Abstract
Seroepidemiological studies of tetanus in Africans have focused mainly on adults especially pregnant women and data on children are scarcely reported. We investigated the seroprevalence of protective immunity level, determined risk factors for non-protection against tetanus, and evaluated the performance of Tetanos Quick Stick® (TQS) among hospitalized children aged 1–9 years in Nigeria. Blood IgG antibody levels to tetanus was determined using enzyme-linked immunosorbent assay (ELISA) in the laboratory and TQS (an immunochromatographic test) at the bedside for 304 children admitted into emergency unit of a tertiary hospital in Ibadan, Nigeria. Demographic information and vaccination history were also collected. TQS results were compared with anti-tetanus antibody measured by ELISA using seroprotection cut-off of 0.1 IU/ml. Seroprevalence of protective level of immunity against tetanus using ELISA and TQS methods was 44.7 and 45.4% respectively. Protective level of immunity increased as age increases. Of the seven potential factors assessed, male gender and being second or more position among mother’s children were independent predictors of non-protective level of immunity. Absence of history of recent tetanus toxoid injection was significantly associated with non-protective level of immunity in univariate analysis but not logistic regression model. The agreement between the ELISA and the TQS results was good with a k coefficient of 0.931. TQS sensitivity was 95.7%, specificity 97.6%, positive predictive value 98.0%, and negative predictive values 96.0%. This study showed that lack of protective immunity against tetanus is common; few demographic characteristics correctly predict non-protection and IgG antibody levels to tetanus was accurately detected by TQS.
Highlights
Tetanus is an acute neurological but vaccine-preventable disease caused by Clostridium tetani that causes significant morbidity and mortality among children in developing countries [1]
Mean age (3.6 ± 1.1 years) and gender distribution (40 male and 31 female) of children who did not participate in the study were not statistically different from those of the study patients
This study has revealed that the prevalence of protection against tetanus among children hospitalized in a tertiary hospital in Nigeria using enzyme-linked immunosorbent assay (ELISA) and Tetanos Quick Stick® (TQS) methods was 44.7 and 45.4% respectively; and TQS is good test kit for assessing tetanus immunity
Summary
Tetanus is an acute neurological but vaccine-preventable disease caused by Clostridium tetani that causes significant morbidity and mortality among children in developing countries [1]. A recent systematic analysis of data from 2000 to 2010 showed that neonatal tetanus decreased in Africa at an annual rate sufficient to attain the Millenium Development Goal 4 and it accounted for 20,000– 276,000 neonatal deaths (1% of all child mortality) in 2010 [2]. Many of the countries in sub-Saharan African are implementing this recommendation and they have either attained the elimination of tetanus or making substantial progress toward achieving this goal but some are not [6]. Nigeria is one of the 27 countries currently accounting for 90% of the global burden of the disease [6,7,8,9]
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