Abstract
A series of two-dose and one-dose antenatal tetanus immunisation schedules using various toxoids and adjuvants have been examined for their efficacy in producing levels of antitoxin protective against neonatal tetanus at the time of delivery. If a maternal antitoxin titre of 0·01 unit per ml. or more at delivery is accepted as protective, then complete protection was afforded by two doses of a 50 limit-flocculation units (Lf) adsorbed toxoid. Standard doses of commercially available tetanus vaccines do not give complete protection unless three doses are given. The best single-dose schedule tested was 100 Lf of an adsorbed toxoid containing the quaternary ammonium adjuvant 'Arquad 2HT' (the principal component of which is dioctadecyl dimethyl ammonium chloride), which achieved 83% protection. There were no adverse reactions of significance reported in any of the schedules. Transfer of antitoxin to the infant is more effective and rapid after a two-dose schedule than after a single dose. Further investigations into immunisation early in pregnancy with adsorbed toxoids in higher doses than used in this investigation (i.e., greater than 100 Lf) are required. From these promising results it is probable that an acceptable one-dose schedule in the prevention of neonatal tetanus will be achieved. Antenatal immunisation effective in protecting against neonatal tetanus does not seem to interfere with subsequent active immunisation in infancy.
Published Version
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