Diphtheria , Tetanus And Pertussis Research Articles

Vaccine Coverage at 36 Months and 7 Years by Parental Birth Country, Washington State.

Ensuring equitable vaccination access for immigrant communities is critical for guiding efforts to redress health disparities, but vaccine coverage data are limited. We evaluated childhood vaccination coverage by parental birth country (PBC) through the linkage of Washington State Immunization Information System data and birth records. We conducted a retrospective cohort evaluation of children born in Washington from January 1, 2006 to November 12, 2019. We assessed up-to-date vaccination coverage status for measles, mumps, and rubella (MMR), diphtheria, tetanus, and pertussis (DTaP), and poliovirus vaccines at ages 36 months and 7 years. Children with ≥1 parent(s) born in selected non-US countries were compared with children with 2 US-born parents, using Poisson regression models to provide prevalence ratios. We identified 902 909 eligible children, of which 24% had ≥1 non-US-born parent(s). Vaccination coverage at 36 months by PBC ranged from 41.0% to 93.2% for ≥1 MMR doses and ≥3 poliovirus doses and 32.6% to 86.4% for ≥4 DTaP doses. Compared with children of US-born parents, the proportion of children up to date for all 3 vaccines was 3% to 16% higher among children of Filipino-, Indian-, and Mexican-born parents and 33% to 56% lower among children of Moldovan-, Russian-, and Ukrainian-born parents. Within-PBC coverage patterns were similar for all vaccines with some exceptions. Similar PBC-level differences were observed at 7 years of age. The linkage of public health data improved the characterization of community-level childhood immunization outcomes. The findings provide actionable information to understand community-level vaccination determinants and support interventions to enhance vaccine coverage.

Vaccination choices among pregnant women: findings from the MAMI-MED cohort

Abstract Background According to the Italian National Immunization Plan 2023-2025, vaccinations against Measles, Mumps, Rubella (MMR), Varicella and Human Papillomavirus (HPV) are indicated for women of childbearing age. During pregnancy, vaccination against Diphtheria, Tetanus, and Pertussis (DTaP), and Seasonal Influenza are recommended. The present analysis aimed to estimate vaccination choice and its main determinants among pregnant women. Methods We used data from the “MAMI-MED” cohort, an ongoing prospective study on mother-child dyads established in December 2020. Socio-demographic information (i.e., age, educational level and employment) were assessed at enrollment, during the first trimester visit at the Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima (Catania, Italy). Self-reported maternal vaccination status was collected at delivery. Results Among 1004 women with a complete vaccination assessment, 83.5% were vaccinated against MMR, 87.4% against DTaP, 68.3% against Varicella, while only 23.7% and 9.4% against HPV and Seasonal Influenza, respectively. During pregnancy, only 8.7% and 21.1% of women were vaccinated against DTaP and Seasonal Influenza, respectively. The lack of information was the main ground for refusal, accounting for 93.7% for HPV, 82.5% for Influenza, 64.7% for DTaP, 31.8% for MPR, and 18.9% for Varicella. Women vaccinated against HPV and MMR were younger than their unvaccinated counterpart (p < 0.001 and p = 0.023, respectively). The logistic regression showed that the odds of being vaccinated against HPV increased with increasing age, adjusting for education and employment (OR = 1.12; 95% CI = 1.09-1.16; p < 0.001). Conclusions The analysis showed modest vaccination coverages, mainly depending on the lack of information about vaccination programs. Moreover, we observed that younger women were more aware of HPV vaccination, which probably reflects improvements in the national vaccination program over the years. Key messages • It is necessary to increase knowledge about vaccination among women in the reproductive age. • Social determinants should be assessed to understand the barriers that might affect vaccination choice.

Prevalence and underreporting of immunization errors in childhood vaccination: results of a household survey.

To investigate underreporting of immunization errors based on vaccination records from children under five years of age. An epidemiological, cross-sectional analytical study, carried out through a household survey with 453 children aged 6 months to 4 years in three municipalities in Minas Gerais in 2021. A descriptive analysis was carried out, and the prevalence of the error was calculated per 100 thousand doses applied between 2016 and 2021. The magnitude was estimated of the association between variables by prevalence and 95% Confidence Intervals (95%CI). To analyze underreporting, State reporting records were used. A prevalence of immunization errors was found to be 41.9/100,000 doses applied (95%CI:32.2 - 51.6). The highest prevalence occurred between 2020 (50.0/100,000 doses applied) and 2021 (78.6/100,000 doses applied). The most frequent error was an inadequate interval between vaccines (47.2%) associated with adsorbed diphtheria, tetanus and pertussis (DTP) vaccine (13.7/100,000) administration. Vaccination delay was related to immunization errors (7.55 95% CI:2.30 - 24.80), and the errors found were underreported. The high prevalence of underreported errors points to a worrying scenario, highlighting the importance of preventive measures.

Implementation of a quality improvement programme using the Active Patient Link call and recall system to improve timeliness and equity of childhood vaccinations: protocol for a mixed-methods evaluation

IntroductionCall and recall systems provide actionable intelligence to improve equity and timeliness of childhood vaccinations, which have been disrupted during the COVID-19 pandemic. We will evaluate the effectiveness, fidelity and...

Infants' diminished response to DTaP vaccine is associated with exposure to organophosphate esters.

Organophosphate esters (OPEs) are commonly applied as flame retardants and plasticizers. Toxicological studies suggest exposure effects on immune endpoints, raising concerns as infants' OPE exposures are elevated compared to older children and adults due to hand-to-mouth behavior and breastfeeding. Here, we sought to evaluate the immune responsiveness of infants to a neoantigen (e.g., a newly encountered antigen) in the presence of OPE exposures. As a proxy for immune responsiveness, children were given three doses of the Diphtheria, Tetanus, and Pertussis (DTaP) vaccine as recommended, and diphtheria and tetanus antibodies were evaluated in serum samples collected when children were 12 months old (n = 84). Titers were compared, based on maximum sample overlap, to measurements of OPE metabolites in spot urine samples collected before vaccination (age 2 months, n = 73) and at the time of antibody assessment (12 months of age, n = 46). Metabolites of two chlorinated OPEs were significantly associated with diminished antibodies for diphtheria and tetanus. A metabolite of tris (1,3-dichloroisopropyl)phosphate (TDCIPP) measured at 2 months was associated with decreased diphtheria antibodies (-0.07 IU/mL per log10 increase in metabolite). One metabolite of tris(2-chloroisopropyl)phosphate (TCIPP) measured at 12 months was associated with decreased tetanus antibodies (-0.57 IU/mL per log10 increase in metabolite). These results provide some preliminary insights for OPE exposure impacts on vaccine responses in early life and may have important implications for immune health through childhood and adulthood.

Linking cohort data and Welsh routine health records to investigate children at risk of delayed primary vaccination

BackgroundDelayed primary vaccination is one of the strongest predictors of subsequent incomplete immunisation. Identifying children at risk of such delay may enable targeting of interventions, thus decreasing vaccine-preventable illness. ObjectivesTo explore socio-demographic factors associated with delayed receipt of the Diphtheria, Tetanus and Pertussis (DTP) vaccine. MethodsWe included 1,782 children, born between 2000 and 2001, participating in the Millennium Cohort Study (MCS) and resident in Wales, whose parents gave consent for linkage to National Community Child Health Database records at the age seven years contact. We examined child, maternal, family and area characteristics associated with delayed receipt of the first dose of the DTP vaccine. Results98.6% received the first dose of DTP. The majority, 79.6% (n = 1,429) received it on time (between 8 and 12 weeks of age), 14.2% (n = 251) received it early (prior to 8 weeks of age) and 4.8% (n = 79) were delayed (after 12 weeks of age); 1.4% (n = 23) never received it. Delayed primary vaccination was more likely among children with older natural siblings (risk ratio 3.82, 95% confidence interval (1.97, 7.38)), children admitted to special/intensive care (3.15, (1.65, 5.99)), those whose birth weight was > 4Kg (2.02, (1.09, 3.73)) and boys (1.53, (1.01, 2.31)). There was a reduced risk of delayed vaccination with increasing maternal age (0.73, (0.53, 1.00) per 5 year increase) and for babies born to graduate mothers (0.27, (0.08, 0.90)). ConclusionsAlthough the majority of infants were vaccinated in a timely manner, identification of infants at increased risk of early or delayed vaccination will enable targeting of interventions to facilitate timely immunisation. This is to our knowledge the first study exploring individual level socio-demographic factors associated with delayed primary vaccination in the UK and demonstrates the benefits of linking cohort data to routinely-collected child health data.

Equity assessment of childhood immunisation at national and subnational levels in Myanmar: a benefit incidence analysis

IntroductionMyanmar, a conflict-affected geographically and ethnically diverse lower middle-income country, was in the donor transition phase for health prior to the political unrest of the last year. This study analyses...

Factores asociados al incumplimiento de la vacunación infantil de difteria, pertussis y tétanos en Perú, año 2019

Introduction:Pertussis tetanus and diphtheria, (DPT) are highly contagious diseases in children; worldwide vaccination schemes have been established for the prevention of these pathologies. However, different factors can lead to non-compliance with them. Objective: To determine the factors associated with non-compliance with the vaccination schedule against diphtheria,pertussis and tetanus(DPT) in Peru in2019. Methods:Analytical, retrospective study of secondary source based on data from 7 187 mothers between 15 and 49 years old regarding the vaccination schedule of their children older than six months of age obtained in the Demographic and Family Health Survey (ENDES) Peru 2019.The vaccination schedule of children over six months of age and the sociodemographic variables of the mothers were analyzed. A bivariate and multivariate analysis was performed using the chi square test for independence (p<0,050). Results:The sample included in the study was 7 187 mothers surveyed regarding the vaccination schedule for their children older than six months of age. The variables associated with the incomplete scheme by multivariate analysis were: low educational level (RPa: 1,19; 95% CI: 1,02-1,40), not having health insurance (RPa: 1,41; 95% CI: 1,23-1,60), wealth index poor (RPa:1,19; CI95%: 1,02-1,40), age of the mother under 20 years (PR:2,63; CI95%:2,06-3,35) and having two or more children (PRa:1,36; CI95%:1,19 -1,57). Conclusion: The index factors of wealth, mother's age, low educational level, not having health insurance and having more than two children are associated with non-compliance with the DPT vaccination schedule.

Artificial intelligence-based literature data warehouse for vaccine safety

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.

A Statistical Study of Lead-Lag Relationship between BCG and DPT Vaccinations in Anambra State: A Cross Spectrum Analysis

This study examined the lead-lag relationship between between Bacille Calmette-Guerin (BCG) and Diphtheria, Pertussis and Tetanus (DPT) vaccinations in Anambra State using cross spectrum analysis with BCG as the input series. The monthly data on the number of vaccinations for BCG and DPT were collected from Expanded Programmes on Immunization office in Awka, Anambra State for the period of January, 2012 to December, 2020. The Fisher’s Kappa and Bartlett Komolgorov-Smirnov white noise tests showed that both series were white noise. The series were differenced stationary using Augumented Dickey-fuller test. The coherence squared presented a strong relationship between BCG and DPT vaccinations, though it did not show consistent pattern of relationship, however identified pattern of relationship existed at both lower and higher frequencies. In addition, the phase showed that at lower frequencies BCG led DPT, while at higher frequencies BCG lagged DPT. The analysis showed that there is a high awareness for both vaccinations in the State and it should be sustained by the state government.

Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar

BackgroundTo reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular...

Association of Social, Demographic, Health, Nutritional and Environmental Factors With the Incidence and Death Rates of COVID-19; a Global Cross-Sectional Analytical Study.

Background: The magnitude of the impact of COVID-19 is dependent on social, demographic, health, nutrition and even environmental factors. These factors act individually and synergistically to impact the incidence, mortality and morbidity of COVID-19. We aimed to evaluate the variables contributing individually to COVID-19 incidence and mortality utilizing techniques to minimize the effects of interaction between these factors. Method: Data regarding 88 variables for 195 countries over three years were extracted from The Health Nutrition and Population Statistics database and aggregated into a consolidated median. Outliers were eliminated and variables having a completeness of more than 70% were selected. The analysis was done separately for the incidence and mortality of COVID19. Principal component Analysis (PCA) and Elastic net regression were used to identify the most important single variables. The significant variables of the PCA which explained the most variance were identified. Subsequently, variables with the highest importance (using normalized ranked regression coefficients) in the Elastic Net model were selected and the intersecting set of variables common to both models was considered as predictors affecting incidence and mortality of COVID-19. Result: The study revealed communities with a high prevalence of anaemia has a negative correlation with COVID-19 incidence which was furthermore, interestingly seen in multiple age groups. Diphtheria, Tetanus and Pertussis (DTP) Immunization in children was also found to have a negative linear correlation. Conclusion: A negative individual association was seen between anaemia (in multiple age groups) and DTP immunization in children with the incidence and mortality of COVID 19.

The half-life of maternal transplacental antibodies against diphtheria, tetanus, and pertussis in infants: an individual participant data meta-analysis

AimThere are few reliable estimates of the half-lives of maternal antibodies to the antigens found in the primary series vaccines. We aimed to calculate the half-lives of passively acquired diphtheria, tetanus and pertussis (DTP) antibodies in infants. We aimed to determine whether decay rates varied according to country, maternal age, gestational age, birthweight, World Bank income classifications, or vaccine received by the mother during pregnancy. MethodsDe-identified data from infants born to women taking part in 10 studies, in 9 countries (UK, Belgium, Thailand, Vietnam, Canada, Pakistan, USA, Guatemala and the Netherlands) were combined in an individual participant data meta-analysis. Blood samples were taken at two timepoints before any DTP-containing vaccines were received by the infant: at birth and at 2-months of age. Decay rates for each antigen were log2-transformed and a mixed effects model was applied. Half-lives were calculated by taking the reciprocal of the absolute value of the mean decay rates. ResultsData from 1426 mother-infant pairs were included in the analysis. The half-lives of the 6 antigen-specific maternal antibodies of interest were similar, with point estimates ranging from 28.7 (95% CI: 24.4 – 35) days for tetanus toxoid antibodies to 35.1 (95% CI: 30.7 – 41.1) days for pertactin antibodies. The decay of maternal antibodies did not significantly differ by maternal age, gestational age, birthweight, maternal vaccination status or type of vaccine administered. ConclusionMaternal antibodies decay at different rates for the different antigens; however, the magnitude of the difference is small. Decay rates are not modified by key demographic or vaccine characteristics.

Exploring national COVID-19 variability across sub-Saharan Africa

Background In early March 2020, coronavirus disease (COVID-19), an infectious disease caused by a novel coronavirus, was declared a pandemic by the World Health Organization. Since its emergence and global spread, the pandemic has been one of the greatest global crises in modern human history. Notably, in Sub-Saharan Africa (SSA), COVID-19-related burden and outcomes have been generally lower than many other parts of the world and substantially better than were initially feared. At the same time, there has been great heterogeneity in COVID-19 burden and outcomes between countries in the region, with some reporting particularly high incidence and death figures compared to others. What accounts for the significant cross-country variability apparent in SSA and why have some countries performed better than others? The present study investigates country-specific factors that may help to explain differences in COVID-19 outcomes across 48 countries in SSA. Methods A novel cross-sectional dataset, comprising a wide array of socio-demographic, political, economic, and health-related variables, is constructed through gathering data from publicly available sources. Descriptive statistics, correlation analyses, and multiple regression analyses are performed to reveal important country-level factors associated with COVID-19 deaths in SSA. Results Findings from statistical analyses show that in SSA COVID-19 deaths per million is positively associated with income inequality and median age, and negatively associated with population density. In contrast, a number of other variables, including gross national income (GNI) per capita, global connectivity, diphtheria, tetanus and pertussis (DTP) immunization coverage, the proportion of seats in parliament held by women, and political system or regime type, are not statistically significant. Conclusions Although findings from recent studies conducted in various settings around the world indicate that a range of socio-economic, demographic, political, and health-related factors may be linked with COVID-19 burden, the present investigation finds that COVID-19 deaths in SSA are associated with population density, median age, and income inequality.

DTaP combination vaccine use and adherence: A retrospective cohort study

Despite universal recommendation of the 4-dose diphtheria, tetanus, and pertussis (DTaP) vaccine series, coverage and timeliness in the US remain suboptimal. DTaP-containing combination vaccines (i.e. quadrivalent and pentavalent) are presumed to improve vaccine coverage rates and timeliness, but research supporting this claim is limited. We sought to investigate the associations between DTaP-containing vaccine use and adherence to the recommended DTaP immunization schedule among children in the US. Using a large claims database, we identified privately insured children born between 2009 and 2016 that received ≥1 DTaP-containing vaccine and had ≥24 months of enrollment from birth, excluding those with DTaP vaccinations not aligned with approved dose indications. Children were classified by DTaP-containing vaccine receipt: combination vaccines only, stand-alone vaccines only, or a mixture of both. Outcome measures included: 1) completion of the 4-dose series and 2) timely receipt of doses. Outcomes were adjusted for gender, birth year, race, and socioeconomic status. The study cohort contained 412,441 children. Of these, 40.5% (167,084) received combination vaccines only, 14.9% (61,342) received stand-alone vaccines only, and 44.6% (184,015) received a mixture of both. Combination vaccine recipients were nearly 3 times as likely to complete the 4-dose series (OR 2.93 (95% CI: 2.88, 2.99)) and for all doses received, more than 4 times as likely to receive doses on time (OR 4.12 (4.04, 4.21), relative to stand-alone vaccine recipients. Significance disparities in adherence were also observed, where minorities were up to 30% less likely (OR 0.70 (0.68, 0.71)) to complete the 4-dose series and up to 27% less likely (OR 0.73 (0.72, 0.75)) to receive doses on time, relative to white children. Our findings demonstrated that adherence to the recommended DTaP immunization schedule was significantly greater among combination vaccine recipients, relative to stand-alone recipients. Further research is needed to investigate underlying causes of disparities in adherence.

1388. DTaP-containing combination vaccines use and adherence to the recommended infant-toddler vaccination series among privately insured children in the US

BackgroundDespite universal recommendation of the 3 + 1 diphtheria, tetanus, and pertussis (DTaP) vaccine series in infants and toddlers, adherence (i.e. coverage and timeliness) remain suboptimal in the US. DTaP-containing combination vaccines are presumed to improve vaccine coverage rates and timeliness, but research on this topic is limited. The purpose of this study was to compare adherence to the recommended infant-toddler vaccination series between recipients of DTaP-containing combination vaccines (i.e. quadrivalent/pentavalent) and stand-alone vaccines (i.e. trivalent).MethodsWe used the Optum de-identified Clinformatics Data Mart database to create a cohort of children born between 2009 and 2016 with > 24 months of continuous enrollment from birth, and records of > 1 DTaP vaccine receipt. Patients were classified by DTaP-containing vaccine receipt: combination vaccines only, stand-alone vaccines only, or a mixture of both. The primary adherence outcome was completion of the 4-dose series within 20 months of life. We adjusted outcomes for gender, birth year, race, and socioeconomic status via a logistic regression model.ResultsThe cohort contained 200,568 female (48.6%) and 211,882 male (51.4%) children. Of these children, 167,091 received combination vaccines only (40.5%), 61,342 received stand-alone vaccines only (14.9%), and 184,017 received a mixture of both (44.6%). Completion of the 4-dose series was highest among children who received combination vaccines only (75.5%), followed by those who received a mixture of vaccines (72.7%) and those who received stand-alone vaccines only (54.5%). Relative to those who received stand-alone vaccines only, adjusted odds of completion were approximately 2.9 times higher among combination vaccine recipients (odds ratio, OR = 2.93 [95% CI: 2.87, 2.98]) and 2.5 times higher among those who received a mixture of vaccines (OR = 2.54 [2.49, 2.59]).ConclusionDTaP-containing combination vaccine use was associated with significantly greater adherence. Although these results warrant further investigation to better understand the determinants of infant vaccination adherence, such evidence may further support preferential recommendations for combination vaccine use.DisclosuresMatthew M. Loiacono, MSc, Sanofi Pasteur (Employee) Vitali Pool, MD, Sanofi Pasteur (Employee) Robertus Van Aalst, MSc, Sanofi Pasteur (Employee)

The second coming: The comeback of the live vaccines.

Live vaccines are gradually replaced by protein-based vaccines given the latter's better safety. But live vaccines seem to be more efficient via stimulation of the innate immune system.

Ensilicated tetanus antigen retains immunogenicity: in vivo study and time-resolved SAXS characterization

Our recently developed ensilication approach can physically stabilize proteins in silica without use of a pre-formed particle matrix. Stabilisation is done by tailor fitting individual proteins with a silica coat using a modified sol-gel process. Biopharmaceuticals, e.g. liquid-formulated vaccines with adjuvants, frequently have poor thermal stability; heating and/or freezing impairs their potency. As a result, there is an increase in the prevalence of vaccine-preventable diseases in low-income countries even when there are means to combat them. One of the root causes lies in the problematic vaccine ‘cold chain’ distribution. We believe that ensilication can improve vaccine availability by enabling transportation without refrigeration. Here, we show that ensilication stabilizes tetanus toxin C fragment (TTCF), a component of the tetanus toxoid present in the diphtheria, tetanus and pertussis (DTP) vaccine. Experimental in vivo immunization data show that the ensilicated material can be stored, transported at ambient temperatures, and even heat-treated without compromising the immunogenic properties of TTCF. To further our understanding of the ensilication process and its protective effect on proteins, we have also studied the formation of TTCF-silica nanoparticles via time-resolved Small Angle X-ray Scattering (SAXS). Our results reveal ensilication to be a staged diffusion-limited cluster aggregation (DLCA) type reaction. An early stage (tens of seconds) in which individual proteins are coated with silica is followed by a subsequent stage (several minutes) in which the protein-containing silica nanoparticles aggregate into larger clusters. Our results suggest that we could utilize this technology for vaccines, therapeutics or other biopharmaceuticals that are not compatible with lyophilization.

Tetanus in School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Need for Booster Doses of Tetanus Vaccine

Background: Tetanus still causes significant morbidity and mortality amongst children in Nigeria despite decades of immunisation with tetanus vaccine.
 Objectives: To determine the prevalence, case fatality rate and predictors of fatality amongst school age children treated for tetanus at the University of Port Harcourt Teaching Hospital.
 Materials and Methods: This was a retrospective study of all children aged 4 to 17 years treated for tetanus at the University of Port Harcourt Teaching Hospital between January 1, 2009 and December 31, 2019. Data was obtained from the case notes and ward registers. Socio-demographic characteristics, presenting complaints, incubation period, onset interval, number of Diphtheria, Pertussis and Tetanus (DPT) vaccine received at infancy, treatment outcome, duration and cost of hospital stay were obtained, entered into a spread sheet and analysed with SPSS version 20. Results are presented in tables and percentages. The level of significance was set at P value <0.05.
 Results: During the period under review, there were 53 children aged 4 to 17 years treated for tetanus, accounting for 0.3% of the total admission. The mean age was 10.79±3.35 years. There were 33 (62.26%) males and 20 (37.74%) females. Majority 26 (49.06%) of the children were of low socioeconomic class. The commonest 28(52.8%) route of infection was broomstick injury. Majority 32(60.3%) of the children were not immunised in infancy. The mean incubation period was 7.34±4.21 days and the mean onset interval was 8.87±10.44 hours. The two most common symptoms were generalized spasms 49 (21.03%) and trismus 47 (20.17%). Short incubation period (≤4 days) and short onset interval (≤4 hours) were significantly associated with higher death rates (p=0.0002; p=0.012). Patients with short incubation period of ≤4 days and short onset interval of≤ 4 hours are more likely to die (p=0.0002; p=0.012).
 Conclusion: There was a high tetanus case fatality rate amongst school age children at University of Port Harcourt. Short incubation period and onset interval were associated with higher mortality. Booster doses of TT containing vaccines should be administered to primary and secondary school children in Port Harcourt to curb the menace.

Has Gavi lived up to its promise? Quasi-experimental evidence on country immunisation rates and child mortality

IntroductionGavi, the Vaccine Alliance, was set up in 2000 to improve access to vaccines for children living in the poorest countries. Funding has increased significantly over time, with Gavi disbursements...