Tetanus Toxoid Vaccine Research Articles

Tetanus Toxoid Vaccination Coverage Among Women of Reproductive Age: Experience From a Rural Community

Tetanus Toxoid (TT) is a routine vaccination activity under Expanded Program on Immunization (EPI) in Bangladesh. The women of reproductive age (15-49 years) are the target population for five doses of TT vaccine to protect them from tetanus. The study was a cross-sectional study in context of a rural community. The study was conducted to assess TT vaccination coverage among the women of reproductive age in a rural community of Bangladesh. A total of 224 women of reproductive age were randomly included in the study following selection criteria. Data was collected by recall history and reviewing immunization card by using a semi-structured questionnaire and checklist respectively. Data was processed and analyzed considering both descriptive and inferential statistics. Mean age of the women was 27.22 ± 6.87 years and major part (30.4%) was illiterate. Most of the women were married (87.6%) and housewives (81.3%). Mean age at marriage was 17+2.37 years and mean age at first child birth was 18+2.24 years. On the basis of recall history and vaccination card, 83.5% women received first dose of TT (TT1), while 16.5% didn't receive any TT vaccine. Among the women received all five doses of TT, 'Crude Vaccination Rate" was 37.0% and ''Valid Vaccination Rate' was 33.0%. By card, these rates were 18.5% and 14.2% respectively. The invalid doses found 6.2% for TT2, 7.3% for TT3, 12.5% for TT4 and the lowest 10.8% for TT5 dose. The dropout rate was 5.3% for TT1-TT2, 14.7% for TT2-TT3, the highest 31.1% for TT3-TT4 and 20.2% for TT4-TT5 while 55.6% was for TT1-TT5. Vaccination coverage was significantly higher among the women aged 25-29 years (91.0%) and having HSC level education (92.3%) (x2 test, p<0.05). An incredible segment of rural women didn't receive any dose of TT5 vaccine and dropout rate was significantly higher among poor and illiterate women. Painstaking interventions and strategies should be taken to increase TT5 vaccination coverage among the rural women to protect them from tetanus. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18780 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 37-41

Efficacy of a non-updated, Matrix-C-based equine influenza subunit-tetanus vaccine following Florida sublineage clade 2 challenge

Assessing the ability of current equine influenza vaccines to provide cross-protection against emerging strains is important. Horses not vaccinated previously and seronegative for equine influenza based on haemagglutination inhibition (HI)...

Baseline immunity to diphtheria and immunologic response after booster vaccination with reduced diphtheria and tetanus toxoid vaccine in Thai health care workers

A prospective study to evaluate immune status against diphtheria and immunologic response after tetanus-diphtheria (Td) booster vaccination was conducted in 250 Thai health care workers (HCWs). A protective antibody was found in 89.2% of the HCWs (95% confidence interval [CI], 83.3%-91.5%) before receipt of the Td booster vaccination, compared with 97.2% (95% CI, 95.1%-99.3%) after receipt of the first dose of booster (P < .001). The mean antibody level against diphtheria increased from 0.39 IU/mL (95% CI, 0.35-0.44 IU/mL) before the Td booster vaccination to 1.20 IU/mL (95% CI, 1.12-1.29 IU/mL) after the vaccination (P < .001). Td booster vaccination should be considered for Thai HCWs to maintain immunity against diphtheria, which still circulates in Thailand.

The quality-coverage gap in antenatal care: toward better measurement of effective coverage.

The proportion of pregnant women receiving 4 or more antenatal care visits (ANC 4+) is used prominently as a global benchmark indicator to track maternal health program performance. This has contributed to an inappropriate focus on the number of contacts rather than on the content and process of care. This paper presents analysis of specific elements of care received among women reporting 4 or more ANC visits. We conducted secondary analysis using Demographic and Health Survey data from 41 countries to determine coverage for specific elements of antenatal care. The analysis was conducted for: (1) women who delivered during the 2 years preceding the survey and who reported receiving 4 or more ANC visits, and (2) all women who delivered during the preceding 2 years. The specific ANC services that we assessed were: blood pressure measurement, tetanus toxoid vaccination, first ANC visit at less than 4 months gestation, urine testing, counseling about danger signs, HIV counseling and testing, iron-folate supplementation (≥ 90 days), and at least 2 doses of sulfadoxine/pyramethamine for malaria prevention. The difference between expected (100%) and actual coverage (the quality-coverage gap) was calculated for each service across the 41 surveys. Coverage for specific elements of care among women reporting 4 or more ANC visits was generally low for most of the specific elements assessed. Blood pressure and tetanus toxoid performed best, with median quality-coverage gaps of 5% and 18%, respectively. The greatest gaps were for iron-folate supplementation (72%) and malaria prevention (86%). Coverage for specific interventions was generally much lower among all pregnant women (reflecting population effective coverage) than among only those who had received ANC 4+ visits. Although ANC 4+ and average coverage across the elements of care correlated relatively well (Pearson r(2) = 0.56), most countries had lower average coverage for the content of care than for ANC 4+ (among all pregnant women). We argue for the adoption of a summary indicator that better reflects the content of antenatal care than does the current ANC 4+ indicator. We propose, as an alternative, the simple average of a set of ANC content indicators available through surveys and routine health information systems.

Humoral immune response to vaccines in patients with rheumatoid arthritis treated with tocilizumab: results of a randomised controlled trial (VISARA)

ObjectiveTo evaluate the effect of tocilizumab (TCZ), an interleukin 6 receptor inhibitor, on humoral immune responses to immunisations in patients with rheumatoid arthritis (RA).MethodsPatients with RA with inadequate response/intolerance to...

Quality Assessment of Some Brands of Tetanus Toxoids Marketed in Open Markets in South-Eastern Nigeria

Aims:&nbsp;This study was designed to verify the immunogenicity (potency) and the safety of tetanus toxoid vaccines marketed in three large open drug markets in South-Eastern Nigeria.Methodology:&nbsp;Tests for Sterility, formaldehyde concentrations, specific toxicity, endotoxin, and immunogenicity (potency) were conducted on three different brands of tetanus toxoids (Brand α - from Ariaria Drug Market, Aba-Abia State; Brand β - from Ogbete Drug Market, Enugu State; and Brand γ - from Bridge-Head Drug Market, Onitsha-Anambra State).Results:&nbsp;All vaccine brands studied passed the sterility testing, but did not comply with the 2011 BP specifications on free formaldehyde concentration, which stipulates that the free formaldehyde concentration should not exceed 0.02%. The three vaccine brands did not show specific, abnormal, or general toxicity, but contained different amounts of endotoxins. The result of the potency testing showed that the three brands were immunogenic and elicited specific antibodies against tetanus toxin; but brand γ was the most immunogenic since it elicited the highest titers of total IgG, IgG1, and IgG2a followed by brand α, and then brand β.&nbsp;Conclusion:&nbsp;Generally, the quality control tests carried out on these three commercial brands of tetanus toxoids marketed in Nigeria showed that they do not comply with all the pharmacopeial standards on quality and safety required for vaccines of this nature. Therefore, we conclude that some of the tetanus toxoids marketed in open drug markets in Nigeria are substandard and may be responsible for the failures of these vaccines used for immunization in the country.

Complex Regional Pain Syndrome Type I Following Tetanus Toxoid Injection

Complex regional pain syndrome (CRPS) type I (formerly reflex sympathetic dystrophy) is an incompletely understood response of the body to an external stimulus, resulting in pain that usually is nonanatomic and disproportionate to the inciting event or expected healing response. A careful history and general examination are essential for accurate diagnosis. We report a case of CRPS type I of the right upper extremity following an injection with tetanus toxoid vaccine into the same extremity. Only 1 similar case was reported before in the French literature in 1977.

Adequacy of resources for provision of maternal health services at the primary health care level in Nnewi, Nigeria.

Background:To determine the adequacy of resources (human and material) for provision of maternal health services at the primary health care (PHC) level in Nnewi, Nigeria.Materials and Methods:A cross-sectional study of women utilising maternal health services in four public PHC facilities in Nnewi selected using multistage sampling technique was done. Data was collected using a mix of quantitative and qualitative methods. Quantitative data was analysed using statistical package for social sciences (SPSS) version 16, while qualitative data was reported verbatim, analysed thematically and necessary quotes presented.Results:Two hundred and eighty women were studied. The mean age of respondents was 29.2 ± 5.9 years, while 231 (82.5%) were married. Most of them (82.5%) and 184 (66.1%), had their blood pressure and body weight respectively measured, while 196 (70.0%) had tetanus toxoid vaccination. Less than half of the respondents (41.4%) had urine test for sugar, and protein, while 94 (33.8%) had blood test for anaemia. The four facilities studied had most of the equipment and drugs available but in insufficient quantities. In three out of the four facilities, the physical structures were mostly good. None of them is equipped to provide an essential obstetric care (EOC) services, while one medical doctor covered all the facilities studied.Conclusions:This study showed that none of the health facilities is equipped with the minimum equipment package, essential drugs nor staff complement required to enable them offer quality maternal health services. With advocacy, technical support and funding, strategies could be implemented to provide quality maternal health services.

Impairment of humoral and cellular immune response to tetanus toxoid in HTLV-1 infected individuals

The human T cell lymphotropic virus type-1 (HTLV-1) infect mainly T cells, dendritic cells and macrophages inducing T cell proliferation and increasing production of chemokines and cytokines by peripheral blood mononuclear cells (PBMC). However, as HTVL-1 may modify the immune response to other infectious agents, the aim of this study was to evaluate the humoral and cellular immune response before and after vaccination with tetanus toxoid (TT). Participants included 14 HTLV-1 carriers and 12 healthy subjects (HS). These individuals were immunized with two doses of tetanus toxoid vaccine. Antibodies to TT were determined by ELISA and the frequency of T cells expressing cytokines as well as the frequency of monocytes expressing co-stimulatory molecules were determined by FACS. The IgG titers anti-TT increased after immunization in both groups (p = 0.001), but HTLV-1 patients had lower levels of IgG anti-TT after immunization when compared with HS (p = 0.007). The frequency of CD4+ T cells expressing IFN-g, TNF and IL-10, after stimulation with TT, was lower in HTLV-1 infected subjects than the HS after immunization (p < 0.05). TNF and IL-12 expression by monocytes after stimulation with TT were higher in the HTLV-1 group than in HS. However there was an impairment in the HLA-DR expression by monocytes from HTLV-1 infected subjects. These results indicate that HTLV-1 infected subjects have a decreasing in humoral response and an impairment in both antigen presenting cells and T cell functions to a biased antigen. Financial Support: INCT-DT, CNPq, NIH R01.

Maternal Health-Care in India: The Case of Tetanus Toxoid Vaccination

Prenatal-care is one of the important elements of maternal health-care. In this paper an attempt has been made to examine the socioeconomic determinants of Tetanus Toxoid (TT) vaccination as a component of prenatal-care by the women in the age group of 15-49 years. Micro-data having 25847 observations from Indian Demographic and Health Survey (IDHS) has been used. To estimate the probability of TT vaccination binary logistic regression has been utilized. The explanatory variables categorized into socio-demographic characteristics of the woman, household characteristics, health-related characteristics, community characteristics and regional characteristics have been included in the analysis. The results explained that probability to have TT vaccination increases by woman’ education, woman’ age at marriage, husband’s age, husband’s education, husband’s living within household, husband’s presence at prenatal visit and household wealth. The woman’s living in small city, town and country side as well as final say on woman’s health-care by woman and husband collectively, and husband alone decrease the probability of TT vaccination. The study proposed targeted approach to enhance the TT vaccination in Indian women. The marginalized households should be targeted through cash transfer programs. Furthermore, the small cities and country sides should also be focused. The awareness and education of woman along with husband’s participation in maternal health-care cannot be ignored in policy making.

Impact of conditional cash transfers on maternal and newborn health.

Maternal and newborn health (MNH) is a high priority for global health and is included among the Millennium Development Goals (MDGs). However, the slow decline in maternal and newborn mortality jeopardizes achievements of the targets of MDGs. According to UNICEF, 60 million women give birth outside of health facilities, and family planning needs are satisfied for only 50%. Further, skilled birth attendance and the use of antenatal care are most inequitably distributed in maternal and newborn health interventions in low- and middle-income countries. Conditional cash transfer (CCT) programmes have been shown to increase health service utilization among the poorest but little is written on the effects of such programmes on maternal and newborn health. We carried out a systematic review of studies on CCT that report maternal and newborn health outcomes, including studies from 8 countries. The CCT programmes have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers and reduced the incidence of low birthweight. The programmes have not had a significant impact on fertility while the impact on maternal and newborn mortality has not been well-documented thus far. Given these positive effects, we make the case for further investment in CCT programmes for maternal and newborn health, noting gaps in knowledge and providing recommendations for better design and evaluation of such programmes. We recommend more rigorous impact evaluations that document impact pathways and take factors, such as cost-effectiveness, into account.

Association Between Undervaccination With Diphtheria, Tetanus Toxoids, and Acellular Pertussis (DTaP) Vaccine and Risk of Pertussis Infection in Children 3 to 36 Months of Age

Undervaccination is an increasing trend that potentially places children and their communities at an increased risk for serious infectious diseases. To examine the association between undervaccination and pertussis in children 3 to 36 months of age. Matched case-control study with conditional logistic regression analysis. Eight managed care organizations of the Vaccine Safety Datalink between 2004 and 2010. Each laboratory-confirmed case of pertussis (72 patients) was matched to 4 randomly selected controls (for a total of 288 controls). The case patients were matched to controls by managed care organization site, sex, and age at the index date. The index date was defined as the date of pertussis diagnosis for the case patients. Undervaccination for the diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine. Undervaccination was defined as the number of doses of DTaP vaccine that was either missing or delayed by the index date. Case patients and controls could be undervaccinated by 0, 1, 2, 3, or 4 doses of DTaP vaccine. Children undervaccinated by 0 doses were considered age-appropriately vaccinated by the index date. Pertussis. Of the 72 case patients with pertussis, 12 (16.67%) were hospitalized, and 34 (47.22%) were undervaccinated for DTaP vaccine by the date of pertussis diagnosis. Of the 288 matched controls, 64 (22.22%) were undervaccinated for DTaP vaccine. Undervaccination was strongly associated with pertussis. Children undervaccinated for 3 or 4 doses of DTaP vaccine were 18.56 (95% CI, 4.92-69.95) and 28.38 (95% CI, 3.19-252.63) times more likely, respectively, to have received a diagnosis of pertussis than children who were age-appropriately vaccinated. Undervaccination with DTaP vaccine increases the risk of pertussis among children 3 to 36 months of age.

Quality of antenatal care services at public health facilities of Bahir-Dar special zone, Northwest Ethiopia

BackgroundAntenatal care (ANC) is one of the evidence based interventions to decrease the probability of bad health outcomes for mothers and their newborns. Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visit. Hence this study attempted to assess the quality of antenatal care services at public health facilities of Bahir-Dar special zone, North Western Ethiopia.MethodsA facility based cross-sectional study employing both quantitative and qualitative methods was conducted from March to April 2010 in Bahir-Dar special zone, North Western Ethiopia. Quality of care was measured as a proportion of patients receiving recommended components of care. To measure the indicators, data was collected from 369 pregnant women who attended ANC clinics in eight public health facilities, during the data collection period. Data were collected through exit interviews with ANC attendees, observation during consultation, and in-depth interviews with health care providers.ResultsPregnant mothers attending ANC clinics were found to receive only part of recommended care components. Venereal Disease Research Laboratory (VDRL) test, blood group and Rhesus factor tests were done only for 73 (19.8%) and 133 (36.0%) of the women, respectively. Moreover 236 (64.0%) of the mothers missed the opportunity of receiving iron/folic acid supplement during their ANC visit. Three hundred fifty five (96.2%) of the women received tetanus toxoid vaccine. And only 226 (61.2%) of the women had their conjunctiva checked for anemia. Lack of reagents partly explained the problems observed in the provision of recommended care components.ConclusionAlmost half, 175 (47.7%) of the study women were not satisfied and a large proportion of mothers are missing opportunities to receive screening (like blood pressure and weight measurements) and preventive components of antenatal care (iron/folic acid supplementation). Therefore, efforts should be targeted to avoid missed opportunities by taking quality improvement measures including the fulfillment of all necessary resources.

Preparation and properties of polycarbonate microspheres containing tetanus toxoid vaccine

ABSTRACTPolycarbonate microspheres TT‐PC containing tetanus toxoid vaccine (TT) were prepared by the modified water‐in‐oil‐in‐water (W/O/W) solvent evaporation technique, using poly(trimethylene carbonate‐co−5,5‐dimethyl trimethylene carbonate) (P(TMC‐co‐DTC), or PC) as a polymeric carrier. TT release studies showed that the microspheres sustained a steady release rate of TT in the phosphate buffer saline solution (0.1 mol L−1, pH 7.4) in vitro for 60 days. In vivo cytotoxicity assays demonstrated that the polycarbonate microspheres had low toxicity and high safety in vivo in guinea pigs. Immunity and inoculation tests indicated that the TT‐PC microspheres acted as an immunological adjuvant in vivo in guinea pigs. In guinea pigs attacked with an active tetanus toxoid, an injection of the TT‐PC microspheres with a single‐dose and booster vaccination induced high levels of antitoxin efficiencies in the blood serum, showing good immunoprotection. © 2013 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2014, 131, 40048.

Evaluation of lactose stabilized tetanus toxoid encapsulated into alginate, HPMC composite microspheres

The utility of both in vitro and in vivo methods to assess the release pattern of alginate, HPMC (TTAL) composite microspheres containing stabilized tetanus toxoid (TT) vaccine were evaluated. TT was stabilized with different concentrations of stabilizer, lactose (1–5%, w/v) and encapsulated into alginate, HPMC composite microspheres by W/O/W multiple emulsion method. The morphology of the prepared microspheres was smooth and spherical in shape with a diameter of around 10μm. The in vitro release efficiency of microspheres was evaluated for the period of 70 days. In TTAL microspheres, 4% (w/v) lactose gave good sustained antigen delivery for the period of 70 days. Antigen releases from microspheres were determined by ELISA. Based on the results of in vitro release, the ideal batch of TTAL was used to carry out the in vivo studies by antibody induction method using alum adsorbed tetanus toxoid (CRIT) as standard. The antibody level was measured for about of 9 months and finally with one booster dose after 12 months. In this case, TTAL antibody level was rose up to 3IU/ml of guinea pig serum and 2.5IU/ml of guinea pig serum was observed in CRIT after 1 year with second booster dose. This novel approach would be helpful to replace the existing adjuvant alum in future.

Effect of abatacept on immunogenicity of vaccines in individuals with type 1 diabetes

Abatacept delayed progression of type 1 diabetes (T1D) when administered soon after diagnosis. Its use in T1D is expanding to prevention trials and, therefore, it is important to fully characterize its immunosuppressive effect. We compared antibody responses to trivalent inactivated influenza vaccine (TIIV) administered during 2 consecutive seasons and to tetanus toxoid (TT) vaccine administered after 24 months of treatment in115 early onset T1D subjects randomly assigned to 24 months of abatacept (N=71) or placebo (N=34). Anti-influenza titers before TIIV were similar between the 2 treatment groups and both groups had significant increases after vaccination. Although the magnitude of antibody responses against some influenza serotypes was significantly lower (p<0.05) in abatacept compared with placebo recipients, no differences were observed in the proportion of subjects with protective titers against influenza after vaccination. The magnitude of antibody responses against TT also tended to be lower (p=0.06) in abatacept compared with placebo recipients, without affecting the proportion of subjects who achieved protective titers. We conclude that abatacept moderately decreases the magnitude of antibody responses to recall vaccination. Further studies are needed to assess its effect on primary immunization.

Effect of Spirulina (Arthrospira) Supplementation on the Immune Response to Tetanus Toxoid Vaccination in a Mouse Model

ABSTRACTThe aim of this study was to investigate whether Spirulina (Arthrospira) supplementation could enhance the immune response to tetanus toxoid (TT) vaccine in a mouse model. Vaccination of TT was performed on day 7 and 21 in mice fed daily with Spirulina (50 and 150 mg/kg body weight). Both Spirulina supplementation and TT vaccination did not significantly affect body weight gain of the mice. Supplementation of Spirulina significantly enhanced IgG level (p = .01) after the first but not after the second TT vaccination. The anti-TT IgG levels of the groups that received low dose and high dose of Spirulina were not significantly different. Spirulina supplementation did not show significant effects on in vitro splenocyte proliferation and cytokine (IFN-γ and IL-4) production induced by Con A and TT. This study showed that Spirulina supplementation could enhance primary immune response in terms of antibody production, but not secondary immune response following TT vaccination in a mouse model.

The effects, safety and acceptability of compact, pre‐filled, autodisable injection devices when delivered by lay health workers

To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers (LHWs) to deliver vaccines and medicines to mothers and children through compact pre-filled autodisable devices (CPADs). We searched electronic databases and grey literature. For the systematic review of effects and safety, we sought randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies. For the systematic review of acceptability, we sought qualitative studies. Two researchers independently carried out data extraction, study quality assessment and thematic analysis of the qualitative data. No studies met our criteria for the review exploring the effects and safety of using LHWs to deliver CPADs. For the acceptability review, six qualitative studies assessed the acceptability of using LHWs to deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or oxytocin using Uniject™ devices. All studies took place in low- or middle-income countries and explored the perceptions of community members, LHWs, supervisors, health professionals or programme managers. Most of the studies were of low quality. Recipients generally accepted the intervention. Most health professionals were confident that LHWs could deliver the intervention with sufficient training and supervision, but some had problems delivering supervision. The LHWs perceived Uniject™ as effective and important and were motivated by positive responses from the community. However, some LHWs feared the consequences if harm should come to recipients. Evidence of the effects and safety of using CPADs delivered by LHWs is lacking. Evidence regarding acceptability suggests that this intervention may be acceptable although LHWs may feel vulnerable to blame.

Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya.

Médecins Sans Frontières Clinic for sexual gender-based violence (SGBV), Nairobi, Kenya. Among survivors of SGBV in 2011, to describe demographic characteristics and episodes of sexual violence, medical management, pregnancy and human immunodeficiency virus (HIV) related outcomes. Retrospective review of clinical records and SGBV register. Survivors attending the clinic increased from seven in 2007 to 866 in 2011. Of the 866 survivors included, 92% were female, 34% were children and 54% knew the aggressor; 73% of the assaults occurred inside a home and most commonly in the evening or at night. Post-exposure prophylaxis for HIV was given to 536 (94%), prophylaxis for sexually transmitted infections to 731 (96%) and emergency contraception to 358 (83%) eligible patients. Hepatitis B and tetanus toxoid vaccinations were given to 774 survivors, but respectively only 46% and 14% received a second injection. Eight (4.5%) of 174 women who underwent urine pregnancy testing were positive at 1 month. Of 851 survivors HIV-tested at baseline, 96 (11%) were HIV-positive. None of the 220 (29%) HIV-negative individuals who returned for repeat HIV testing after 3 months was positive. Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.

FRI0106 Preliminary results from a controlled trial (VISARA) to evaluate the humoural immune response to vaccines in RA patients treated with tocilizumab (TCZ)

BackgroundTCZ is an IL-6-receptor signalling inhibitor licensed for use in RA. Because TCZ may impact how IL-6 affects T-cell activation and B-cell differentiation, response of TCZ-treated pts to vaccination is...