terms of pathology and management. Most body organs, as well as the nervous system, are severely affected by tetanus toxins. (2) Prevention is not only by immunization, but also by specific treatment. Since the toxin cannot be therapeutically eradicated from the body, therapy is directed towards preventing continued spread of the toxins and the consequences of intoxication. (3) Variability in terms of prevalence and prognosis. The natural incidence and severity of tetanus varies greatly with social environment, season, climate and soil. Prognosis is influenced by age, source of infection and delay in treatment.

Child↗

PubMed1994

Immune status and booster effects of low doses of tetanus toxoid in Swedish medical personnel.

Of 102 medical staff at a Swedish hospital, 81% had tetanus antitoxin titres > or = 0.01 IU/ml in 1984-85. The unprotected individuals (antitoxin titre < 0.01 IU/ml) were all > 30 years of age. Of this group, one-third lacked a protective antibody level against tetanus toxin. Low booster doses of tetanus toxoid (0.75 or 1.9 Lf) were given to 66 vaccinees with a history of previous basic vaccination and no history of booster vaccination within the previous 5 years. The median titre increased from 0.26 IU/ml before to 3.3 IU/ml after vaccination. Low doses of tetanus toxoid may thus still provide an adequate immune response when given as a booster vaccination to individuals with a reliable history of basic immunization.

Adult↗

PubMed2002

[Tetanus in a young unvaccinated girl after a fall in the street].

A 4-year-old girl developed tetanus after she had fallen on the street a week before. She had never been vaccinated and despite pressure from the family practitioner, the parents refused to allow her to be given human anti-tetanus immunoglobulin as a matter of principle after the wound had been stitched. Seven days later she was admitted to hospital with trismus and risus sardonicus. Upon initial treatment with human anti-tetanus immunoglobulin and penicillin, and subsequently metronidazole, her clinical condition deteriorated with opisthotonus and life-threatening respiratory insufficiency, upon which she was moved to the intensive-care department where she was intubated and mechanically ventilated for two weeks. Finally she made a complete clinical recovery. Thanks to the extensive national vaccination program, tetanus has become a rare disease in the Netherlands. However, the very serious course and possible fatal outcome warrant a keen attitude and adequate treatment.

Accidental Falls↗

PubMed1975

[Experimental investigations on oral immunization with tetanus-toxoid (author's transl)].

Model-experiments in mice were used for the investigation of oral immunization with tetanus-toxoid. The efficacy of oral toxoid application was tested by challenge and anti-toxin determination. The oral immunization with tetanus-toxoid induced only a sufficient protection, when toxoid was in intensive contact with the mucous membranes of the oral cavity. Local immunization via gastro-intestinal-tract failed. After a single vaccination with 200 Lf tetanus-toxoid onto mucous membranes of the oral cavity the efficiency index was 75. In comparison, a single subcutaneous application of 2 Lf tetanus-toxoid resulted in an efficiency index of 100 and a single intranasal immunization of 100 Lf in an efficiency index of 93. So the application of toxoid subcutaneously or onto nasal mucous membranes induced higher protection than oral application. Temporary development of immunity after immunization via the mucous membranes of the oral cavity was much better than parenteral immunization. 20 per cent of orally immunized animals were immune 5 days p. vacc. At the same time subcutaneously immunized animals failed to develop any protection. The efficiency rates obtained in challenge correlate with antitoxin content in the serum.

Administration, Oral↗

PubMed1991

[The level of postvaccinal immunity to diphtheria, tetanus and poliomyelitis in relation to the number of inoculations].

The work was aimed at the comparative study of the intensity of immunity to diphtheria, tetanus and poliomyelitis, depending on the number of injections of adsorbed diphtheria-pertussis-tetanus (DPT) vaccine and poliomyelitis vaccine, for the purpose of finding out the possibility of reducing the antigenic load given to children without diminishing the intensity of immunity. To determine the level of immunity to diphtheria and tetanus, 1900 children under school age were serologically studied by the micromethod in the passive hemagglutination test. The intensity of immunity to poliomyelitis virus was studied in 333 children by means of the neutralization test. The immunogenic properties of the diphtheria component of adsorbed DPT vaccine were found to be less pronounced than those of the tetanus component of the vaccine, which made it impossible to reduce the antigenic load by decreasing the number of vaccinations against diphtheria. The results of the study of postvaccinal immunity to poliomyelitis suggest that during the first and second year of life the course of vaccination against poliomyelitis may be reduced to 3 injections.

Antibodies, Bacterial↗

PubMed1981

[Further improvements in schedules for immunizing children against diphtheria and tetanus].

The study of the rational schedule of revaccinations made at different ages for the prevention of diphtheria and tetanus was carried out on 800 children belonging to the age groups of 6-9 years and 11-14 years. The content of diphtheria antitoxin was determined by Jensen's method, and the content of tetanus antitoxin in the passive hemagglutination test. In the first age group immunity to the above-mentioned infections was determined after the primary immunization, and in the second age group after the first revaccination made at an age indicated in the schedule. The high level of immunity to both diphtheria and tetanus was shown to preserve for 6-7 years. For this reason intervals between revaccinations scheduled for children achieving a definite age in accordance with the existing scheme of immunization against diphtheria and tetanus may be increased. the most rational time for such revaccinations is the age of 9 (instead of 6) years and 16 (instead of 11) years.

Age Factors↗

PubMed1980

[Experience in organizing tetanus prevention].

Mass immunization against tetanus has been organized in the Livny district of the Orel region. The centralized depository of the registration cards for all the vaccinees has been created at the reception department of the central district hospital. The continuity in the activities of the institutions for prophylaxis and treatment has been established. The immune stratum of the population has reached 80%. The frequency of the injections of tetanus antitoxin in connection with wounds decreased from 96% to 39.2%; as a result the consumption of tetanus antitoxin dropped 2.5-fold. No tetanus cases were registered in the district during the last 4 years.

Documentation↗

PubMed1998

Tetanus toxoid immunization coverage among women in zone 3 of Dhaka city: the challenge of reaching all women of reproductive age in urban Bangladesh.

Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.

Adolescent↗