Tetanus Infection Research Articles

Specific anti-toxic immunotherapy: use in medical practice and perspectives

The results of use of approaches and means of antitoxic immunotherapy in medical practice are summarized: passive transfer of various variants of antibodies specific to toxic compounds, vaccination – specific active immunization with vaccines carrying determinants of the immunochemical specificity of target toxic compounds. The practical effectiveness of the known approaches of passive transfer and vaccination is associated with the ability of specific antibodies, by binding target bioactive compounds with pronounced toxicity, to change the availability of corresponding structures in the body-targets and, in the presence of a sufficient number of specific antibodies with high binding ability to the target compounds, neutralize their toxicity. In medical practice, polyspecific heterologous antisera or the gamma globulin fraction of antisera (extremely rare monoclonal antibodies of narrow specificity) are widely used for passive transfer as antidotes in the treatment of victims in order to prevent deaths and extensive necrosis of soft tissues at the site of the bite of poisonous snakes and insects. Active immunization – vaccination with appropriate antigenic drugs should create in immunized individuals a state of humoral immunity with the corresponding characteristics of antibody formation specific to the target compound. When a target toxic compound enters an immunized organism, it is also possible to neutralize its toxicity. The most successful experience in using the principles of active immunization as a technology for specific antitoxic therapy is associated with the practice of using toxoids for toxinemic infections. Specific practical techniques used to achieve the effectiveness of possible approaches to specific antitoxic immunotherapy in the form of passive transfer of specific antibodies or their fragments are considered: to combat lethal infections in the pathogenesis of which the toxic effects of bacterial exotoxins are significant; when treating victims of snake and insect bites, exposure to poisons of marine organisms, algae and plant toxins; in the treatment of severe intoxication with certain low molecular weight toxic substances: digoxin, colchicine, tricyclic antidepressants. The most successful experiences of using the principles of active immunization as a technology for specific antitoxic therapy, based on the use of toxoids with specificity for diphtheria, tetanus, botulism, cholera, typhoid fever, dysentery, gas gangrene and other toxinemic infections, are also considered. The fairly high immunogenicity of toxoids with the possibility of activating both constitutional and adaptive immunity has become the basis for their use as macromolecular carriers of hapten analogues of narcotic substances – a promising direction in drug addiction, in the implementation of which a number of experimental molecular and combined vaccines of opiates, methamphetamine, cocaine, and nicotine. This variant of practical efforts in medicine can be regarded as a new direction of specific antitoxic immunotherapy – an option to combat drug addiction by vaccinating drug addicts.

Health Facility Capacity and Health-care Worker Knowledge, Attitudes, and Practices of Hepatitis B Vaccine Birth-dose and Maternal Tetanus-Diphtheria Vaccine Administration in Nigeria: A Baseline Assessment.

Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria. This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics. The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns. The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

Tetanus– a case report highlighting the challenges in diagnosis and treatment

Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus.

Hubungan Sumber Informasi dengan Kelengkapan Imunisasi Tetanus Toxoid Ibu Primigravida

Tetanus toxoid (TT) immunization is the process of building immunity as an effort to prevent tetanus infection. The coverage of TT immunization at the Kassi-Kassi Health Center is still low. In 2017, out of 1869 pregnant women, the coverage of TT1 immunization was 1516 (81%), and for TT2 coverage was 757 (41%). The achievement of tetanus toxoid immunization coverage can be influenced by several factors, including sources of information and knowledge about TT immunization. The purpose of this study is to determine the relationship between the source and the completeness of Tetanus Toxoid immunization of Mrs. Primigravida at the Kassi-Kassi Health Center in Makassar City. This type of research is an Analytical Survey with a cross-sectional design. The sample in this study is all primigravida mothers with a gestational age of more than 32 weeks and primigravida mothers who have received TT1 and TT2 immunization at the Kassi-Kassi Health Center totaling 35 people. Data analysis uses the Chi-Square test with a confidence level of 95% (?=0.05). The results of the study showed that there was a meaningful relationship between information sources and the Immunization Completeness of Ibu Pimigavida (p=0.020) at the Kassi-Kassi Health Center in Makassar City. Puskesmas is expected to improve promotive and preventive functions to be able to increase public knowledge about TT immunization so that it can increase the coverage of TT immunization.

An unexpected case of tetanus in a fully immunized 20-year-old female: a case report

BackgroundWidespread vaccinations have significantly decreased the number of tetanus cases in developed countries. Today, most cases of tetanus affect the elderly and those with inadequate immunization in developed countries such as Japan. As vaccinations were believed to be nearly 100% effective in preventing tetanus, tetanus in young, immunized individuals were considered unlikely. However, unexpected tetanus infection has been reported in young adequately immunized individuals.CaseWe herein describe a 20-year-old immunized female who visited our emergency department with trismus and painful muscle spasms that started after receiving a puncture wound to her right foot. A physical examination revealed an elevated body temperature (38°C), trismus, muscle spasms in her right leg and neck, and a puncture wound at the sole of her right foot. Following the development of dyspnea after admission to the intensive care unit, the patient was intubated and mechanically ventilated. She fully recovered after six days in intensive care.ConclusionThe present case serves as a stark reminder that tetanus may still occur in young, immunized individuals. Patients with a history of immunization may have a better prognosis than those with no immunizations.

Vaccination in Diabetes: Updated Guidelines for 2024

Diabetes presents a significant public health challenge globally, with India emerging as a hotspot for the disease burden. The International Diabetes Federation (IDF) Diabetes Atlas 2021 highlights India with 1 in 7 adults affected with diabetes. Given the heightened susceptibility of individuals with diabetes to vaccine-preventable diseases, vaccination has become indispensable in comprehensive diabetes management. Major vaccines against influenza, pneumonia, hepatitis, shingles, varicella, tetanus, diphtheria, and pertussis infections are important for individuals living with diabetes. Despite strides in pediatric vaccination coverage through initiatives like the Universal Immunization Program (UIP), adult vaccination rates remain suboptimal in India. Vaccine hesitancy, compounded by factors such as inadequate education, affordability concerns, and accessibility issues, disproportionately affects this population. Even though there are multiple organizations recommending vaccination in adults, guidelines specific to the Indian population with diabetes are still lacking. This paper is an attempt to suggest the use of vaccines for people with diabetes in India. By advocating for increased awareness and accessibility to vaccines, healthcare providers can play a pivotal role in safeguarding the health of this vulnerable population. As the global community continues to combat diabetes and vaccine hesitancy, collaborative efforts are essential to ensure equitable access to life-saving vaccines and promote optimal health outcomes. This review examines the evolving landscape of vaccination in India, particularly focusing on adults with diabetes.

A woman with Clostridium tetani infection and metastatic breast cancer: A case report

Tetanus could be a genuine and possibly dangerous neurological infection caused by the tetanus poison delivered by the bacterium Clostridium tetani. Infection occurs through contaminated wounds, burns, surgical wounds, and insect bites. Related symptoms include muscle spasms, autonomic instability, and respiratory failure. Complications occur in the form of fractures, sprains, muscle tears, and death. Early diagnosis and prompt treatment are crucial to prevent complications and improve outcomes. Risk factors for tetanus infection include the lack of routine vaccinations, wound contamination with C. tetani-contaminated soil, and improper hygiene practices during childbirth. We presented a case report of a 32-year-old woman with a history of breast cancer, who developed a rapidly growing and foul-smelling mass. Despite early diagnosis and treatment measures, the patient did not respond to treatment and died due to the severity of mixed infections. The case highlights the importance of early diagnosis, prompt treatment, and routine vaccinations to prevent complications and improve outcomes in tetanus infection.

ANALYSIS OF FACTORS RELATED TO THE COMPLETENESS OF TETANUS TOXOID IMMUNIZATION IN TRIMESTER III PREGNANT WOMEN

Tetanus toxoid immunization in third trimester pregnant women is very important to prevent the risk of tetanus infection in newborns. Most cases of neonatal death in developing countries are due to tetanus, and neonatal tetanus is the second leading cause of death worldwide in diseases that can be prevented through vaccination. The purpose of this study was to determine the factors associated with the completeness of Tetanus Toxoid immunization in third trimester pregnant women. This study employed an analytical cross-sectional observational design on pregnant women in the third trimester (n=47) at Puskesmas Karangan in 2023. A total sampling method was used, resulting in a sample of 47 infants. Data collection instruments included questionnaires (primary data) and the PWS KIA book (secondary data). The variables examined were immunization completeness (dependent variable) and knowledge, attitude, and spousal support (independent variables). Data were analyzed using the Chi Square test. The results of univariate analysis showed that the majority of respondents with incomplete TT immunization were 24 (51.1%). The results of the bivariate analysis found a relationship between knowledge and P Value (0.004), mother's attitude P Value (0.025) and husband's support P Value (0.029) with the completeness of Tetanus Toxoid immunization in third trimester pregnant women with a value of α = 0.05. The study highlights the strong influence of maternal knowledge on the completeness of Tetanus Toxoid immunization in pregnant women in the third trimester (P-value=0.004), which is more significant compared to maternal attitude and spousal support. Enhancing maternal knowledge regarding TT immunization is crucial in improving immunization coverage and reducing the risk of tetanus infection in newborns.

Pregnant women’s knowledge of Tetanus disease and immunization against Tetanus disease in the City of Baghdad

Objective: To estimate the understanding of tetanus and tetanus toxoid injections among pregnant women.Method: The cross-sectional study was conducted at the Baghdad General Hospital and a primary healthcare centrein Bab-Almuadham, Iraq, from November 15, 2020, to January 15, 2021, and comprised 100 pregnant women aged15-45 years. Data was gathered through face-to-face structured interviews using a complete self-assessmentquestionnaire. Data was analysed using SPSS 27.Results: Of the 100 women with mean age of 28.4±10.6 years (range: 15-44 years), 27(27%) were aged 20-24 years,70(70%) were from the urban areas, 40(40%) had primary education, 69(69%) were housewives, and 85(85%) had hadfull or partial tetanus toxoid vaccine doses. With respect to knowledge about tetanus disease, 60(60%) subjectsanswered correctly that tetanus is a serious disease, 52(52%) knew that tetanus infection could also kill the foetus,and 30(30%) recognised that tetanus produces significant side effects. Besides, 80(80%) women considered the vaccinea necessity, and the most common source of information about tetanus vaccination was the health authorities 76(76%).Conclusion: The pregnant women studied were found to have an acceptable level of knowledge about tetanus andtetanus toxoid immunisation.Keywords: Pregnancy, Tetanus, Clostridium tetani, Asymptomatic infections, Tetanus toxoid, Nervous system,Demography, Uterus, Foetus

THE CORRELATION BETWEEN KNOWLEDGE AND ATTITUDE OF PREGNANT WOMEN WITH TETANUS DIPHTERIA IMMUNIZATION TO PREGNANT WOMEN IN BANDAR SETIA VILLAGE

One of the causes of maternal death is infection. Tetanus infection caused by the bacterium Clostridium tetani is one of the causes of maternal and infant mortality. The author aims to conduct research on the relationship between knowledge and attitudes of pregnant women with tetanus diphtheria immunization in the village of Bandar Setia, Deli Serdang Regency. This was a descriptive study with a cross sectional approach. The population was pregnant women recorded at the Bandar Setia Polindes in January - March 2023 totaling 34 people. The sampling technique in this study was the total sampling technique because the total population was less than 100 people. The time of the study was January - March 2023. The data collection technique was primary data by filling out a questionnaire. Questionnaires are used to measure the knowledge and attitudes of pregnant women, while secondary data is obtained from the register of pregnant women who come to check their pregnancies. Data analysis included Univariate and Bivariate with the chi square test. The test was carried out to determine the significance test using a 95% confidence level and an error rate (α) = 5%. The results of the chi square statistical test on the knowledge variable, the value of p = 0.003 (p <0.05) this shows that knowledge has a significant relationship with the administration of Td immunization, as well as on the attitude variable the results of the chi square statistical test obtained a value of p = 0.001 (< 0.05) this shows that attitude has a significant relationship with giving Td immunization to pregnant women. It is hoped that health workers will promote more promotion of Tanus Diphtheria Immunization for women of childbearing age, especially pregnant women, to increase the knowledge of women of childbearing age about Tetanus Diphtheria immunization.

A nine-year facility-based review of the pattern and outcome of neonatal tetanus in Ondo State, Nigeria

Tetanus is an infection caused by the Clostridium tetani; a ubiquitous Gram-positive, motile, spore-forming, and toxin-producing anaerobe. It is the only vaccine-preventable infection that is not communicable and which is still causing regrettable morbidity and mortality in newborns in Nigeria. The objective of this study was to review the pattern of neonatal tetanus infection and to document its outcome in a secondary health care level in South-west Nigeria. This was a hospital-based prospective study. Questionnaires were also administered to collect information from the parents. Out of a total of 4,277 out-born babies, 23 had Neonatal Tetanus (NNT). The mean incubation period was 6.62±2.2 days; the period of onset was less than 24 hours in 9 (39.1%) of the babies and greater than 24 hours in 14 (60.9%) babies. Four babies (17.4%) died, 4 (17.4%) left against medical advice, and the mean age at death was 11.7±3.5 days. Other clinical records showed that 56.5% of mothers did not receive antenatal care or tetanus toxoid, 65.2% had non-hospital deliveries, cord care was sub-optimal in the majority of cases, and the case fatality ratio was 17.4%. The study reveals that NNT still contributes to morbidities and mortalities among Nigerian neonates. The incidence per year, though, waxes and wanes with no particular pattern; the disease still has the tendency to dip the neonatal indices.

Penyuluhan Imunisasi Tetanus Toksoid Untuk Calon Pengantin Dan Wanita Usia Subur Di Fasilitas Kesehatan Tingkat Pertama

Tetanus is a serious disease caused by spores of the bacterium Clostridium tetani. Tetanus infection has no boundaries as people of all ages can be infected and it is still a public health problem today, especially for pregnant women and newborns. Neonatal tetanus (TN) is the tetanus infection in infants aged 3 – 28 days after birth and maternal tetanus (MT) is the infection that occurs during pregnancy and up to 6 weeks after delivery. Tetanus infection generally occurs if the delivery is not carried out in health facilities with adequate equipment and is known as one of the most common causes of death during childbirth. The aim of this Community Service activity was to provide counseling about the importance of Tetanus Toxoid (TT) T immunization for prospective brides and WUS who came to the mother and children out-patient clinic at the Primary Health Care. Cadres those bearing an important role in expanding health information for the community were also involved in this program. This Community Service activity held counseling for the prospective bride and fertile-aged women, while the cadres were given refreshing additional knowledge about TT immunization. The results of this activity were increasing the cadres’ knowledge about TT immunization, and those prospective-bride and fertile-aged women were also encouraged to carry out active TT immunization at the Primary Health Care. There is also a need for cross-sector collaboration with the Religious Affairs office in the application of evidence of TT immunization for prospective-bride as a mandatory requirement that could be implemented properly.

Awareness of Women about Tetanus in Baghdad

Background: Tetanus toxoid (TT) vaccine is still recommended for pregnant women even in countries that declared elimination of neonatal tetanus (NT) and consequently the maternal tetanus (MT). Many factors may affect TT vaccination during pregnancy. Awareness is a key factor that greatly affect the pregnant women to receive tetanus toxoid vaccination during pregnancy. Aims of study: To assess the awareness of women regarding different aspects of tetanus and tetanus toxoid vaccination as well as to identify the factors influencing their awareness. Subjects and Method: A cross sectional study conducted in Baghdad from first of April to the end of September 2021. Convenient sample of women in reproductive age, attended the designated primary health care centers for the study were enrolled. An interview questionnaire was used to collect quantitative data pertaining to awareness of women about tetanus toxoid immunization and tetanus infection. Results: The total number of women enrolled in the study was 400, the study found that that 35.2% and 35% of women had good and fair level of awareness respectively. Good awareness level was significantly higher among older aged women and those with higher level of education as well as working women. Good awareness was more prominent among women’s having1-2 children (39%), as compared to those having five and more children (21.3%). Antenatal care attendance and place of delivery shown statistical significant link with level of awareness. Women identify family members and friends as their primary sources of information about tetanus infection and immunization. Conclusion: Women’s awareness was acceptable regarding Tetanus and TT immunization. Yet still there is a place for proper health education targeting young women to bridge gap in the connection between the tetanus immunization status of women and the occurrence of Maternal neonatal tetanus (MNT), as well as need for the appraisal of the components of health information delivered by health care providers to women attending antenatal care clinics.

Implementation of the preventive vaccination program in the time of the COVID-19 pandemic - single center study.

In addition to many diagnostic and therapeutic procedures, the COVID-19 pandemic also limited prophylaxis, including the implementation of the vaccination program among children. The aim of the study was to assess the implementation of the vaccination program in the area covered by the care of patients of a selected Primary Health Care clinic in the city of Krakow in the field of selected vaccinations during the COVID-19 pandemic. A retrospective study based on secondary data was conducted in a selected clinic (Kraków, Poland) that cares for 1,982 children aged 0-19 years. An analysis of the vaccination coverage in selected groups of children in 2019, 2020 and 2021 was carried out based on annual reports (MZ-54). Vaccination coverage against: diphtheria, tetanus, whooping cough, measles, mumps, rubella, influenza and pneumococcal infection was analyzed. The collected data were analyzed using descriptive statistics, Chi2 test and Fisher's exact test. In the general vaccination status of two-year-olds, no significant differences were observed in the period 2019-2021 (p=0.156). The percentage of fully vaccinated increased from 77.6% in 2019, to 81.5% in 2020 and to 85.2% in 2021. However, a high rate of vaccination refusals was observed in 2021 (4.1%) in this group. The percentage of 2-year-olds vaccinated against pneumococci (PCV) and 3-year-olds against diphtheria, tetanus, pertussis (DTP), and measles, mumps, rubella (MMR) in the years 2019-2021 was increasing. For DTP and MMR, this increase was significant (p<0.05). In the group of older children, in 2020 the percentage of 7- and 15-year-olds vaccinated decreased compared to 2019 and 2021, but the difference was insignificant (p>0.05). A significant difference in vaccination coverage was observed in the group of 19-year-olds, in which in 2020 the percentage of vaccinated was 58% (in 2019 - 74.6%, in 2021 - 81%). The largest number of children under the age of 5 were vaccinated against influenza in 2021, but it was only less than 2% of this group. Sanitary restrictions introduced during the COVID-19 pandemic did not significantly affect the vaccination status of children in selected age groups against the analyzed vaccine-preventable diseases. The exception is the group of 19-year-olds, whose vaccination coverage in 2020 was much lower than in 2019 and 2021. In addition, an increase in refusals of vaccination was observed, reaching 4.1% in 2021 in the group of the youngest patients.

Generalized tetanus in a farmer following treatment of an open ankle fracture by a traditional bone setter

Key Clinical MessageThis is the case of a 31‐year‐old farmer diagnosed with an open right ankle fracture and tetanus sustained from an accident after opting for traditional bonesetter treatment. Open fractures increase the risk of tetanus infection therefore herbal treatment should be discouraged. Source control is important for holistic management of tetanus.

Safety of equine tetanus antitoxin for prophylactic use in Ethiopia: a retrospective multi-center study

BackgroundTetanus remains a severe life-threatening infectious disease and neurological disorder in many parts of the world, where immunization programs are suboptimal. Any human injury or trauma has the possibility of getting infected with Clostridium tetani which is the sole causative bacterium of tetanus. Evidence is available that TAT may cause anaphylaxis and late serum sickness, while there has been no study conducted in Ethiopia. The Ethiopian Ministry of Health standard treatment guideline recommends tetanus prophylaxis for all tetanus-prone wounds. This study aimed to evaluate the safety of TAT administration in adults exposed to tetanus-prone wounds in Ethiopia.MethodsThe target product of this study was the equine tetanus antitoxin developed and manufactured by the ViNS Bioproducts Limited, India (Code: 130202084, A.W.No: 15/AAW/PI/02.00, DT: 25.04.2016). The product is delivered with the dose of 1000/1500 IU intramuscularly or subcutaneously to individuals at risk of tetanus infection for prophylactic purposes. The study was carried out in 11 healthcare facilities in Addis Ababa, Ethiopia, that had a relatively high clients load for tetanus-prone wounds. Medical records of patients with tetanus-prone wounds who received the equine TAT were reviewed retrospectively for any adverse events following immunization according to the World Health Organization (WHO) definition for adverse events following immunization (AEFI).ResultsThere were more than 20,000 patients treated for trauma in the facilities from 2015 to 2019. Upon revision of available registration books, we identified 6000 charts to be eligible for the study, of which 1213 charts that had complete and reliable data on the AEFI profile of the TAT were included in the final analysis. The median age of the study participants was 26 years (IQR = 11 years, age range: 18–91 years) and 78% (949) were male. The tetanus-prone wounds resulted mainly from stab (44%, 535) and blunt force (30%, 362), and the most common sites of wounds were hand (22%, 270) and head (21%, 253). The most and least frequently occurring types of wounds were open wounds (77%, 930) and organ system injury (0.003%, 4), respectively. The mean time of presenting at health facilities from the onset of trauma was 2.96 h. Of the total 1231 participants, one male participant who presented within 3 h after experiencing a wound on his nose at the workplace had a severe local reaction immediately after injection of the TAT. No AEFI was recorded for the other participants.ConclusionsThe adverse event following immunization of the equine tetanus antitoxin produced by the ViNS Bioproducts Limited was very rare. A regular review of the product’s safety performance and systematic collection and analysis of adverse event reports are important to ensure the safety of the product.

In silicooptimization of prenatal vaccine regimens to promote early-life immunity

Abstract Newborn children are vulnerable to infection due to their dampened humoral immune response. Maternal immunoglobulin G (IgG) transferred across the placenta provides passive immunity to newborns, and prenatal vaccination to boost pathogen-specific IgG transfer successfully reduced the incidence of neonatal tetanus, diphtheria, and acellular pertussis (Tdap) infections. Despite this, higher rates of infection among premature neonates signifies a deficiency in current immunization programs. To identify regulators of IgG transfer and refine prenatal vaccine regimens, we used a novel in silico approach. To disentangle the role of placental Fc gamma receptors (FcγRs) in IgG transfer, we conducted multiplexed immunofluorescence (mIF) to measure FcγR expression in paraffin-embedded placental tissue. A mechanistic model of placental IgG transfer informed by single cell RNA sequencing and the mIF data revealed FcγRIIb as a key driver of dynamic subclass-specific IgG transcytosis in placental endothelial cells (ECs). In model simulations and experiments in vitro with human umbilical vein ECs, we found the maternal IgG profile fine-tunes antigen- and subclass-specific IgG transfer dynamics. To identify immunization windows of opportunity for maximum IgG transfer, we simulated maternal vaccination by integrating a model of B cell activation and antibody production into the mechanistic model. This revealed first trimester vaccination as a potential strategy to maximize Tdap-induced IgG transport to premature newborns. We conclude that optimal prenatal vaccine regimens depend on gestational length and that novel prenatal vaccines can leverage these determinants of IgG transport to maximize neonatal immune protection. Supported by grants from NIH (T32 GM145443) the Jeffress Trust Awards Program.

If the Mind Doesn’t Know, the Eyes cannot See: A Case report of Localized Tetanus

Tetanus is a vaccine-preventable disease caused by a potent neurotoxin released by an obligate anaerobic bacterium, Clostridium tetani infection. Presentations of tetanus include generalized tetanus, neonatal tetanus, cephalic tetanus, and localized tetanus, the latter two being much rarer. This is a case report of localized tetanus involving the facial muscle in the form of lock jaw in 63-year inadequately immunized gentleman following an unhygienic tooth extraction from rural area. The condition deteriorated further, and the patient was under ventilatory support for 3days. The patient had antibiotics, antitetanus serum, sedatives, and wound care. The case is reported because of the rarity of localized tetanus, the diagnostic dilemma presented by the case, and the cultural interplay and understanding of the disease process by the patient/caregivers. It is also reported to highlight the gap in routine immunization and the need for booster doses in this age group. Successful management includes prompt diagnosis, neutralization of circulating toxin and elimination of C. tetani infection, control of spasms, maintenance of the airway, and management of respiratory failure and autonomic dysfunction. Bangladesh J Medicine 2023; 34(2): 168-170

Vaccine-Preventable Infections Among Solid Organ Transplant Recipients in Switzerland

Vaccine responses are decreased in solid organ transplant (SOT) recipients, and given the complexity of implementation, vaccination programs may be suboptimal. The actual burden of vaccine-preventable infections (VPIs) among SOT recipients remains unclear. To assess the incidence rate of VPIs among SOT recipients and to evaluate whether SOT recipients are at increased risk for specific VPIs compared with the general population. This nationwide cohort study used data from the Swiss Transplant Cohort Study on VPIs in individuals who underwent SOT from May 2008 to June 2019 (follow-up until December 2019) and data from the Swiss Federal Office of Public Health on notifiable VPIs in the general population in the same period. Data were analyzed from January 2021 to June 2022. Solid organ transplant. The main outcomes were the incidence rate of the following VPIs in SOT recipients: hepatitis A and B, diphtheria, Haemophilus influenzae infection, influenza, measles, mumps, pertussis, pneumococcal disease, poliomyelitis, meningococcal disease, rubella, tetanus, tick-borne encephalitis, and varicella zoster virus infection. Age-adjusted standardized incidence ratios were used to assess whether VPIs occurred more frequently in SOT recipients compared with the general population. For SOT recipients, factors associated with occurrence of VPIs were explored and the associated morbidity and mortality assessed. Of 4967 SOT recipients enrolled (median age, 54 years [IQR, 42-62 years]; 3191 [64.2%] male), 593 (11.9%) experienced at least 1 VPI. The overall VPI incidence rate was higher in the population that underwent SOT (30.57 per 1000 person-years [PY]; 95% CI, 28.24-33.10 per 1000 PY) compared with the general population (0.71 per 1000 PY). The standardized age-adjusted incidence ratio for notifiable VPIs in SOT recipients was higher compared with the general population (27.84; 95% CI, 25.00-31.00). In SOT recipients, influenza and varicella zoster virus infection accounted for most VPI episodes (16.55 per 1000 PY [95% CI, 14.85-18.46 per 1000 PY] and 12.83 per 1000 PY [95% CI, 11.40-14.44 per 1000 PY], respectively). A total of 198 of 575 VPI episodes in the population that underwent SOT (34.4%) led to hospital admission, and the occurrence of a VPI was associated with an increased risk for death and/or graft loss (hazard ratio, 2.44; 95% CI, 1.50-3.99; P = .002). In multivariable analysis, age 65 years or older at the time of transplant (incidence rate ratio [IRR], 1.29; 95% CI, 1.02-1.62) and receipt of a lung (IRR, 1.77; 95% CI, 1.38-2.26) or a heart (IRR, 1.40; 95% CI, 1.05-1.88) transplant were associated with an increased risk of VPI occurrence. In this study, 11.9% of SOT recipients experienced VPIs, and the incidence rate was higher than in the general population. There was significant morbidity and mortality associated with these infections in the population that underwent SOT, which highlights the need for optimizing immunization strategies.

Tetanus Neonatorum: its Associated Risk Factors and Mortality Rate in Khyber Pakhtunkhwa

Background: Tetanus neonatorum is a preventable cause of mortality and neurological squeal that is more prevalent in resource-poor nations, perhaps because to low rates of mother immunization and unclean cord care procedures. Objectives: The study was conducted in different districts of Khyber Pakhtunkhwa to investigate the prevalence of tetanus neonatorum, its associated risk factors and mortality rate. Methods: This was a retrospective study conducted in five districts of Khyber Pakhtunkhwa during the year 2020-22, through evaluation of the hospital records of 185 tetanus infected neonates, for the assessment of acute risk factors and clinical outcome of the infection. Results: It was found that a significantly higher proportion (p&lt;0.05) of the infected were neonatal fetuses of age less than ten days with the incidence of 83.24%. High mortality rate of 31.35% was observed in the infected infants in which 58 out of 185 infected infants did not survive. Most of the infected patients (p&lt;0.05) were born at home (129/185), through vaginal birth (104/185) and delivered in unhygienic environment (156/185). A significantly high number of women were not immunized against the tetanus infection (p&lt;0.05) and fetal umbilical cords were not managed aseptically and were cut with used razors (12.97%) and fastened with unhygienic threads (38.37%), rendering them vulnerable to the fatal infections. Conclusion: It was concluded that poor tetanus toxoid immunization of the mothers and unhygienic conditions were likely causes. Keywords: Deep wounds; Immunization; Umbilical cord; Unhygienic deliveries.