Studies on the effect of tetanus antitoxin against tetanus toxin.
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The present study includes 50 cases of tetanus neonatorum who were given 200 IU of tetanus antitoxin (equine) intrathecally once only and 500 IU intravenously daily for 3 consecutive days. Nutrition was provided with intravenous drip containing dextrose and other electrolytes. The overall mortality was 78%. It appears that the course of the disease remains unaltered with intrathecal tetanus antitoxin in tetanus neonatorum.
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Serum tetanus antitoxin (TAT) concentrations were measured in a group of 30 foals from birth to 4 months of age. Five of 30 foals (16.6%) had serum titers less than 0.01 IU of TAT/ml by 1 month of age. At 2 months of age, 17 of 28 foals (60.7%) had titers less than 0.01 IU/ml. By 3 months of age, 22 of 29 (75.5%) foals tested had titers of less than 0.01 IU/ml. At the age of 4 months, 24 of 29 foals (82.1%) had titers of less than 0.01 IU/ml. The TAT given to foals at birth resulted in an immediate increase in titer when circulating antitoxin was absent or minimal. Titers considered protective against tetanus resulting from an IM injection of exogenous TAT at birth were maintained for at least 3 months after the injection.
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Tetanus toxin blocks Ca2(+)-evoked catecholamine release from permeabilized bovine adrenal chromaffin cells preloaded with gangliosides. Tetanus toxin preincubated with its specific antibodies F(ab')2 is without any effect on exocytosis. Specific antitetanus F(ab')2 presented to chromaffin cells which are pretreated with tetanus toxin and permeabilized by digitonin cannot restore exocytosis. Under the same conditions, however, 125I-labeled F(ab')2 accumulates in chromaffin cells. The accumulation depends on the presence and concentration of tetanus toxin and can be prevented by an excess of unlabeled F(ab')2. Once tetanus toxin has initiated block of exocytosis, it cannot be neutralized by binding to its specific antibody.
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Immunochemically pure tetanus antitoxin obtained from enzyme-treated horse serum is less reactogenic and anaphylactogenic and possesses higher therapeutic properties than antitoxin purified by nonspecific physico-chemical methods and containing ballast antigens. Due to its increased persistence in the recipient's body, the immunochemically pure antitoxin induces passive immunity in considerably lower doses than the preparations purified by the method "Diaferm-3".
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The use of human tetanus antitoxin by lumbar intrathecal injection for the treatment of tetanus in five consecutive cases is reported. The intrathecal administration of human tetanus antitoxin as part of treatment appears to be the most effective treatment of tetanus and should be given as soon as the diagnosis of tetanus is established. The dose of antitoxin does not relate with the rapid improvement of muscle spasm.
The present European Pharmacopoeia monograph for human tetanus immunoglobulin specifies that the estimate of potency has to be performed in guinea pigs or mice. In the course of the state control of such products we have so far used the potency test in mice. Aimed at a reduction of the numbers of animals used for testing tetanus potency of immunoglobulins in the course of official batch release we have used the enzyme linked immunosorbent assay (ELISA). 51 batches of 19 different immunoglobulin preparations of 10 manufacturers were included. Almost all tetanus immunoglobulins contained more than 250 I.U. of tetanus antitoxin per millilitre as agreed with manufacturers during marketing authorization negotiations in Germany. Normal human immunoglobulins for intravenous use had - depending on individual products - lower and fluctuating tetanus antitoxin titers. However, some of them fulfil the Ph. Eur. Monograph requirement of not less that 50 I.U./ml. The question is raised whether such products could be useful in treatment of persons with view to their immediate bioavailability, whenever the antitoxin titer is stated in particular on the package inserts. Our titration results were reliably reproducible. We have drawn the conclusion that we can largely renounce at animal tests when determining tetanus antitoxin potency in immunoglobulins.
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BACKGROUND: Serosurveys that measure tetanus antitoxin can complement immunization coverage surveys to allow evaluation of immunization services in developing countries. Measurement of IgG tetanus antitoxin in oral fluid was investigated as a practical and noninvasive alternative to and correlate of serum antibodies. METHODS: Serum and oral fluid were collected from Malian infants, toddlers and adults (males without a history of tetanus vaccination). Specific IgG tetanus antitoxin was measured by enzyme-linked immunosorbent assay in serum (S-ELISA) and oral fluid (OF-ELISA). RESULTS: One hundred forty-two pairs of serum and oral fluid samples were collected from infants, 35 pairs from toddlers and 35 pairs from adults. IgG tetanus antitoxin titers measured by OF-ELISA were 100-fold lower than those measured by S-ELISA but they correlated strongly (r = 0.90, P < 0.001). All 35 toddlers who had received 2 or 3 doses of diphtheria-tetanus-pertussis (DTP) vaccine (100%) had serum tetanus antitoxin levels >or=0.15 IU/mL and 28 of 35 (80%) had oral fluid values >or=0.0015 IU/mL. Among adults lacking a history of tetanus immunization, only 6 of 35 (17.1%) had serum titers >or=0.15 IU/mL and 4 of 35 (11%) had oral fluid titers >or=0.0015 IU/mL in oral fluid. CONCLUSIONS: IgG tetanus antitoxin in oral fluid correlates well with levels in serum. OF-ELISA values >or=0.0015 IU/mL constitute protection against tetanus and in subjects >12 months of age imply multiple prior contacts with immunization services. IgG tetanus antitoxin measured by OF-ELISA provides a logistically practical alternative for performing seroprevalence surveys.
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