Tetanus Toxoid Vaccine Research Articles

Effect of cash incentives on tetanus toxoid vaccination among rural Nigerian women: a randomized controlled trial

ABSTRACT Tetanus toxoid vaccination is freely available for most women in developing countries, yet maternal and neonatal tetanus are still prevalent in 13 countries, 9 of which are in sub-Saharan Africa. We evaluated whether providing cash incentives increases the uptake of tetanus toxoid vaccination among women of childbearing age in rural northern Nigeria. We randomized amounts of cash incentives to women in three groups: 5 Nigerian naira (C5), 300 naira (C300), and 800 naira (C800) (150 naira = 1 U.S. dollar). Overall, of 2,482 women from 80 villages, 1,803 (72.6%) women successfully received the vaccination (419 of 765 [54.8%] women in C5, 643 of 850 [75.7%] women in C300, and 741 of 867 [85.5%] women in C800). Women in C300 and C800 were significantly more likely to receive the vaccine than women in C5. We further found that transportation costs are one of the significant barriers that prevent women from receiving vaccination at clinics, and that cash incentives compensate for transportation costs unless such costs are large.

Assessment of Socio-Demographic Factors, Mother and Child Health Status, Water, Sanitation, and Hygienic Conditions Existing in a Hilly Rural Village of Nepal.

In many low income developing countries, socioeconomic, environmental and demographic factors have been linked to around half of the disease related deaths that occur each year. The aim of this study is to investigate the sociodemographic factors, mother and child health status, water, sanitation, and hygienic conditions of a Nepalese community residing in a hilly rural village, and to identify factors associated with mother and child health status and the occurrence of diarrheal and febrile disease. A community-based cross-sectional survey was carried out and 315 households from the village of Narjamandap were included in this study. Factors associated with diarrhea, febrile disease, and full maternal and under-five immunizations were assessed using logistic regression. Results showed that higher education level (middle school versus primary education; Odds Ratio (OR): 0.55, p = 0.04; high school versus primary education; OR 0.21, p = 0.001) and having a toilet facility at home were significantly associated with a lower risk of developing diarrhea and febrile disease (OR 0.49, p = 0.01), while, interestingly, the use of improved water supply was associated with higher risk (OR 3.07, p = 0.005). In terms of maternal immunization, the odds of receiving a tetanus toxoid vaccination were higher in women who had regular antenatal checkups (OR 12.9, p < 0.001), and in those who developed complications during pregnancy (OR 4.54, p = 0.04); for under-five immunization, the odds of receiving full vaccination were higher among children from households that reported diarrhea (OR 2.76, p < 0.001). The findings of this study indicated that gaps still exist in the mother and child healthcare being provided, in terms of receiving antenatal checkups and basic immunizations, as evidenced by irregular antenatal checkups, incomplete and zero vaccination cases, and higher under-five deaths. Specific public health interventions to promote maternal health and the health of under-five children are suggested.

Factors Contributing to Low Tetanus Toxoid Vaccination Coverage among Young Adult Women in Khairpur District, Sindh

Background: Tetanus remains endemic in poor and developing countries since last decades as compared to rich and advanced countries. Low Tetanus Toxoid (TT) vaccination coverage has led to Tetanus related high morbidity and mortality amongst women and children in developing countries like Pakistan. Therefore, this study aims to assess the coverage of TT vaccination, knowledge about importance of TT vaccination and barriers to get full coverage among young women. Methodology: A cross-sectional study was conducted in district Khairpur among the female students of one Public Sector University. Total of 384 unmarried female students of more than 17 years of age were enrolled in the study. Information on vaccination status and different associated factors was collected through a questionnaire. We used logistic regression analysis to assess factors associated with vaccination status. Results: The mean age of study participants were 20.9 years with 2.15 standard deviation. Total of 311 (81%) respondents had heard about TT vaccination and among 160 (41.7%) major source of information was health care provider. Most of the respondents 303 (78.9%) were considering Tetanus as a health problem. Furthermore, 141 (36.7%) respondents knew that completion of 5 doses of TT vaccination can protect them from Tetanus disease. About 53 % young women were vaccinated for TT including 11% fully vaccinated and 42% partially vaccinated. In multivariable model, those who were aware of Tetanus diseases were more likely to be vaccinated than those who had not heard about Tetanus disease (odds ratio 2.76: 95% confidence interval; 1.19-6.43). Conclusion: We have found significant relationship of knowledge of Tetanus disease and vaccination coverage in the young adult women of Khairpur district. Study suggests the enhanced focus of government and other stakeholders on women’s health education which can increase the uptake of vaccination among young women.

New evidence on the impact of the quality of prenatal care on neonatal and infant mortality in India

Evidence on the impact of the quality of prenatal care on childhood mortality is limited in developing countries, including India. Therefore, using nationally representative data from the latest round of the National Family Health Survey (2015-16), this study examined the impact of the quality of prenatal care on neonatal and infant mortality in India using a multivariable binary logistic regression model. The effect of the essential components of prenatal care services on neonatal and infant mortality were also investigated. The results indicate that improvement in the quality of prenatal care is associated with a decrease in neonatal (OR: 0.93, 95% CI: 0.91-0.97) and infant (OR: 0.94, 95% CI: 0.92-0.96) mortality in India. Tetanus toxoid vaccination, consumption of iron-folic acid tablets during pregnancy and having been weighed during pregnancy were statistically associated with a lower risk of neonatal and infant mortality. Educating women on pregnancy complications was also associated with a lower risk of neonatal mortality. No effect of blood pressure examination, blood test and examination of the abdomen during pregnancy were found on either of the two indicators of childhood mortality. Although the coverage of prenatal care has increased dramatically in India, the quality of prenatal care is still an area of concern. There is therefore a need to ensure high-quality prenatal care in India.

Tetanus Toxoid Vaccination coverage and Reason for non-vaccination among females of reproductive age group

Tetanus Toxoid Vaccination coverage and Reason for non-vaccination among females of reproductive age group

Effectiveness of booster dose of tetanus and diphtheria toxoids (Td) vaccine in management of recurrent aphthous stomatitis: a prospective, randomized, triple-blind and placebo-controlled clinical trial

Background Recurrent aphthous stomatitis (RAS) is the most common oral disease. The activation of the immune system by vaccines might reduce the interactions between oral mucosa and microorganisms. Aim To evaluate the effect of the tetanus-diphtheria toxoids (Td) vaccine in management of RAS. Design and setting This prospective, randomized, triple-blind and placebo-controlled clinical trial study was conducted on 70 eligible patients with minor RAS at the dermatology outpatient clinic. Method Finally, a total of 66 participants (48 male, 18 female; mean age: 38.56 ± 10.98 years) completed the study in two groups, one in which colchicine and a single dose of vitamin B6 (placebo group) was treated and one in which colchicine and a single dose of Td vaccine (intervention group) was treated. Results After six months of follow-up, the patients were evaluated, which revealed significant effects of the Td vaccine on pain intensity, ulcer size, recovery time, and the interval between episodes. At the end of the six month follow-up, 27 patients (81.8%) in the intervention group and 13 patients (39.4%) in the placebo group showed partial or complete recovery, and there was statistically significant difference between the groups (p < .001). Recovery was not significantly associated with sex, education level, marital status and duration of RAS. However, occupation and positive family history of RAS had significant relations with recovery. Conclusions A booster dose of Td vaccine had relatively favorable effects on pain intensity and recurrence of RAS, but further research is needed to confirm its efficacy.

A Survey on Tetanus Toxoid (TT) Vaccination Status of Women of Reproductive Age (15 - 49 years) in a Rural Community of Satkhira

Background: Tetanus is a preventable disease. No age is immune unless protected by previous vaccination. Infection generally occurs through wound infection and unhygienic condition of child birth.&#x0D; Objective: To find out the TT vaccination status of women of reproductive age group.&#x0D; Materials and Method: This cross-sectional type of descriptive study was carried out during January, 2017 to May 2017. Data were collected from 219 respondents selected by purposive type of sampling through face to face interview using a pretested mixed type of questionnaire.&#x0D; Results: Among total respondents, majority 53 (24.20%) were belonged to 20-25 years of age group. Two hundred and fourteen (97.71%) of total respondents had knowledge about TT vaccination. In present study, 184 (84.02%) had coverage and among them 93 (42.47%) of respondents had completed their vaccination (5 doses). One hundred and seventy (92.39%) of respondents received vaccination from government organization. Current study also reflects gradual increase in health consciousness among young women as 44 (28.38%) of respondents completed vaccination before their first pregnancy.&#x0D; Conclusion: Acceptance of TT vaccination has been increased up to a satisfactory level. Another large scale study is recommended to find out TT coverage among all women of reproductive age group (15-49 years) of Bangladesh.&#x0D; KYAMC Journal Vol. 10, No.-2, July 2019, Page 73-76

Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning

BackgroundSafe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs. MethodsPATH and the University of Malawi’s Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers. ResultsWe identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers’ views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs. ConclusionsLessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.

In silico rational design of a novel tetra-epitope tetanus vaccine with complete population coverage using developed immunoinformatics and surface epitope mapping approaches

Presentation of many unwanted epitopes within tetanus toxoid vaccine to lymphocyte clones may lead to production of many unwanted antibodies. Moreover an ideal vaccine must cover all individuals in a population that is dependent to the kinds of human leukocyte antigen alleles. Concerning these issues, our study was aimed to in silico design of a multi-epitope tetanus vaccine (METV) in order to improve population coverage and protectivity of tetanus vaccine as well as reduction of complications. Concerning these issues, a novel rational filtration was implemented to design a novel METV using immunoinformatics and surface epitope mapping approaches.Prediction of epitopes for tetanus toxin was performed in the candidate country in which the frequency had been gathered from almost all geographical distributions. The most strong binder epitopes for major histocompatibility complex class II were selected and among them the surface epitopes of native toxin were selected. The population coverage of the selected epitopes was estimated. The final candidate epitopes had highly population coverage. Molecular docking was performed to prediction of binding affinity of our candidate epitopes to the HLA-DRB1 alleles.At first, 680 strong binder epitopes were predicted. Among them 11 epitopes were selected. Finally, 4 epitopes had the most population coverage and suggested as a tetra-epitope tetanus vaccine. 99.41% of inessential strong binders were deleted using our tree steps filtration. HLA-DP had the most roles in epitope presentation. Molecular docking analysis proved the strong binding affinity of candidate epitopes to the HLA-DRB1 alleles.In conclusion, we theoretically reduced 99.41% of unwanted antibodies using our novel filtration strategies. Our tetra-epitope tetanus vaccine showed 100% population coverage in the candidate country. Furthermore, it was demonstrated that HLA-DP and HLA-DQ had more potential in epitope presentation in comparison to HLA-DRB1.

Why Should We Advocate Maternal Immunization?

Maternal vaccination provides a method for protecting the pregnant woman, fetus and neonate during a period when there is increased susceptibility to infectious diseases. A dynamic state of immune tolerance during pregnancy and the need to develop adaptive memory to a new foreign antigen-rich environment lead to windows of vulnerability to infection for the mother and neonate, respectively. Passive transfer of humoral immunity through the placenta and breast milk from the mother can bridge the gap in immunity for the neonate. Studies on boosting this natural process of antibody transfer have led to the recommendation for administering inactivated influenza, diphtheria, tetanus toxoid and acellular pertussis vaccines during pregnancy. Several new maternal vaccine candidates are on the horizon.

Common Genetic Variations Associated with the Persistence of Immunity following Childhood Immunization

Vaccines have revolutionized public health, preventing millions of deaths each year, particularly in childhood.Yet, there is considerable variability in the magnitude and persistence of vaccine-induced immunity. Maintenance of specific antibody is essential for continuity of vaccine-induced serological protection. We conducted a genome-wide association study into the persistence of immunity to three childhood vaccines: capsular group C meningococcal (MenC), Haemophilus influenzae type b, and tetanus toxoid (TT) vaccines. We detail associations between variants in a locus containing a family of signal-regulatory proteins and the persistence MenC immunity. We postulate a regulatory role for the lead SNP, with supporting epigenetic and expression quantitative trait loci data. Furthermore, we define associations between SNPs in the human leukocyte antigen (HLA) locus and the persistence of TT-specific immunity. Moreover, we describe four classical HLA alleles, HLA DRB1∗0301, HLA DQB1∗0201, HLA DQB1∗0602, and HLA DRB1∗1501, associated with TT-specific immunity, independent of the lead SNP association.

Vaccine immune response, autoimmunity and morbidity after neonatal blood exchange transfusion

IntroductionA blood exchange transfusion (BET) is most commonly performed to treat severe neonatal haemolytic disease. A distinct form of blood transfusion adverse reaction is transfusion-related immunomodulation. The purpose of our retrospective single-centre case-control cohort study was to investigate whether a blood exchange transfusion in the neonatal period provokes immunomodulation and affects humoral immune response to vaccination, morbidity and occurrence of autoantibodies. MethodsStudy subjects were 74 apparently healthy children, who were born at term as appropriate for gestational age and received four doses of diphtheria and tetanus toxoid vaccine. Forty-one received BET due to neonatal hemolytic disease and no other blood product afterwards, while 33 did not receive any blood products. Analysis of diphtheria, tetanus and autoimmune antibodies was performed and their medical records were analyzed for infectious, allergic, cancerous and autoimmune diseases. ResultsA clearly exaggerated immune response to diphtheria (1.016 IU/mL, 95% confidence interval (CI) 0.662–1.369 IU/mL vs. 0.515 IU/mL, 95% CI 0.363 to 0.626 IU/mL, P = 0.011) and slightly exaggerated immune response to tetanus vaccine (1.798 IU/mL, 95% CI 1.180–2.416 IU/mL vs. 1.036 IU/mL, 95% CI 0.398–1.673 IU/mL, P = non-specific) were observed in BET subjects. A propensity towards autoimmunity (25.8% vs. 12.5%, P = non-specific) was observed in BET subjects. However, BET in the neonatal period did not influence the occurrence of bacterial, childhood viral diseases with exception of varicella (43.9% vs. 21.2%, P = 0.040), autoimmune and cancer diseases. ConclusionBET impacted humoral immune response to diphtheria and tetanus vaccine and occurrence of autoimmune antibodies, but did not affect morbidity and the occurrence of autoimmune diseases. These effects could be related to massive antigenic load of BET and an accelerated priming of immune cells and consequent immunomodulation.

Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care.

IntroductionDespite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania.MethodsData from the 2014–2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to ≥60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level.ResultsA total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%–60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8–16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3–3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3–4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4–5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1–3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1–3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1–8.4] were significantly associated with better adherence to first-visit antenatal care standards.ConclusionsThe study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.

Extended delivery of vaccines to the skin improves immune responses

Vaccines prevent 2–3 million childhood deaths annually; however, low vaccine efficacy and the resulting need for booster doses create gaps in immunization coverage. In this translational study, we explore the benefits of extended release of licensed vaccine antigens into skin to increase immune responses after a single dose in order to design improved vaccine delivery systems. By administering daily intradermal injections of inactivated polio vaccine according to six different delivery profiles, zeroth-order release over 28 days resulted in neutralizing antibody titers equivalent to two bolus vaccinations administered one month apart. Vaccinations following this profile also improved immune responses to tetanus toxoid and subunit influenza vaccine but not a live-attenuated viral vaccine, measles vaccine. Finally, using subunit influenza vaccine, we demonstrated that daily vaccination by microneedle patch induced a potent, balanced humoral immunity with an increased memory response compared to bolus vaccination. We conclude that extended presentation of antigen in skin via intradermal injection or microneedle patch can enhance immune responses and reduce the number of vaccine doses, thereby enabling increased vaccination efficacy.

Role of Health Education in Raising Tetanus Toxoid Vaccination Coverage among Pregnant Women and Mothers with Newborns in Khartoum North-Sudan, 2019

&lt;p&gt;&lt;em&gt;Tetanus is an acute disease caused by the toxin of a bacterium called C&lt;/em&gt;&lt;em&gt;lostridium tetani which is often found in soil. It is a life-threatening bacterial disease, which causes severe mortality among maternal, neonatal, and young infant. It is so serious even it can waste pregnancy, harm her baby during pregnancy or after delivery. A quasi experimental community based study was conducted among pregnant women and mothers with newborns in Khartoum North Locality from 2015-2019 with the aim to assess the effectiveness of health education intervening in raising tetanus toxoid vaccination coverage among pregnant women and mothers with new born. 266 participants were selected by using a systematic random sampling technique. The intervention that continued for six months includes; health talks, home visits, video show, presentations with power points, focus groups discussion, exhibitions, distribution of printed materials, pamphlets, brochures and posters. The data was statistically analyzed by using the (SPSS) and significant t and &lt;/em&gt;&lt;em&gt;c&lt;/em&gt;&lt;em&gt;2 - tests. The result showed a significant increase in the participants’ knowledge after the intervention towards tetanus toxoid at P value 0.00, the mode of infection with tetanus at P value 0.00, vulnerable group to tetanus at p value is 0.00, the seriousness of the tetanus at P value 0.00, neonatal tetanus at P value 0.00. There was a significant positive modification of the participants’ attitudes towards the easiness to communicate with the health workers at P value 0.00. The result showed a significant change in the participants’ practices towards vaccination against tetanus toxic at P value 0.00 and significant change towards taking vaccine dose regularly at P value 0.00. The study recommended that Federal Ministry of Health has to conduct many health education interventions to raise the tetanus toxoid vaccination coverage. &lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Evaluation of pneumococcal and tetanus vaccine responses in patients with rheumatoid arthritis receiving baricitinib: results from a long-term extension trial substudy

BackgroundClinical guidelines recommend pneumococcal and tetanus vaccinations in patients with rheumatoid arthritis (RA). Baricitinib is an oral, selective Janus kinase (JAK) 1/JAK 2 inhibitor and is approved for the treatment of moderately to severely active RA in adults in over 50 countries including European countries, the USA, and Japan. This substudy evaluated pneumococcal conjugate and tetanus toxoid vaccine (TTV) responses in patients with RA receiving baricitinib. These vaccines elucidate predominantly T cell-dependent humoral antibody response.MethodsEligible RA patients receiving baricitinib 2 mg or 4 mg with or without concomitant methotrexate (MTX) were enrolled in a phase 3 long-term extension trial (RA-BEYOND; ClinicalTrials.gov, NCT01885078) in USA/Puerto Rico. Patients were vaccinated with 13-serotype pneumococcal conjugate vaccine (PCV-13) and TTV. Primary endpoints were the proportion of patients achieving a satisfactory humoral response for PCV-13 (≥ 2-fold increase in anti-pneumococcal antibody concentrations in ≥ 6 serotypes) and TTV (≥ 4-fold increase in anti-tetanus concentrations) at 5 weeks post-vaccination. Secondary endpoints included humoral responses at 12 weeks and functional responses of serotypes 4, 6B, 14, and 23F (twofold and fourfold increases in opsonic indexes at 5 and 12 weeks).ResultsOf 106 patients with a mean duration of RA of approximately 12 years, 80% were female, 30% were taking corticosteroids, and 89% (N = 94) were taking baricitinib plus MTX; most patients (97% PCV-13/96% TTV) completed the evaluations. Overall, 68% (95% CI 58.4, 76.2) of patients achieved a satisfactory response to PCV-13, 43% (34.0, 52.8) achieved a ≥ 4-fold increase in anti-tetanus concentrations, and 74% (64.2, 81.1) achieved a ≥ 2-fold increase. PCV-13 response was similar for patients taking corticosteroids (71%; 53.4, 83.9) vs those not (67%; 55.2, 76.5). The percentage of sera with a ≥ 2-fold increase in post-vaccination opsonic indexes at week 5 ranged from 47% (serotype 14) to 76% (serotype 6B). Through 12 weeks post-vaccination, seven patients (6.6%) reported injection-site events. There were no deaths during the substudy, and three patients experienced a serious adverse event.ConclusionsApproximately two thirds of patients on long-term baricitinib achieved satisfactory humoral and functional responses to PCV-13 vaccination, while TTV responses were less robust. PCV-13 response was not diminished in those taking concomitant corticosteroids.Trial registrationClinicalTrials.gov, NCT01885078. Registered on 24 June 2013.

More than a Toxin: Protein Inventory of Clostridium tetani Toxoid Vaccines.

Clostridium tetani is the etiological agent of tetanus, a life-threatening bacterial infection. The most efficient protection strategy against tetanus is a vaccination with the C. tetani neurotoxin, which is inactivated by formaldehyde-crosslinking. Since we assumed that besides the tetanus toxin, other proteins of C. tetani may also be present in toxoid preparations, we analyzed commercially available vaccines from different countries in respect to their protein content using mass spectrometry. In total 991 proteins could be identified in all five analyzed vaccines, 206 proteins were common in all analyzed vaccines and 54 proteins from the 206 proteins were potential antigens. The additionally present proteins may contribute at least partially to protection against C. tetani infection by supporting the function of the vaccine against the devastating effects of the tetanus toxin indirectly. Two different label-free protein quantification methods were applied for an estimation of protein contents. Similar results were obtained with a Total Protein Approach (TPA)-based method and Protein Discoverer 2.2 software package based on the minora algorithm. Depending on the tetanus toxoid vaccine and the quantification method used, tetanus neurotoxin contributes between 14 and 76 % to the total C. tetani protein content and varying numbers of other C. tetani proteins were detected.

Under-Five Mortality and Associated Factors: Evidence from the Nepal Demographic and Health Survey (2001⁻2016).

Child mortality in Nepal has reduced, but the rate is still above the Sustainable Development Goal target of 20 deaths per 1000 live births. This study aimed to identify common factors associated with under-five mortality in Nepal. Survival information of 16,802 most recent singleton live births from the Nepal Demographic and Health Survey for the period (2001–2016) were utilized. Survey-based Cox proportional hazard models were used to examine factors associated with under-five mortality. Multivariable analyses revealed the most common factors associated with mortality across all age subgroups included: mothers who reported previous death of a child [adjusted hazard ratio (aHR) 17.33, 95% confidence interval (CI) 11.44, 26.26 for neonatal; aHR 13.05, 95% CI 7.19, 23.67 for post-neonatal; aHR 15.90, 95% CI 11.38, 22.22 for infant; aHR 16.98, 95% CI 6.19, 46.58 for child; and aHR 15.97, 95% CI 11.64, 21.92 for under-five mortality]; nonuse of tetanus toxoids (TT) vaccinations during pregnancy (aHR 2.28, 95% CI 1.68, 3.09 for neonatal; aHR 1.86, 95% CI 1.24, 2.79 for post-neonatal; aHR 2.44, 95% CI 1.89, 3.15 for infant; aHR 2.93, 95% CI 1.51, 5.69 for child; and aHR 2.39, 95% CI 1.89, 3.01 for under-five mortality); and nonuse of contraceptives among mothers (aHR 1.69, 95% CI 1.21, 2.37 for neonatal; aHR 2.69, 95% CI 1.67, 4.32 for post-neonatal; aHR 2.01, 95% CI 1.53, 2.64 for infant; aHR 2.47, 95% CI 1.30, 4.71 for child; and aHR 2.03, 95% CI 1.57, 2.62 for under-five mortality). Family planning intervention as well as promotion of universal coverage of at least two doses of TT vaccine are essential to help achieve child survival Sustainable Development Goal (SDG) targets of <20 under-five deaths and <12 neonatal deaths per 1000 births by the year 2030.

The effectiveness and safety of pertussis booster vaccination for adolescents and adults: A systematic review and meta-analysis.

Background:Due to the resurgence of pertussis, many countries have revised the pertussis immunization schedules and recommended booster doses of pertussis component vaccine for adolescents and adults. Here we aim to investigate the effectiveness and safety of pertussis component vaccines in adolescents and adults.Methods:Based on a prospectively registered protocol, we reviewed the literature and selected trials in adolescents and adults using pertussis component vaccine. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.Results:A total of 17 clinical trials were included. At post-vaccination with pertussis component vaccine, the vaccine protective rate of pertussis reached 88.89%, the vaccine response rate of pertussis antibodies in most trials were above 85%, and the antibody titers at post-vaccination were higher than at pre-vaccination. Reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine was associated with significantly higher incidences of nausea [RR = 1.26, 95%CI:1.01, 1.57] and vomiting [RR = 2.08, 95%CI:1.21, 3.58] in acellular pertussis vaccines combined with tetanus and diphtheria (Tdap) group than diphtheria tetanus-toxoid vaccines (Td) group. Higher dose of diphtheria toxoid and adjuvant in dTap might cause higher incidence of fever.Conclusions:Except for significant difference in gastrointestinal reaction (nausea, vomiting), acellular pertussis component vaccines are quite safe and has short-term effectiveness for the adolescents and adults. The adverse event of acellular pertussis component vaccine is similar to or safer than that of placebo or other vaccines without pertussis component.

Abstract B132: A new concept of cancer immunotherapy by targeting pancreatic ductal adenocarcinoma through a childhood recall antigen

Abstract Patients with pancreatic ductal adenocarcinoma (PDAC) have a five-year survival of only 6%. Cancer immunotherapy has shown promising results for metastatic cancer but only in 20% of the patients. Our lab has developed a new concept of immunotherapy using an attenuated non-pathogenic bacterium Listeria monocytogenes for the selective delivery of a highly immunogenic recall antigen tetanus toxoid (TT) into tumor cells of pancreatic tumors and metastases. Most individuals have been exposed to TT during childhood vaccinations and memory T-cells to TT circulate in blood for live. These memory T-cells to TT can be reactivated by Listeria-TT at any time in life and will now destroy the infected tumor cells. Low doses of gemcitabine (GEM) were added to further improve T-cell responses. Panc-02 and KPC mice were immunized with the “human TT vaccine” to generate memory T-cells before development of the pancreatic cancer. After cancer development, mice were treated with Listeria-TT and GEM, and tumors (weight) and metastases (number) were analyzed by eye in the Panc-02 mice, and by SUVmax (measurement of tumor growth) in the KPC mice. T-cell responses in the spleen were analyzed by flow cytometry and ELISPOT, and KPC tumors were analyzed by RNAseq. Listeria-TT and GEM nearly completely eliminated both early and advanced pancreatic cancer in Panc-02 and KPC mice, in correlation with abundant CD4 and CD8 T-cell responses producing perforin, granzyme B, or IFNγ, in vivo or in vitro, respectively. RNAseq analysis of “treated” KPC tumors showed a strong influx of CD4 and CD8 T-cells, upregulation of multiple granzymes, perforin, co-stimulatory molecules, and cell death pathways. These results suggest the multiple synergistic effects of Listeria-TT and GEM on pancreatic cancer. This novel treatment modality of Listeria-TT and GEM warrants further investigation in a clinical setting. Citation Format: Benson C. Selvanesan, Dinesh Chandra, Wilber Quispe, Ankur Patel, Kiran Meena, Steven K. Libutti, Ziqiang Yuan, Jennifer Chuy, Claudia Gravekamp. A new concept of cancer immunotherapy by targeting pancreatic ductal adenocarcinoma through a childhood recall antigen [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B132.