Dose Of Tetanus Vaccine Research Articles

Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic.

To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

Magnitude of Tetanus Toxoid Immunization and Associated Factors among Pregnant Women in Ethiopia

Background:Maternal and neonatal tetanus remains a major global health problem. Two-thirds of the cases of neonatal tetanus occur in the poorest and least developed countries, including Ethiopia.Objective:This study aimed to calculate the magnitude and identify associated factors of tetanus toxoid immunization among pregnant women in Ethiopia.Methods:The 2016 Ethiopian demographic and health survey data were accessed and used for the analysis. A total of 7193 pregnant women were included in this study. A multilevel hurdle Poisson model was conducted to identify factors associated with tetanus toxoid immunization among pregnant women.Results And Discussion:Only 41.6% of pregnant women had received at least two doses of tetanus vaccine, while 58.4% received less than two doses. The multilevel hurdle Poisson model showed that residence, wealth index, education level of women, occupation of women, education level of husbands, ANC, presence of mobile phones, region, frequency of listening radio and frequency of watching television were significantly associated with tetanus toxoid immunization.Conclusion:Tetanus toxoid immunization coverage in Ethiopia was low. The concerned governmental organization sought to resolve enumeration area variation in tetanus toxoid immunization and closely monitored its implementation. Providing quality antenatal care, enhancing women’s educational level, and involving husbands in tetanus toxoid immunization are effective strategies to increase tetanus toxoid immunization coverage. Besides, the low-income households and the rural settings should also be given special consideration.

Reported History of Measles and Long-term Impact on Tetanus Antibody Detected in Children 9-59 Months of Age and Receiving 3 Doses of Tetanus Vaccine in the Democratic Republic of the Congo.

Recent studies suggest measles-induced immune amnesia could have long-term immunosuppressive effects via preferential depletion of memory CD150+ lymphocytes, and associations with a 2-3 year period of increased mortality and morbidity from infectious diseases other than measles has been shown in children from wealthy and low-income countries. To further examine the associations previous measles virus infection may have on immunologic memory among children in the Democratic Republic of the Congo (DRC), we assessed tetanus antibody levels among fully vaccinated children, with and without a history of measles. We assessed 711 children 9-59 months of age whose mothers were selected for interview in the 2013-2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report and classification of children who had measles in the past was completed using maternal recall and measles IgG serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. Tetanus IgG antibody serostatus was similarly obtained. A logistic regression model was used to identify association of measles and other predictors with subprotective tetanus IgG antibody. Subprotective geometric mean concentration tetanus IgG antibody values were seen among fully vaccinated children 9-59 months of age, who had a history of measles. Controlling for potential confounding variables, children classified as measles cases were less likely to have seroprotective tetanus toxoid antibody (odds ratio: 0.21; 95% confidence interval: 0.08-0.55) compared with children who had not had measles. History of measles was associated with subprotective tetanus antibody among this sample of children in the DRC who were 9-59 months of age and fully vaccinated against tetanus.

Antibody Response against Vaccine Antigens in Children after TCRαβ-Depleted Haploidentical Stem Cell Transplantation: Is It Similar to That in Recipients with Fully Matched Donors?

Recipients of hematopoietic stem cell transplantation (HSCT) with HLA-mismatched donors are more immune suppressed than those with fully matched donors. The immunologic response to vaccines also may differ in HLA-mismatched haploidentical HSCT recipients. In this study, we aimed to evaluate the antibody response to vaccines in pediatric TCRαβ-depleted haploidentical HSCT recipients. This longitudinal study included a study group of 21 children who underwent haploidentical HSCT without CD19 depletion and with TCRαβ depletion and a control group of 38 children who underwent fully matched donor HSCT. Antibody levels were quantified by serologic tests before vaccination and after each dose against tetanus, diphtheria, pneumococcus, hepatitis B, hepatitis A, measles, rubella, mumps, and varicella. The median recipient age was significantly lower (P=.037) and the median donor age was significantly higher (P=.000) in the haploidentical group compared with the fully matched group. At the months 1, 3, 6, 9 and 12 post-transplantation, the median CD4, CD8, and CD19 cell counts and lymphocyte counts were similar in the haploidentical and fully matched groups. The median natural killer cell count was higher in the haploidentical group at the months 1, 3, and 6 post-transplantation (P=.001, .006, and .004, respectively). The median time to first vaccination was similar in the 2 groups (12.5 [range, 11 to 14] months for the haploidentical group and 11 [range, 9 to 13] months for the fully matched group; P=.441). Seroprotection rates were 100% in both groups after the second and third doses of diphtheria vaccine, the third dose of tetanus vaccine, the third dose of hepatitis B vaccine, the second and third doses of pneumococcal conjugate vaccines (PCV13), and pneumococcal polysaccharide vaccine (PSPV23), although lower after the initial doses and before vaccination. Seroprotection for hepatitis A, rubella, and varicella was >90% in the fully matched group and 100% for the haploidentical group after the second doses. Measles and mumps seroprotection rates were >80% in the haploidentical group and approximately 70% for the fully matched group after the second dose. Antibody response and seroprotection rates against vaccine antigens were similar in the haploidentical group and the fully matched when revaccination was started at 12 months post-transplantation. These findings support the idea that TCRαβ-depleted haploidentical HSCT recipients can be revaccinated according to the same vaccination schedule as fully matched HSCT recipients. Revaccination earlier after transplantation and vaccine responses for recipients of different types of HSCT should be evaluated in future studies.

Tetanus seroprotection among children in the Democratic Republic of the Congo, 2013-2014.

BackgroundTetanus is a potentially fatal disease that is preventable through vaccination. While the Democratic Republic of the Congo (DRC) has continued to improve implementing routine vaccination activities throughout the country, they have struggled to maintain high childhood vaccine coverage. This study aims to examine the seroprevalence of tetanus in children 6 to 59 months to identify areas for intervention and improvement of vaccination coverage.MethodsIn collaboration with the 2013–2014 Demographic and Health Survey, we assessed the seroprevalence of tetanus antibodies among children in the DRC. Dried blood spot samples collected from children 6–59 months of age were processed using a prototype DYNEX Multiplier® chemiluminescent automated immunoassay instrument with a multiplex measles, mumps, rubella, varicella and tetanus assay. Multivariable logistic regression was used to determine factors associated with tetanus vaccination and seroprotection.ResultsOverall, 36.1% of children 6–59 months of age reported receiving at least 1 dose of tetanus vaccine while 28.7% reported receiving 3 doses; tetanus seroprotection was 40%. Increasing age in children was associated with decreased tetanus seroprotection, but increased number tetanus vaccinations received. Factors related to increased tetanus seroprotection included number of children in the household, wealth index of the family, urban residence compared to rural, level of maternal education, and province and geography.ConclusionsOur findings in this nationally representative sample indicate that serology biomarkers may help identify children who are not fully immunized to tetanus more accurately than reported vaccination. While children may be captured for routine immunization activities, as children age, decreasing seroprevalence may indicate additional need to bolster routine vaccination activities and documentation of vaccination in school aged children. Additionally, the study highlights gaps in rural residential areas and vaccination coverage based on maternal education, indicating that policies targeting maternal education and awareness could improve the coverage and seroprevalence of tetanus antibodies in the DRC.

Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria

ObjectivesThe aim of this study was to assess and determine associations between maternal health literacy (MHL) levels, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers. Study designCross-sectional descriptive study. MethodsIn total, 185 newly delivered mothers were selected from two health facilities using a purposive sampling technique. Data were collected using an adapted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, Kruskal-Wallis test and logistic regression. The level of significance was set at 0.05 (p < 0.05). ResultsMore than one-third of participants (41.6%) had inadequate MHL. Utilisation of maternal healthcare services was moderate; only 55.7% of participants were registered for antenatal care at ≤14 weeks of pregnancy and 59.5% received three doses of tetanus vaccine, however, the majority of participants (85.9%) attended antenatal care with skilled birth attendants. Almost half of participants (49.2%) had poor pregnancy outcomes. A significant association was found between MHL and utilisation of maternal healthcare services (p < 0.05). MHL was also significantly associated with certain sociodemographic characteristics of participants (i.e. age, educational level, occupation and income). ConclusionsMore than one-third of participants had inadequate MHL, utilisation of maternal healthcare services was moderate and approximately half of study participants had poor pregnancy outcomes. Health workers should provide training sessions for pregnant women to improve MHL.

Knowledge about antenatal care and warning signs in pregnancy among pregnant females of Nandpora area

Background: Knowledge gap about antenatal care and warning signs in pregnancy can result in adverse consequences in pregnancy and can also affect the developing foetus.Methods: This cross-sectional study was conducted in Nandpora area of Block Hazratbal in 2018. Pregnant women who came to the subcentre Nandpora for registration of pregnancy in this year were included in the study. A predesigned questionnaire was used. Information was collected about the demographic details, details of the pregnancy and the questions related to knowledge about the antenatal care and warning signs in pregnancy. Data was entered in microsoft excel 2010 and analysed using Statistical package for social sciences (SPSS) version 23.Results: Mean age was 33 (±4.6) years, 40% of the women were pregnant for second time and 67% were illiterate. About 73% of women were aware that at least 4 antenatal check-ups are necessary and about 84% knew that two doses of tetanus vaccine are required. About 89% of the women said that IFA tablets are necessary. About 51% of the women were aware of the bleeding per vaginum as being the warning sign in pregnancy. Fever and convulsions were reported as warning signs by about 49% of the subjects.Conclusions: The women in our study had adequate knowledge about the antenatal care but there was low knowledge about the danger signs in pregnancy. The healthcare workers must be involved in improving the knowledge about danger signs of pregnancy by giving one to one knowledge to pregnant females at antenatal visits besides also creating awareness in the community.

Young but not older adults exhibit an expansion of CD45RA+CCR7+CD95+ T follicular helper cells in response to tetanus vaccine.

A subset of CD4+ T cells, known as T follicular helper (Tfh), provides co-stimulating signals required to establish long-term humoral immunity. Recent studies have shown a reduced frequency and functionality of this population in older adults in comparison to young adults, in response to vaccination. To evaluate whether memory generation of circulating Tfh (cTfh) cells contributes to this phenomenon, the memory subpopulations of cTfh, and their activation degree, were evaluated both ex-vivo and in-vitro, in response to the model antigen tetanus toxoid (TT) after the first dose of tetanus vaccine. Here, we report a lower frequency of cTfh after vaccination in older adults compared to young adults. Moreover, whereas cTfh from older adults preferably expanded with an effector memory phenotype, young adults experienced a temporal increase of CCR7+CD45RA+ cTfh cells, which also displayed higher levels of CD95, CD40L, CXCR3, and Bcl-6 upon antigen re-encounter. This phenotype was confirmed using automatized algorithm. In conclusion, our results suggest that an age-related loss of heterogeneity and an expansion of more differentiated memory cells within the cTfh compartment could affect the responsiveness of older individuals to vaccines, making this phenotype a characteristic feature of immunosenescence.

2572. Decreased T-Cell Response, but Appropriate Antibody Production to Tetanus Vaccine Among HIV-Exposed Uninfected Infants in Botswana

BackgroundIn Botswana, more than 10% of HIV-exposed, uninfected infants (HEU) are hospitalized or die in the first 6 months of life, largely due to infectious causes. Vaccine responses can act as a marker of the immune response to infectious antigens. Previous studies of vaccine responses in HEU have had conflicting results. We compared T-cell responses to tetanus and purified protein derivative (PPD), and antibody titers to tetanus, between HEU and HIV-unexposed infants (HUU).MethodsA total of 443 HIV-infected and 451 HIV-uninfected mothers and their 453 HEU/457 HUU live-born infants were followed from pregnancy/delivery through 24 months postpartum in a prospective observational study in Botswana (“Tshipidi”). T-cell expression of interferon (IFN)-γ and interleukin (IL)-2 were measured at 6 months using FluoroSpot after stimulation with tetanus toxoid or PPD. Quantitative tetanus toxoid IgG was measured in plasma at 18 months using ELISA. Mean spot-forming units (sfu) per 105 cells and geometric mean antibody titers were compared between HEU and HUU infants who had received 3 doses of tetanus and 1 dose of Bacille Calmette–Guérin (BCG) vaccines by 6 months, and 3 or 4 doses of tetanus vaccine by 18 months. Results. Peripheral blood mononuclear cells were available at 6 months for 63 HEU and 18 HUU. Plasma was available at 18 months for 39 HEU and 42 HUU. HEU infants had significantly lower IL-2 expression after tetanus stimulation than HUU infants (4.4 vs. 16.1 sfu/105 cells, P = 0.004; figure), but no difference in IFNγ expression. There were no differences in T-cell responses to PPD between HEU and HUU. There were no differences in tetanus geometric mean antibody titers between HEU and HUU. Conclusion. In this cohort of infants from Botswana, we found decreased T-cell responses, but not antibody responses, to tetanus toxoid and no differences in T-cell responses to PPD. Cell-mediated immune defects may play a greater role than humoral immune defects in the increased susceptibility to infection among HEU. BCG vaccine produces robust T-helper 1 responses, which may overcome cell-mediated immune defects in HEU. Disclosures All authors: No reported disclosures.

Excess respiratory viral infections and low antibody responses among HIV-exposed, uninfected infants

HIV-exposed uninfected (HEUs) infants have frequent severe infection, hospitalization, and death. We performed a serologic investigation to determine the role of common childhood respiratory pathogens in the excess incidence of infections in HEUs. Prospective cohort study of mother-infant pairs. Among 247 HEUs and 88 HIV-unexposed uninfected (HUU) infant-mother pairs, we measured maternal antibodies to respiratory syncytial virus (RSV) and pneumococcus (PNC 1, 5, 6B, 14); infant antibodies to RSV, influenza A (flu), parainfluenza viruses (1, 2, 3), and PNC 1, 5, 6B, and 14 were measured at 0 and 6 months, and antitetanus antibodies at 6 months. HIV-infected mothers had higher RSV and lower PNC antibody concentrations at delivery than uninfected mothers. Transplacental transfer of maternal antibodies, particularly for RSV, was lower in HEUs compared with HUUs. At birth, HEUs had higher concentrations of anti-RSV antibodies than HUUs, but lower antibodies to the other respiratory agents. At 6 months, HEUs had significantly higher proportions of seroconversions and higher antibody concentrations against parainfluenza viruses 1, 2, and 3. There were no significant differences in seroconversions to flu and RSV, but antibody concentrations to RSV were six-fold lower in HEUs versus HUUs at 6 months. Antibody responses to at least two doses of tetanus vaccine were also six-fold lower in HEUs compared with HUUs. Six-month-old HEUs had a higher incidence of respiratory viral infections than HUUs. In addition to the low passive protection from maternal antibodies, low antibody responses of HEUs may contribute to increased morbidity and mortality.

No Difference in Antibody Responses to Tetanus Vaccine Among HIV-Exposed and -Unexposed Infants in Botswana

BackgroundIn Botswana, more than 10% of HIV-exposed, uninfected infants (HEU) are hospitalized or die in the first 6 months of life, largely due to infectious causes. Vaccine responses can act as a marker of the immune response to infectious antigens. Previous studies of antibody responses to vaccines in HEU have had conflicting results. We compared antibody titers to tetanus vaccine between HEU and HIV-unexposed infants (HUU), and explored whether tetanus antibody titers predicted risk of hospitalization in the first 2 years of life among HEU.Methods443 HIV-infected and 451 HIV-uninfected mothers and their 453 HEU / 457 HUU live-born infants were followed in a prospective observational study in Botswana (“Tshipidi”). Quantitative tetanus toxoid IgG was measured in plasma samples from 18-month-old infants. Geometric mean antibody titers (GMT) were compared between HEU and HUU infants, and between HEU infants who were or were not hospitalized by age 2.ResultsPlasma was available at 18 months for 39 HEU and 42 HUU infants. Within this subset, there were 15 hospitalizations (12 in HEU) [RR of hospitalization among HEU = 1.34 (P = 0.009)]. 73% of hospitalizations overall, and 83% in HEU, were due to infection (primarily pneumonia/bronchiolitis and gastroenteritis). Among infants who had received 3 or 4 doses of tetanus vaccine by 18 months, there were no significant differences in tetanus GMT between HEU and HUU (Fig A). Among HEU who had received 3 or 4 doses of tetanus vaccine by 18 months, there were no significant differences in tetanus GMT between infants who were hospitalized and infants who were not (Fig B).ConclusionIn this small sample of infants from Botswana, we did not identify differences in antibody responses to tetanus vaccine between HEU and HUU. Although HEU demonstrated an increased risk of hospitalization, response to tetanus vaccine did not appear to be a significant predictor of morbidity. It is possible that cell-mediated immune defects play a larger role than humoral immune defects in the increased susceptibility to infection among HEU.Disclosures All authors: No reported disclosures.

Elimination of maternal and neonatal tetanus in Senegal: evolution of survey indicators of 2003-2009

This study aimed to estimate the evolution of the maternal and neonatal tetanus in Senegal from the tetanus vaccination coverage among pregnant women, the proportion of deliveries attended by trained medical personnel and the number of cases of tetanus declared by respective districts, helping to identify districts at high risk of neonatal tetanus (NNT). Data analysis of the epidemiological surveillance realized from 2003 to 2009 in 65 districts of Senegal. Data were collected from the reports of vaccination usage and from the Statistical Directories of the National Health Information Services of the Ministry of Health & Prevention. A district is at high risk when the incidence of NNT is ≥1 case per 1 000 Live births (LB). There were 153 reported cases of NNT in Senegal between 2003 and 2009. National incidence decreased from 0.08 to 0.03 case per 1 000 LB (p = 0,0008). The vaccination coverage of the pregnant women by at least two doses of tetanus vaccine (VAT2+) increased from 66% in 2003 to 78% in 2009. The percentage of districts that had reached a vaccination coverage ≥80% was 20% in 2003 compared to 60% in 2009 (p = 0.009). The proportion of deliveries attended by qualified medical staff evolved from 53% in 2003 to 67% in 2009 (p = 0,02). By 2009, the incidence of NNT was less than 1 case per 1,000 LBs in all districts. Assessing the elimination of maternal and neonatal tetanus in Senegal shows that progress has been made from 2003 to 2009. This was made possible through the organization of vaccination campaigns for women of childbearing age and the improvements in the conditions of deliveries.

Tetanus immunization: Perception of residents in a tertiary care teaching hospital in Western India

Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals.

A Cross-sectional Study on Perception of Medical Students Regarding Tetanus Immunization

Introduction: Tetanus is an acute, often fatal, disease caused by an exotoxin and highly potent neurotoxin, tetanospasmin, which is produced during the growth of the anaerobic bacterium Clostridium tetani. Tetanus can be prevented by vaccination with tetanus toxoid (TT). A thorough knowledge of the tetanus immunisation in wounds is necessary to prevent the occurrence of wound related tetanus. Knowledge regarding TT vaccination as per the NIS among all levels of health care personnel is important not only for the prevention of neonatal tetanus but also tetanus in the children and adults Materials and method: The present cross-sectional study was conducted among final year medical students of Katuri Medical College and Hospital, Guntur, Andhra Pradesh during June -August 2010. A pre-tested, pre-designed questionnaire was adapted. Results: 68.97 % students were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years and 62.07% students were not aware of the number of doses of tetanus vaccine recommended for adults over the age of 16 years. More than half of the study population (51.15%) considered every cut injury to be tetanus prone. The majority of the students (79.31% and 77.01%) considered burn injury and animal bite wounds to be tetanus prone. More than 70% of the students were aware that age of the wound, type of wound and previous immunization status of patients as important considerations before immunizing a patient against tetanu. Conclusion: Better awareness and knowledge regarding tetanus vaccine is needed in medical students which are future health care providers.

Kırk Yaşın Üzerindeki İnsanlarda Tetanoz Antitoksin Titre Düzeylerinin Araştırılması

Objective: Tetanus is a disease that can be prevented with vaccination, but protective antitoxin titers decrease to undetectable levels with old age. The aim of this study is to evaluate tetanus antitoxin levels in individuals over 40 years of age and to investigate the vaccination and physical injury status via survey. Material and Methods: A total of 361 participants, 178 men and 183 women, were enrolled in the study and blood was drawn from each participant to measure tetanus antibody level by enzyme immunoassay (EIA) method. Results: Tetanus antibodies were undetectable in 55 male (30.9%) and 71 female patients (38.8%) at the end of the study. It was determined that tetanus antitoxin levels significantly decrease with age in both women and men especially after 50 years of age which is accepted as the limit age in which antibody is likely to be negative. Conclusion: In adult age group, booster vaccination for tetanus is recommended every 10 years in developing and developed countries, but this recommendation can not be put into practice as anticipated. Similarly in our country, vaccination of adult age group is not common and tetanus vaccine is not generally administered at every ten years. The results of this study show that one dose of tetanus vaccine should be administered at least to individuals over 50 years of age, and individuals who do not recall their vaccination history should be taken into a three-dose vaccination program.

Étude de l’immunité antitétanique chez les femmes enceintes durant l’année 2007 au service de maternité Souissi de Rabat

Summary The prevention against tetanus has considerably improved in the world. The eradication of neonatal tetanus is the one of the main aim of the WHO program. Even though the administration of tetanus toxoid has resulted in a decrease of the cases of tetanus in major industrialized countries, the situation in many developing countries is still alarming. In order to assess the impact of antitetanus vaccination, a prospective study was conducted from January 2007 to April 2007 in the emergency department of motherhood of Souissi for the assessment of the immune status of term parturient. We used immunochromatographic test for the detection of antitetanic antibodies. The results showed that 62% of cases (99 women) were immunized for tetanus, and 38% of the cases (61 women) were not. The strengthening of the immune status by the administration of booster doses of tetanus vaccine to teenagers and women of childbearing potential will enable the eradication of tetanus.

Diphtheria boosters for adults: Balancing risks

Combined tetanus-diphtheria vaccines are now the only means of protecting adults from tetanus or diphtheria. When advising on the benefits and risk of vaccinating for one disease, clinicians now have to consider the other vaccine component, and questions have arisen about where the balance of risk lies for different patients. Five doses of diphtheria-toxoid containing vaccine are probably sufficient protection for individuals who remain in low-incidence countries such as those in most of Western Europe. Adults who remain in the UK are extremely unlikely to be exposed to diphtheria and this needs to be taken into account when assessing the balance of risk where individuals have received fewer than five doses of diphtheria toxoid but five or more doses of tetanus toxoid. In contrast to diphtheria, if someone has received fewer than five doses of tetanus toxoid but is up to date for diphtheria toxoid, the balance of lifelong risk is probably in favour of giving tetanus toxoid irrespective of the individual's diphtheria status. For travellers to diphtheria endemic countries boosters are recommended if more than 10 years has elapsed since the last dose. For individuals who have already received five or more doses of tetanus vaccine in the past, receiving further boosters of tetanus in combination with diphtheria toxoid is unlikely to cause any significant reactions. The only absolute contraindication to such boosters is a previously documented anaphylactic reaction to either diphtheria or tetanus toxoid. Individuals who have a history of such a reaction should be well advised regarding probable risk of infection, symptoms of the disease and the need to seek early treatment.

Tetanus in Injecting Drug Users, United Kingdom

Tetanus in Injecting Drug Users, United Kingdom

Couverture vaccinale antitétanique des adultes au Canada — Année 2002

The rare cases of tetanus that have occurred in Canada were in adults whose vaccination was not up-to-date. The objective of this study was to estimate the vaccine coverage in Canadian adults. 1,002 individuals 18 years of age and older selected by random digit dialing were interviewed by telephone in February 2002. Information was collected about their vaccination status, the circumstances of their vaccination, and their opinion about the duration of the protection of the tetanus vaccine and the recommended interval between booster doses. The participation rate was 38%. Overall, 54% of participants reported having received one dose of tetanus vaccine during the last 10 years: 58% for men and 51% for women. The vaccine coverage was lower in adults > or =60 years of age than in those under 60 (38% vs. 59%). Most doses (57%) were administered as part of treatment for a wound. 30% of participants thought they were protected for life by their childhood immunization against tetanus, whereas 52% knew they had to receive a booster dose each 6-10 years. Vaccine coverage against tetanus is insufficient in adults, especially those > or =60 years of age. As most doses are administered as part of wound treatment, it is not likely that this situation will improve without developing specific interventions.

Reactions to Booster Doses of Tetanus Vaccines, Continued

Dr. Ricardo Perez-Martin's inquiry regarding tetanus toxoid booster (Pediatrics, 42:711, 1968) is a timely one. The use of 0.1 ml of tetanus fluid toxoid (not alum precipitated) intradermally, instead of 0.5 ml intramuscularly, will give more than adequate booster response, with no or little local and systemic reactions. In addition, the allergic phenomena may be minimized.