Tetanus Toxoid Vaccine Research Articles

Assessment of the facilities provided to patients in selected Basic Health Units (BHUs) of Peshawar, Pakistan

Introduction: Primary health care is essential healthcare made universally accessible to individuals and acceptable to them through their full participation and at an affordable cost. It can be effectively delivered at the Basic health unit (BHU). Assessment of its performance at regular basis is also crucial for the health care system.
 Objectives: To assess the services (EPI, antenatal care and basic healthcare) provided at selected BHUs of Peshawar with a view to determine service provision gaps in these BHUs.
 Materials & Methods: It was a questionnaire based descriptive survey conducted from September to November 2019, in which simple random sampling technique was used to select 15 BHUs of district Peshawar for assessment and evaluation purposes. Data were collected using a checklist and an indigenous structured questionnaire where responses were recorded in yes/no format. Data analyzed using SPSS V.22 for descriptive statistics.
 Results: All vaccines of the EPI program were being provided in BHUs except for Hepatitis B. Regarding BHU staff, in 80% BHUs male medical officers were absent, and in 40% BHUs female medical officers were absent. For the Maternal and Child Health Care (MCHC) services, Tetanus Toxoid vaccine and Folic Acid supplements were present in all BHUs but status of malnutrition was unsatisfactory. About 80% of BHUs had a satisfactory infrastructure; the safety and sanitation precautions in BHUs were not up to the mark regarding disposal of hazardous waste and needles.
 Conclusion: Majority of the healthcare facilities were present in sampled BHUs including immunization services, MCHC services, infrastructure, safety, and sanitation. While the female staff was adequate in number, the attendance of male staff was poor.
 Primary health care; basic health unit; Immunization; Prenatal care

Tetanus vaccine coverage in recommended and more than recommended doses among mothers in a West Cameroon health district: a cross sectional study

Background: Vaccination is the best way to protect newborns and mothers against tetanus. The number of doses of Td vaccine recommended by the Expanded Program of Immunization is based on documented protective immune response. During this decade, the Foumban Health District (FHD) was the seat of an epidemic despite the satisfactory administrative immunization coverage. This study was conducted in 2019 in the FHD to assess tetanus vaccine coverage among mothers for their last pregnancy and the cumulative number of vaccine doses administered to the mothers. Method: This was a descriptive cross-sectional study conducted in the FHD in 2019. Mothers living in the district with at least one child younger than five years were included and were selected by random stratified cluster sampling. Trained surveyors used a face-to-face questionnaire, data extraction grid and data-tracking grid to review and collect data from antenatal care booklets, vaccination cards and the women’s own reports of immunization. The immunization coverage per vaccine dose and vaccination completeness rate were estimated. Results: From 621 women visited, 602 (96.9%) responded. A total of 176/511 women (34.4%) had evidence of vaccination. For the last pregnancy, the two-dose immunization proportion was 21.7% (111/511) for documented coverage and 47.6% (243/511) for undocumented coverage. 306/570 women (53.7%) had received more than the recommended five doses necessary for lifetime protection. The recruitment, two and five doses completeness rates were 99.9% (569/570), 95.8% (546/570) and 65.3% (372/570), respectively. Conclusion: More than half of mothers received more doses of tetanus toxoid vaccine than necessary in FHD. This increased the resources needed and the cost of vaccination. Health personnel should be trained and supervised to assess pregnant women’s vaccination status before planning the number of vaccine doses to be administered during pregnancy.

Tetanus Toxoid Vaccination Status of Women of child bearing age in Rangamati Pourashava

Tetanus Toxoid (TT) is a routine vaccination activity under Expanded Program on Immunization (EPI) in Bangladesh. This was a descriptive type of cross-sectional study with a sample size of 110, selected purposively by non-probability sampling technique. Data were collected through a pretested questionnaire. The aim of this study was to assess TT vaccination coverage among the women of child bearing age, Rangamati Pourashava. As per survey, among 110 respondents, 29 (26.4%) were of 15-25 years, 52 (47.3%) were of 26-35 years, 25(22.7%) were of 36-45 years & only 4(3.6%) were of >45years. In this study, the major group, 86(78.2%) were married, 17(15.4%) were unmarried & only 7 (6.4%) were widow. Most of the respondents considered vaccination as the way of disease prevention, so that the coverage being 92 (83.6%) in case of TT vaccination. It was found that 70% women received TT vaccine from Government EPI centers followed by 23.6% from NGO facilities and only6.4% from private clinics. Among the respondents, 56.3% respondents had completed their dose schedule of TT vaccine respectively. Most of the respondents had their vaccination card. The percentage was 70 for TT respectively. Among others, 20% failed to follow it because of forgetfulness of doses and 3.34% because of losing their card. So, TT vaccination coverage among the women of child bearing age was satisfactory but it also suggests that more awareness campaign for vaccination is sensational among the mass people of our country. This study TT vaccination status among women of child bearing age will help to get idea about the woman of our country regarding the situation.
 Mediscope Vol. 8, No. 1: January 2021, Page 40-44

Pertussis in infants in Nordic countries.

A life-course immunisation approach is required to prevent and control pertussis. We aimed at reviewing pertussis incidence among infants in Denmark, Finland, Norway and Sweden, and at putting these data in the context of national surveillance systems and vaccination schedules. We collected 2014-2018 data on pertussis incidence, on pertussis vaccination schedules and on coverage of the third dose of the diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine from publicly available sources. We gathered opinions on national surveillance systems from public health and paediatrics experts of the relevant countries. The pertussis vaccination schedules and coverage in infancy were similar across countries. All countries except Denmark recommended an additional booster vaccine dose for adolescents. None of the countries had maternal immunisation recommendation. Mean pertussis incidence in Denmark, Sweden and Finland was 168, 76 and 35 per 100,000 infant-years, respectively. Data were insufficient to derive a mean incidence in Norway. There were no systematic differences in the national surveillance systems across the countries. The higher mean pertussis incidence in Denmark may be explained by the lack of recommendations for adolescent pertussis booster vaccination. Further investigations are warranted.

Vaccines - safety in pregnancy.

Vaccination during pregnancy is important for active immunity of the mother against serious infectious diseases, and also for passive immunity of the neonate to infectious diseases with high morbidity and mortality. As a rule, live vaccines are contraindicated during pregnancy as they may cause fetal viremia/bacteremia. Inactivated vaccines are generally safe.Vaccines safe to be administered to all pregnant ladies are tetanus toxoid (TT; tetanus, diphtheria, acellular pertussis (Tdap) and Flu vaccines. During pre-pregnancy counselling, vaccination for MMR (measles, mumps, and rubella) should be offered, with an advice to avoid pregnancy for a month. All pregnant mothers should receive TT and Tdap vaccination during the third trimester. Flu vaccine can be given to all mothers at any gestation, and if not offered during pregnancy, it can be given postpartum.Vaccinations that should be offered to women if at high risk of exposure are for hepatitis A and B, pneumococcal, meningococcal, yellow fever, Japanese encephalitis (JE), polio, typhoid, and cholera infections.Vaccines to be given only for post-exposure prophylaxis (PEP) are smallpox, rabies, and anthrax. Postpartum women should be offered human papillomavirus (HPV) vaccination. If not immunized earlier, they should be offered MMR, Tdap, and Flu vaccines. Future vaccines being developed are for malaria, Zika virus, respiratory syncytial virus (RSV), group B streptococcus, CMV, and COVID-19 (SARS-Cov-2).

Determinants of vaccination dropout among children 12-23 months age in north Gondar zone, northwest Ethiopia, 2019.

BackgroundVaccination is a proven tool in preventing and eradicating childhood infectious diseases. Each year, vaccination averts an estimated 2–3 million deaths from vaccine preventable diseases. Even though immunization coverage is increasing globally, many children in developing countries still dropout vaccination. The objective of this study was to identify determinants of vaccination dropout among children age 12–23 months in North Gondar, North west Ethiopia.MethodsCommunity based unmatched case-control study was conducted in north Gondar from March 1–27, 2019 among 366 children age 12–23 months (92 cases and 274 controls). Multistage sampling was used for reaching to the community. Data were collected from mothers who had 12–23 months age children using a pretested structured face to face interview. Data were entered using Epi info v. 7 and exported to SPSS v. 20 for analysis. On multivariable logistic regression variables with P-value <0.05 at 95% CI were considered statistically significant.ResultCounseling for mothers about vaccination (AOR = 7.2, 95% CI: (2.93–17.5)); fear of vaccine side effects (AOR = 3.5, 95% CI: (1.56–8.12)); PNC attended (AOR = 3.6, 95% CI: (1.52–8.39)) and mothers not received tetanus toxoid vaccination (AOR = 2.4, 95% CI: (1.03–5.35)) were found risk factors of vaccination dropout.ConclusionCounseling on vaccination, fear of vaccine side effects, PNC attended and mothers’ tetanus toxoid vaccination status during ANC visit were found risk factors. Management bodies and health workers need to consider “reaching every community” approach, Counsel every mother at any opportunity, and provide TT vaccination for all pregnant mothers helps to reduce vaccination dropout among children.

COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

Community pharmacy role in universal health coverage was a qualitative study that entailed close contact to the role played by community pharmacies in healthcare provision. As a "small healthcare" in provision of pharmaceutical services, community pharmacies are required to be included in realization of Universal Health Coverage in Mombasa since it is among the Big 4 Agenda of the national government (MOH, 2013). The objective of the study was to determine community pharmacy role in universal health coverage. A descriptive cross sectional study design was used to collect both qualitative and quantitative data and the design estimate the prevalence of the outcome of interest commonly for the purpose of public health planning. A sample size of 196 was calculated using fishers formula. Data was collected using in-depth interviews and structured questionnaire were administered on a target population of community pharmacies health providers and clients seeking services respectively. The collected data was analysed using SPSS version 20 and interpreted using tables and pie charts. On community pharmacy practitioners respondents; 58% were male, 90.3% diploma holders in pharmacy, 39.8% registered with PPB and 65% had practised for less than two years. 78% of the respondents agree that community pharmacy has a role in UHC and there was 74% affordability of community pharmacy medicines. Bivariate analysis findings show that training and inspection on UHC (P=0.003) Covid 19 (p=0.000) and inspection fee (p=0.000). Accessibility; location of community pharmacies (p=0.000) and doctors attitudes (p=0.000). Essential medicines; acyclovir 200mg tablets (p=0.000), chlorpromazine 100mg tablets (p=0.000) and tetanus toxoid vaccine (p=0.000). Key determinants of community pharmacy role in UHC were diploma (AOR 666.7; CI 129.6-3429.5), Erythromycin 125mg suspension (AOR 120.3; CI 15.4-940.8), Acyclovir 200mg tablets (AOR 46.823; CI 17.7-124.1) and Occupation (AOR 45.271; CI 15.363-133.404. The study recommends reduction of tax on essential medicines, MOH revise the UHC policy to incorporate community pharmacies and empowerment on management of controlled drugs and vaccines in order to realize effective and efficient UHC in Kenya

Safety of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccine in Adults in Japan.

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is generally used for booster vaccination of infants in Europe and the United States to avoid increased reactogenicity after diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccination. However, Japan has extended the use of additional DTaP vaccination without reducing the antigen dose for diphtheria and pertussis in adolescents and adults, despite limited reports on its safety in adults. This prospective, observational, questionnaire-based study investigated the occurrence of adverse events (AEs) following DTaP vaccination between June 2018 and June 2019 in participants aged 10 years or older. Of the 250 eligible participants, 235 (94%) responded regarding AEs. Among them, 133 (56.6%) reported AEs, of which 39 reported systemic AEs (16.6%) and 120 reported local AEs (51.1%) attributed to DTaP vaccination. The incidence of local AEs was markedly higher with DTaP vaccination than with non-DTaP vaccination (51.1% vs. 10.5%), and AEs appeared later (P < 0.01) and lasted longer (P < 0.01) with DTaP vaccination. However, more than 75% of these AEs resolved within 7 days. DTaP vaccination was not associated with any serious AEs. These results indicate that the DTaP vaccine can be widely used as a booster in adults as an alternative to the Tdap vaccine.

Neonatal mortality in the central districts of Ghana: analysis of community and composition factors

BackgroundCommunities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana.MethodsThis was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality.ResultsRegarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05–1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08–1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02–1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51–0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18–0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94–0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45–0.70), private maternity home (aHR = 0.45, 95% CI: 0.30–0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26–0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52–0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85–0.97) had lower risk of mortality.ConclusionThe findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.

Biological properties the novel application of N-trimethyl chitosan nanospheres as a stabilizer and preservative in tetanus vaccine.

PurposeChitosan is a natural polymer that has excellent properties include biocompatibility, biodegradability, no cytotoxicity, high charge density, low cost, mucoadhesive, permeation enhancing (ability to cross tight junction), and immunomodulating ability that makes the spectrum of its applicability much broader. This study was conducted to investigate the stabilizing, preservative and immunogenicity properties of N-trimethyl chitosan nanospheres (N-TMCNS).Materials and MethodsThe tetanus toxoid (TT) was encapsulated into N-TMCNS and then characterized by scanning electron microscope, atomic force microscope, and dynamic light scattering. For stabilizer assay of N-TMCNS after storage of TT-N-TMCNS at different temperatures for 3 weeks, they were used for immunization of mice and different temperatures groups' anti-TT-N-TMCNS production compared with other groups. Finally, the immunized mice were challenged with tetanus toxin. The preservation activity of TT-N-TMCNS against Escherichia coli was compared with thimerosal formulated TT.ResultsOur results revealed that heat-treated TT-N-TMCNS could induce higher titer of neutralizing immunoglobulin G in compared to TT vaccine and was able to protect the mice better than TT vaccine in challenge test. Furthermore, N-TMCNS as a preservative inhibited the growth of E. coli more effective than thimerosal.ConclusionOverall, the obtained results indicated that the N-TMCNS is one of the best stabilizer and preservative agent that can be used in the formulation of TT vaccine.

Factors Associated with Maternal Tetanus Vaccination in Myanmar: An Analysis of Demographic and Health Survey Data

Background: Tetanus toxoid vaccination is a life-saving maternal and child health intervention. Understanding gaps in maternal vaccination coverage is key to informing progress towards universal health coverage. We assessed maternal tetanus vaccination coverage in Myanmar and investigated factors associated with being unvaccinated. Method: We analysed 2015-16 Demographic and Health Survey data including women aged 15-49 years with at least one childbirth in the last five years. The outcome was self-reported receipt of tetanus vaccine at least once during the last pregnancy. We used logistic regression models to assess factors associated with being unvaccinated. Results: Overall maternal tetanus vaccination coverage was 85·7%. Sub-national coverage was lowest in the predominantly ethnic minority states of Shan, Kayin, and Chin at 69·6%, 77·4%, and 79·9%, respectively. Factors associated with a lack of vaccination were: not receiving antenatal care (odds ratio (OR): 18·99, 95% confidence interval (CI): 14·21, 25·39); receiving antenatal care at home (OR: 2·05, 95% CI: 1·46, 2·88), private and non-governmental organization clinics (OR: 2·88, 95% CI: 1·81, 4·58, compared to public facilities); and not wanting to go to a health facility alone (OR: 1·53, 95% CI: 1·14, 2·06). Higher educational attainment was associated with lower odds of being unvaccinated (OR: 0·48, 95% CI: 0·32, 0·70 for secondary relative to no education). Interpretation: We identified regional, structural, and individual differences in maternal tetanus vaccination coverage. Achieving universal coverage of maternal tetanus vaccination will largely depend on the ability to provide accessible antenatal care to most women who do not currently receive it. Funding Statement: No funding was received for this work. Declaration of Interests: We declare no competing interest. Ethics Approval Statement: Ethical approval was not required as this is a secondary analysis of publicly available data.

1552. Clinical Outcomes and Healthcare Costs of Inpatients with Tetanus in Korea in 2011–2019

BackgroundWe aimed to investigate the recent trend of clinical outcomes and medical costs of inpatients with tetanus, which is a rare, vaccine-preventable but extremely grave disease, in Korea, in 2011–2019 for the first time.MethodsFrom January 2011 to October 2019, this study examined 49 patients with tetanus admitted in 2 national university hospitals in Gwangju and Daegu of South Korea. Patients’ medical records were retrospectively reviewed to determine the clinical factors and medical cost for tetanus management.ResultsThe mean age was 65.3 ± 16.1 years and 32 (65.3%) of them were female. All patients (100.0%) had generalized tetanus, and 5 (10.2%) died during admission. The median duration from symptom onset to hospital visit was 4 days. Trismus (85.7%) was the most common symptom, and wound of the lower extremities (24.5%) was the most frequent presumed entry site of toxin. Only 6 (15.0%) patients were operated for wound management. The median hospital stay was 39 (9; 49) days. Furthermore, 32 (65.3%) needed mechanical ventilation, and 20 (40.8%) patients developed aspiration pneumonia. The median total healthcare cost was 21,072 KRW(Korean Republic Won) (17,560 USD(United States Dollar); 1 USD = 1200 KRW) per person. After discharge, 35 (79.5%) patients fully recovered without any disability.ConclusionTetanus remains a grave disease that requires long duration of admission and huge medical cost in Korea. The completion rate of 3-time tetanus toxoid (Td) or tetanus toxoid, acellular pertussis and diphtheria vaccine (Tdap) vaccination was low; thus, the medical staff needs to establish more medical advice or policies to the general population of KoreaDisclosures All Authors: No reported disclosures

Does tetanus vaccination contribute to reduced severity of the COVID-19 infection?

We present the hypothesis to the scientific community actively designing clinical trials and recommending public health guidelines to control the pandemic that – “Tetanus vaccination may be contributing to reduced severity of the COVID-19 infection” – and urge further research to validate or invalidate the effectiveness of the tetanus toxoid vaccine against COVID-19. This hypothesis was revealed by an explainable artificial intelligence system unleashed on open public biomedical datasets. As a foundation for scientific rigor, we describe the data and the artificial intelligence system, document the provenance and methodology used to derive the hypothesis and also gather potentially relevant data/evidence from recent studies. We conclude that while correlations may not be reason for causation, correlations from multiple sources is more than a serendipitous coincidence that is worthy of further and deeper investigation.

Levels of antibodies specific to diphtheria toxoid, tetanus toxoid, and Haemophilus influenzae type b in healthy children born to Tdap-vaccinated mothers

IntroductionVaccination of pregnant women protects both women and their newborns against some infectious diseases. Thailand implemented tetanus toxoid (TT) vaccination of pregnant women in 1977, which was replaced by tetanus–diphtheria toxoid (dT) vaccination in 2005. The tetanus–diphtheria–acellular pertussis (Tdap) vaccine has been recommended for pregnant women at 27–36 weeks of gestation since 2012 in several countries. Data on antibody responses to diphtheria toxoid (DT), TT, and Hemophilus influenzae type b (Hib) induced by combined vaccines in children born to TT-vaccinated and/or Tdap-vaccinated mothers are limited. Material and methodsWe investigated anti-DT, anti-TT, and anti-Hib IgG responses in a cohort of Thai children (ClinicalTrial.gov NCT02408926) born to mothers who received a TT-containing and/or the Tdap vaccine during pregnancy. Children born to Tdap-vaccinated mothers were randomized to receive either a hexavalent (Infanrix-hexa) or pentavalent (Quinvaxem) vaccine, whereas children born to TT-vaccinated mothers received only Quinvaxem vaccine at 2, 4, 6, and 18 months of age. IgG levels were evaluated at birth (cord blood), 2 (pre-primary), 7 (post-primary), 18 (pre-booster), and 19 months of age (post-booster) using a commercially available enzyme-linked immunoassay. ResultsSeroprotective concentrations of anti-DT, anti-TT, and anti-Hib IgG were achieved in >90% and >99% of children following primary and booster vaccination, respectively. Among children born to Tdap-vaccinated mothers, the pentavalent vaccine induced higher levels of anti-Hib IgG than the hexavalent vaccine after primary and booster vaccination. Significantly higher anti-Hib IgG levels were observed among children receiving the pentavalent vaccine and who were born to TT-vaccinated mothers than among children receiving the pentavalent vaccine and born to Tdap-vaccinated mothers after primary and booster vaccination. ConclusionsVaccination with a TT-containing and/or the Tdap vaccine during pregnancy did not compromise the seroprotection rate achieved following primary and booster immunization in individuals receiving either the pentavalent or hexavalent vaccine.

Evaluation of a recombinant tetanus toxin subunit vaccine

Tetanus is an acute, fatal disease caused by exotoxin produced by Clostridium tetani. The current vaccine against tetanus is based on inactivated tetanus toxin (TeNT). To develop a recombinant TeNT vaccine suitable for replacement of full-length tetanus toxoid (TT) vaccine for use in humans, a recombinant non-tagged isoform of the Hc domain of the tetanus toxin (THc) was expressed in Escherichia coli and purified by sequential chromatography steps. The immunogenicity and protective effect of the THc antigen were explored and compared with those of TT in Balb/c mice. The THc-based subunit vaccine provided complete protection against TeNT challenge following a high dosage as a toxoid vaccine. While the anti-THc and neutralising antibody titres were higher for the THc-based vaccine than the TT vaccine because protective epitopes are located on the THc domain. Frequency- and dose-dependent immunoprotection were also observed in THc-immunised mice. Mice immunised with one injection of 1 μg or 4 μg THc antigen were completely protected against 102 or 103 50% mouse lethal dose (LD50) of TeNT, respectively. Furthermore, the THc protein was found to recognise and bind to ganglioside GT1b in a dose-dependent manner, and anti-THc sera antibodies also inhibited binding between THc and GT1b. Antigen on the form of recombinant non-tagged THc domain expressed in E. coli achieved strong immunoprotective potency, suggesting that it could be developed into a candidate subunit vaccine against tetanus as an alternative to the current TT vaccine.

Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization

BackgroundMaternal neonatal tetanus is a substantial public health problem in many developing countries. In 2017, nearly, 30,848 newborns died of neonatal tetanus; thus, high immunization coverage remains a necessity. This study aims to assess knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization.MethodsA cross-section survey of 700 females attending health offices in Alexandria was done using an interview questionnaire to collect data regarding women’s knowledge and beliefs about tetanus toxoid vaccine (TTV) and maternal and neonatal tetanus (MNT). Nine health offices were selected using multi-stage random sampling.ResultsMost of studied women (83.6%) had poor knowledge of MNT and TTV. The highest percentage of women had low perception of susceptibility to MNT (48.0%), moderate perception of severity of MNT (57.4%) and barriers to TTV (58.9%), high perception of benefits of TTV (86.6%), and high self-efficacy in taking the vaccine (76.2%). Less than one-third of the sampled women (27.7%) were immune by (TT2+). Logistic regression models showed that the place of antenatal care, level of knowledge, perceived barriers, and socio-economic level were significant predictors of immunity status (p = 0.008, p = 0.032, p = 0.011, and p = 0.001, respectively).ConclusionWomen lacked information about MNT/TTV and may even have been discouraged by their private obstetricians from taking the vaccine. Perceived barriers to receiving tetanus toxoid vaccination were shown to be an important predictor of immunization behavior

Immunogenicity, safety, and reactogenicity of combined reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine administered as a booster vaccine dose in healthy Russian participants: a phase III, open-label study

ABSTRACT As vaccine-induced immunity and protection following natural pertussis infection wane over time, adults and adolescents may develop pertussis and become transmitters to unprotected infants. In Russia, diphtheria and tetanus but not pertussis-containing vaccines are registered for older children, adolescents, or adults. The reduced-antigen-content diphtheria toxoid, tetanus toxoid, and acellular pertussis (dTpa) vaccine (Boostrix, GSK) was developed for booster vaccination of children ≥4 years of age, adolescents, and adults. A phase III, open-label, non-randomized study was performed in eight centers in Russia between January and July 2018. The objective of this study was to assess immunogenicity, reactogenicity and safety of a single dose of dTpa vaccine in healthy Russian participants ≥4 years of age (age categories 4–9 years, 10–17 years, 18–64 years, and ≥65 years). At 1 month post-booster vaccination, across all age groups, >99.0% of participants were seroprotected against diphtheria and tetanus and >96.0% of participants were seropositive for anti-pertussis antibodies. For all antibodies across all age groups, antibody GMCs increased from pre- to 1 month post-booster vaccination and booster responses to diphtheria (in 71.5% of participants), tetanus (85.3%), and pertussis antigens (≥85.6%) were observed. One serious adverse event that was not causally related to the study vaccine was reported. No fatal cases were reported throughout the study period. In conclusion, administration of the dTpa vaccine as a booster dose in healthy Russian participants induced a robust immune response to all vaccine antigens and was generally well tolerated across all age groups.

Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis

The phase IIIb A Study to Evaluate the Effects of Ocrelizumab on Immune Responses in Participants With Relapsing Forms of Multiple Sclerosis (VELOCE) study (NCT02545868) assessed responses to selected vaccines in ocrelizumab (OCR)-treated patients with relapsing multiple sclerosis. Patients were randomized 2:1 into the OCR group (n = 68; OCR 600 mg) or control group (n = 34; interferon beta or no disease-modifying therapy). All received tetanus toxoid (TT)-containing vaccine, Pneumovax (23-valent pneumococcal polysaccharide vaccine [23-PPV]), and keyhole limpet hemocyanin (KLH). The OCR group was subdivided into OCR1 (n = 33) and OCR2 (n = 35) at randomization. The OCR1 group received Prevnar (13-valent conjugate pneumococcal vaccine) 4 weeks after 23-PPV; the OCR2 and control groups received influenza vaccine. Vaccinations started 12 weeks after OCR initiation (OCR group) or on day 1 (control group). Positive response rate to TT vaccine at 8 weeks was 23.9% in the OCR vs 54.5% in the control group. Positive response rate to ≥5 serotypes in 23-PPV at 4 weeks was 71.6% in the OCR and 100% in the control group. Prevnar did not enhance response to pneumococcal serotypes in common with Pneumovax. Humoral response to KLH was decreased in the OCR vs control group. Seroprotection rates at 4 weeks against 5 influenza strains ranged from 55.6% to 80.0% in the OCR2 group and 75.0% to 97.0% in the control group. Peripherally B-cell-depleted OCR recipients mounted attenuated humoral responses to clinically relevant vaccines and the neoantigen KLH, suggesting that use of standard nonlive vaccines while on OCR treatment remains a consideration. For seasonal influenza vaccines, it is recommended to vaccinate patients on OCR because a potentially protective humoral response, even if attenuated, can be expected. This study provides Class II evidence confirming that the humoral response to nonlive vaccines in patients with relapsing multiple sclerosis after OCR treatment is attenuated compared with untreated or interferon beta-treated patients, but they can still be expected to be protective. NCT02545868.

Cash-based maternal health interventions can improve childhood vaccination-Evidence from India.

Childhood vaccination has lagged in countries like India, despite its demonstrated positive effects on health outcomes like infant mortality. At the same time, many conditional cash transfer programs have been effective in improving health outcomes. We estimate the effect of the world's largest maternal health program, Janani Suraksha Yojana (JSY, maternal protection scheme), on childhood vaccination in India. We exploit exogenous variations in the expansion of the policy around the country and the fact that some key vaccines are given at or near birth to identify the effects of cash-based maternal health policy on infant immunization. We find that JSY increased the probability of Bacillus Calmette-Guérin (BCG) and diphtheria, pertussis, and tetanus toxoid (DPT) vaccination among newborns and infants. However, we find almost no significant effects on the measles vaccine, which is administered several months after birth.

Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone

BackgroundImmunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone.MethodsThis study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods.ResultsThe overall prevalence of receiving TT immunization during women’s last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639,2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well.ConclusionHigher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.