Tetanus Toxoid Research Articles

Tetanus Cases in Mogadishu-Somalia: A Tragic Disease Despite the Existence of a Century-Old Safe and Efficient Tetanus Vaccine.

Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities. This study includes tetanus patients who were admitted to the Recep Tayyip Erdoğan Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients' sociodemographic details. The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1-38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p<0.001), generalized/neonatal tetanus (p<0.001), high non-vaccination rate (p:0.011), antibiotic usage (p<0.001), and a positive blood culture (p<0.001). Almost all of the complications (p<0.001) and all of the deaths (p<0.001) were in the severe group. In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine's low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.

Vaccines coverage and associated factors among children aged 12–23 months in the Pawie district, Ethiopia: A cross-sectional study

BackgroundAlthough access to vaccines for children is increasing at healthcare facilities, outbreaks of vaccine preventable diseases and deaths have been reported in different areas of the Benishangul Gumuz region, in Ethiopia. Various interventions have been designed to provide vaccines for each child at an appropriate age. Still there is limited information on full vaccination coverage and associated factors among children aged 12–23 months in the Benishangul-Gumuz region, particularly in the Pawie district. MethodA community-based cross-sectional study design was used from April, 1–30, 2022 among 750 participants. Study populations were selected using a simple random sampling technique. Data was collected using structured questionnaires. Data was coded and entered into the SPSS Statistics 23.0. Bi-variable and multivariate logistic regression analyses were used to assess factors associated with the children vaccination status. Variables with p-value <0.05 were considered significantly associated with the outcome variable. ResultThe results of this study revealed that 542 (72.3 %) (95 % CI: 68.9, 75.2) of the children were fully vaccinated. Factors significantly associated with full vaccination coverage included employed mothers (AOR = 0.53, 95 % CI: 0.29, 0.95), antenatal care (ANC) follow-up (AOR = 1.74, 95 % CI: 1.00, 3.03), post-natal care (PNC) follow-up (AOR = 6.19, 95 % CI: 3.62, 10.56), health institution delivery (AOR = 4.70, 95 % CI: 1.90, 11.66), birth order of children (AOR = 3.63, CI: 2.00, 6.59), maternal tetanus toxoid (TT) vaccination (AOR = 3.05, CI: 1.36, 6.86) and knowledge of vaccination schedule (AOR = 2.49, 95 % CI: 1.19, 5.21). ConclusionsThis study revealed that among children aged 12–23 months, full vaccination coverage was notably low. Factors significantly associated with higher rates of full vaccination included mothers’ occupation, attendance at ANC visits, PNC visits, birth order of children, place of delivery, maternal awareness of vaccination schedules, and maternal TT vaccination status. These findings highlight the multifaceted influences of maternal characteristics, healthcare use patterns, and maternal knowledge on childhood vaccination in this population.

Development of a Shigella conjugate vaccine targeting Shigella flexneri 6 that is immunogenic and provides protection against virulent challenge

Immunity protective against shigella infection targets the bacterial O-specific polysaccharide (OSP) component of lipopolysaccharide. A multivalent shigella vaccine would ideally target the most common global Shigella species and serotypes such as Shigella flexneri 2a, S. flexneri 3a, S. flexneri 6, and S. sonnei. We previously reported development of shigella conjugate vaccines (SCVs) targeting S. flexneri 2a (SCV-Sf2a) and 3a (SCV-Sf3a) using a platform squaric acid chemistry conjugation approach and carrier protein rTTHc, a 52 kDa recombinant protein fragment of the heavy chain of tetanus toxoid. Here we report development of a SCV targeting S. flexneri 6 (SCV-Sf6) using the same platform approach. We demonstrated that SCV-Sf6 was recognized by serotype-specific monoclonal antibodies and convalescent sera of humans recovering from shigellosis in Bangladesh, suggesting correct immunological display of OSP. We vaccinated mice and found induction of serotype-specific OSP and LPS IgG and IgM responses, as well as rTTHc-specific IgG responses. Immune responses were increased when administered with aluminum phosphate adjuvant. Vaccination induced bactericidal antibody responses against S. flexneri 6, and vaccinated animals were protected against lethal challenge with virulent S. flexneri 6. Our results assist in the development of a multivalent vaccine protective against shigellosis.

Determination of degradation for sulfo-SIAB, SM(PEG)2, and sulfo-GMBS by RPLC-UV analysis

Bi-functional N-Hydroxysuccinimide (NHS) linkers are widely used in the conjugation processes linking an immunogen with a carrier protein capable of boosting immunity. A potential vaccine candidate against HIV-1, called fusion peptide (FP), is covalently linked to the recombinant tetanus toxoid heavy-chain fragment C (rTTHC) via this type of linker. A reversed-phase liquid chromatography (RPLC-UV) method was used to monitor the linker’s degradation kinetics in various buffers, mimicking the steps in the conjugation process. The kinetics of the reactivities of the linkers are revealed in this study and can provide a good guidance to help effective conjugation process before these linkers are completely hydrolyze to the inactive degradants. Three cross-linkers degradation pathways were evaluated: Sulfosuccinimidyl (4-iodoacetyl) aminobenzoate (Sulfo-SIAB), PEGylated SMCC (SM(PEG)2), and N-γ-maleimidobutyryl-oxysulfosuccinimide ester (Sulfo-GMBS). We have reported kinetics for Sulfo-SIAB.

Evaluation of interventions to improve timely hepatitis B birth dose vaccination among infants and maternal tetanus vaccination among pregnant women in Nigeria

Background: Nigeria has the largest number of children infected with hepatitis B virus (HBV) globally and has not yet achieved maternal and neonatal tetanus elimination. In Nigeria, maternal tetanus diphtheria (Td) vaccination is part of antenatal care and hepatitis B birth dose (HepB-BD) vaccination for newborns has been offered since 2004. We implemented interventions targeting healthcare workers (HCWs), community volunteers, and pregnant women attending antenatal care with the goal of improving timely (within 24 hours) HepB-BD vaccination among newborns and Td vaccination coverage among pregnant women. Methods: We selected 80 public health facilities in Adamawa and Enugu states, with half intervention facilities and half control. Interventions included HCW and community volunteer trainings, engagement of pregnant women, and supportive supervision at facilities. Timely HepB-BD coverage and at least two doses of Td (Td2+) coverage were assessed at baseline before project implementation (January–June 2021) and at endline, one year after implementation (January–June 2022). We held focus group discussions at intervention facilities to discuss intervention strengths, challenges, and improvement opportunities. Results: Compared to baseline, endline median vaccination coverage increased for timely HepB-BD from 2.6% to 61.8% and for Td2+ from 20.4% to 26.9% in intervention facilities (p < 0.05). In comparison, at endline in control facilities median vaccination coverage for timely HepB-BD was 7.9% (p < 0.0001) and Td2+ coverage was 22.2% (p = 0.14). Focus group discussions revealed that HCWs felt empowered to administer vaccination due to increased knowledge on hepatitis B and tetanus, pregnant women had increased knowledge that led to improved health seeking behaviors including Td vaccination, and transportation support was needed to reach those in far communities. Conclusion: Targeted interventions significantly increased timely HepB-BD and Td vaccination rates in intervention facilities. Continued support of these successful interventions could help Nigeria reach hepatitis B and maternal and neonatal tetanus elimination goals.

Non-HIV Vaccine-Induced Immune Responses as Potential Baseline Immunogenicity Predictors of ALVAC-HIV and AIDSVAX B/E-Induced Immune Responses.

Identifying correlations between immune responses elicited via HIV and non-HIV vaccines could aid the search for correlates of HIV protection and increase statistical power in HIV vaccine-efficacy trial designs. An exploratory objective of the HVTN 097 phase 1b trial was to assess whether immune responses [focusing on those supported as correlates of risk (CoR) of HIV acquisition] induced via the RV144 pox-prime HIV vaccine regimen correlated with those induced via tetanus toxoid (TT) and/or hepatitis B virus (HBV) vaccines. We measured TT-specific and HBV-specific IgG-binding antibody responses and TT-specific and HBV-specific CD4+ T-cell responses at multiple time points in HVTN 097 participants, and we assessed their correlations at peak time points with HIV vaccine (ALVAC-HIV and AIDSVAX B/E)-induced responses. Four correlations were significant [false discovery rate-adjusted p-value (FDR) ≤ 0.2]. Three of these four were with IgG-binding antibody responses to TT measured one month after TT receipt, with the strongest and most significant correlation [rho = 0.368 (95% CI: 0.096, 0.588; p = 0.008; FDR = 0.137)] being with IgG-binding antibody responses to MN gp120 gDneg (B protein boost) measured two weeks after the second ALVAC-HIV and AIDSVAX B/E boost. The fourth significant correlation [(rho = 0.361; 95% CI: 0.049, 0.609; p = 0.021; FDR = 0.137)] was between CD4+ T-cell responses to a hepatitis B surface antigen peptide pool, measured 2 weeks after the third HBV vaccination, and IgG-binding antibody responses to gp70BCaseAV1V2 (B V1V2 immune correlate), measured two weeks after the second ALVAC-HIV and AIDSVAX B/E boost. These moderate correlations imply that either vaccine, TT or HBV, could potentially provide a moderately useful immunogenicity predictor for the ALVAC-HIV and AIDSVAX B/E HIV vaccine regimen.

Maternal Helminth Infection Causes Dysfunctional B Cell Development in Male Offspring.

Infections during pregnancy are known to trigger alterations in offspring immunity, often leading to increased disease susceptibility. Maternal helminth infections correlate with lower Ab titers to certain childhood immunizations and putative decreased vaccine efficacy. The mechanisms that underlie how maternal infection blunts offspring humoral responses are unclear. Using our murine model of maternal schistosomiasis, we found that maternal helminth infection decreases the germinal center response of all offspring to tetanus immunization. However, only male offspring have defects in memory B cell and long-lived plasma cell generation. We found this sex-specific aberration begins during B cell development within the bone marrow via alteration of the IL-7 niche and persists throughout antigenic activation in the germinal center in the periphery. Critically, these defects in males are cell intrinsic, persisting following adoptive transfer to control male pups. Together, these data show that maternal infections can alter both the bone marrow microenvironment and the development of B lymphocytes in a sex-specific manner. This study correlates maternal infection induced defects in early life B cell development with ineffective Ab responses after vaccination.

National Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2023.

Based on safety and efficacy data, vaccinations are the best defense to protect persons and communities from serious vaccine-preventable diseases. The Advisory Committee on Immunization Practices recommends routine vaccination of adolescents aged 11-12 years with three vaccines including tetanus, diphtheria, and acellular pertussis vaccine; quadrivalent meningococcal conjugate vaccine; and human papillomavirus vaccine. CDC analyzed data from the 2023 National Immunization Survey-Teen for 16,658 adolescents aged 13-17 years (born during January 2005-December 2010) to assess vaccination coverage in 2023, recent trends in coverage by birth year, and trends in coverage by eligibility for the Vaccines for Children (VFC) program and birth year. In 2023, coverage with all routine vaccines recommended for adolescents was similar to coverage in 2022. Vaccination coverage among VFC-eligible adolescents was generally stable during the COVID-19 pandemic, except for a decrease in the percentage of VFC-eligible adolescents who were up to date with HPV vaccination by age 13 years among those born in 2010 compared with those born in 2007. Whereas coverage differences were found between VFC-eligible and non-VFC-eligible adolescents before the COVID-19 pandemic, coverage was similar among the most recent birth years in the survey. Providers should make strong recommendations for all routine vaccines and review adolescent vaccination records to verify if adolescents are up to date with all recommended vaccines.

Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program - United States, 1994-2023.

Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines. This report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non-VFC-eligible children born during 1994-2023. Diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; oral and inactivated poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine were included. Averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during 1994-2023 were estimated using established economic models. Net savings were calculated from the payer and societal perspectives. Among approximately 117 million children born during 1994-2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. From both payer and societal perspectives, routine childhood vaccinations among children born during 1994-2023 resulted in substantial cost savings. Childhood immunizations continue to provide substantial health and economic benefits, while promoting health equity.

Determination of DTaP vaccine potency by multiplex immunogenicity testing using electrochemiluminescence

Lot release testing of diphtheria, tetanus and acellular pertussis vaccines traditionally relied on in vivo protection models involving challenge of laboratory animals with toxins. Meanwhile, many labs have switched to serological testing of these vaccines, which is often performed in separate in vivo assays, even if all components were formulated into one vaccine product. Here we describe the results of simultaneous serological potency determination of diphtheria (D), tetanus (T) and acellular pertussis (aP) antigens obtained following immunization of guinea pigs with multicomponent pediatric and booster vaccines from different manufacturers. The 4th World Health Organization (WHO) International Standard (IS) for diphtheria toxoid (No. 07/216) and the 4th WHO IS for tetanus toxoid (No. 08/218) were used as reference preparations. For aP, a pediatric vaccine batch containing the antigens pertussis toxoid, filamentous hemagglutinin, pertactin and fimbriae proteins type 2/3 was established as internal control. Quantification of IgG against D, T and aP antigens in guinea pig sera was performed using a hexaplex electrochemiluminescence immunoassay. We further provide proof-of-concept using experimental vaccine samples lacking or containing reduced amounts of diphtheria toxoid in the presence of full amounts of tetanus and pertussis antigens and alum adjuvant. Importantly, the assay confirmed dose-response relationships for all antigens tested and was able to detect diphtheria out-of-specification batches. The results confirmed the suitability of the protocol for combined serology batch release testing of DTaP combination vaccines as first measure towards implementation of full in vitro testing of DTaP vaccines. This report summarizes the data and the protocol used for validation prior to implementation of this method in routine batch release testing of DTaP vaccines, which led to replacement of in vivo challenge experiments in our laboratory following the 3 R (replace, reduce, refine) principle.

Factors influencing vaccine acceptance in pregnancy during the COVID-19 pandemic: A multicenter study from West Bengal, India

ABSTRACT Influenza, COVID-19, tetanus, pertussis and hepatitis B pose increased risk for pregnant women and infants and could be mitigated by maternal immunization. In India Tetanus-diphtheria (Td) and COVID-19 vaccines are recommended during pregnancy, while influenza and tetanus-acellular pertussis-diphtheria (Tdap) vaccines are not. We conducted a multicenter study from November 2021 to June 2022 among pregnant women (n = 172) attending antenatal clinics in three public hospitals in West Bengal, to understand the factors that influence women’s decisions to get vaccinated during pregnancy. Questions assessed vaccination coverage, knowledge, intention and willingness to pay for influenza vaccine, and factors influencing decisions to get Td, influenza, and COVID-19 vaccines. 152/172 (88.4%) women were vaccinated with Td, 159/172 (93%) with COVID-19, 1/172 (0.6%) with influenza, and none with Tdap. 10/168 (6%) had received hepatitis B vaccine (HBV). Community health workers advice was crucial for Td uptake and, the belief of protection from COVID for COVID-19 vaccines. Most women were unaware about Tdap (96%), influenza (75%), and influenza severity during pregnancy and infancy (85%). None were advised for influenza vaccination by healthcare providers (HCP), albeit, 93% expressed willingness to take, and pay INR 100–300 (95% CI: ≤100 to 300–500) [$ 1.3–4.0 (95% CI: ≤1.3, 4–6.7)] for it. Vaccination on flexible dates and time, HCP’s recommendation, proximity to vaccination center, and husband’s support were most important for their vaccination decisions. Women were generally vaccine acceptors and had high uptake of vaccines included in the Universal Immunization Program (UIP). Inclusion of influenza, Tdap, and HBV into UIP may improve maternal vaccine uptake.

Assessment of knowledge and utilization of antenatal care services among tribal women of Palakkad district, Kerala: a cross-sectional study

Background: Nearly 800 women die out of preventable causes associated with pregnancy and childbirth worldwide every day, with low and middle-income countries contributing approximately 90% of the mortality. The majority of pregnancy-related deaths are preventable with the provisioning of cost-effective services like antenatal care (ANC). Despite Kerala having a good human development index compared to other states in India, marginalized groups like Dalit, Adivasi, and fisher folks are still behind the development process, including the utilization of ANC services. This study assessed the knowledge and utilization of ANC services among tribals in Kerala, India. Methods: A cross-sectional study was conducted among 45 tribal women of Palakkad district, Kerala, who registered for ANC and delivered child. Convenient sampling was used to select study participants. Descriptive statistics were used to obtain frequency and percentage. The chi-square test was carried out to see the association between identified variables. Results: Among 45 participants, 28.89% fell under the adequate ANC utilization. 64.46% did early ANC registration, 73.3% visited ANC more than four times, 75.56% completed the 2 tetanus toxoid (TT) injections, and 66.67% consumed more than 100 iron-folic acid tablets. About 73.3% of participants knew the importance of immunizing children against vaccine-preventable diseases. Conclusions: Even in an egalitarian state like Kerala with high literacy, ANC service utilization among tribal communities is still below 70%. The issue is multifaceted and requires a more nuanced approach. The health system must adopt comprehensive, context-specific, and community-based approaches.

Maternal Pertussis Immunization and Immunoglobulin G Levels in Early- to Late-Term and Preterm Infants

Maternal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination protects newborns against severe pertussis. Data on transplacental antibody transfer on Tdap vaccination before 24 weeks' gestation remain scarce and are particularly relevant for preterm infants to increase the time interval for maternal antibody transfer. To assess noninferiority of anti-pertussis toxin (anti-PT) immunoglobulin G (IgG) antibody levels at age 2 months in early- to late-term infants following Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation and compared with preterm infants. This prospective, multicenter cohort study included pregnant women aged 18 years or older in birthing centers and hospitals in the Netherlands between August 2019 and November 2021 who received Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation. Women with imminent premature birth were recruited if they had received maternal Tdap vaccination between 20 and 24 weeks' gestation. Blood samples were collected from mothers at delivery, from the umbilical cord, and from infants at age 2 months. Data from infants' blood samples at age 2 months were compared with a reference cohort (recruited between January 2014 and February 2016) of early- to late-term infants of the same age whose mothers had received Tdap vaccination between 30 0/7 and 33 0/7 weeks' gestation. Maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation or 30 0/7 and 33 0/7 weeks' gestation. The primary outcome was the geometric mean concentration (GMC) of anti-PT IgG antibodies in early- to late-term infants (≥37 0/7 weeks' gestation) at age 2 months, comparing maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' vs 30 0/7 and 33 0/7 weeks' gestation (reference cohort). Anti-PT GMC in 2-month-old infants born preterm (<35 0/7 weeks' gestation) compared with early- to late-term infants after maternal Tdap vaccination between 20 and 24 weeks' gestation was a secondary outcome. In total, 221 women who delivered 239 offspring were enrolled in the study; 66 early- to late-term infants (median gestational age [GA], 40.6 weeks [IQR, 39.8-41.0 weeks]; 38 [57.6%] male) and 73 preterm infants (median GA, 32.1 weeks [IQR, 29.5-33.0 weeks]; 42 [54.5%] female) had blood samples collected at 2 months of age. Anti-PT GMC was 14.7 IU/mL (95% CI, 10.6-20.4 IU/mL) in early- to late-term infants following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 27.3 IU/mL (95% CI, 20.1-37.1 IU/mL) in 55 infants in the reference group (median GA, 40.3 [IQR, 39.1-41.0]; 33 [60.0%] female). The mean anti-PT GMC in preterm infants in the study group was 11.2 IU/mL (95% CI, 8.1-15.3 IU/mL) (P = .23 compared with early- to late-term infants). In this cohort study, 2-month-old preterm and early- to late-term infants showed significantly lower anti-PT antibody levels following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation; preterm and early- to late-term infants had similar anti-PT antibody levels, but both groups showed significantly lower antibody levels compared with the reference group. Epidemiological research should investigate whether maternal Tdap vaccination before 24 weeks' gestation provides sufficient protection against clinical pertussis, particularly in preterm infants, as long as no correlate of protection is available.

Comparison of Physicians' Attitudes and Practice Regarding Vaccination during Pregnancy in Turkey.

This study aimed to investigate the knowledge, attitudes, and behaviors of family physicians (FPs), pediatricians (PPs), and obstetricians and gynecologists (OGs) regarding vaccine administration during pregnancy in Turkey as factors that contribute to decision-making. The survey was distributed among FPs, OGs, and PPs, and participants were asked to rate their knowledge on specific topics using a five-point scale ranging from "Not Effective" to "Effective". The tetanus and diphtheria (Td) vaccine was highly recommended by 94.9% of physicians and considered very effective. Among the physicians surveyed, 80% of PPs and 66.0% of OGs were aware of the disease burden of pertussis. We also found that 74.5% of FPs and 77.2% of PPs believed they needed more information about vaccination during pregnancy. All physicians surveyed agreed or strongly agreed that explaining the disease risks and benefits of vaccination increases the vaccine acceptance rate. The results of this survey study indicate that the knowledge and awareness of physicians need to be improved to increase vaccination rates during pregnancy in Turkey, and it is essential to incorporate influenza and tetanus, diphtheria, and pertussis (TdaP) vaccines into the standard maternal immunization schedule for newborns.

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

The Impact of Lebrikizumab on Vaccine-Induced Immune Responses: Results from a Phase3 Study in Adult Patients with Moderate-to-Severe Atopic Dermatitis.

Lebrikizumab, a high-affinity IgG4 monoclonal antibody that selectively inhibits interleukin-13 with high binding affinity and slow dissociation rate, prevents the formation of the interleukin-4Rα/interleukin-13Rα1heterodimer receptor signaling complex. Here we report the impact of lebrikizumab on responses to two non-live vaccines in adult patients with moderate-to-severe atopic dermatitis (AD). ADopt-VA (NCT04626297) was a double-blind, placebo-controlled, parallel-group, 16-week, phase3 randomized study to assess the impact of lebrikizumab treatment on non-live vaccine immune responses, and efficacy and safety of lebrikizumab compared with placebo. Eligible patients included adults from 18 to 55years of age with moderate-to-severe chronic AD who were randomly assigned 1:1 to lebrikizumab 250mg every 2weeks or placebo and stratified according to disease severity. The primary endpoints were the development of a booster response to tetanus toxoid and a positive antibody response to meningococcal conjugate vaccine (MCV), 4weeks after administration of the corresponding vaccine. At week16, 73.6% of patients in the lebrikizumab group (n = 78/106) achieved Tdap booster response compared with 73.4% of patients in the placebo group (n = 58/79). MCV vaccine response was observed in 86.9% of patients in the lebrikizumab group (n = 86/99) and 75.0% of patients in the placebo group (n = 60/80). At week16, IGA0,1 with ≥ 2-point improvement from baseline was achieved by 40.6% (n = 51/125) of patients treated with lebrikizumab and 18.9% (n = 23/122) of patients who received placebo (p < 0.001). There was a higher proportion of patients achieving EASI75 at week16 in the lebrikizumab-treated patients (58.0%, n = 72/125) compared with placebo (32.7%, n = 40/122, p < 0.001). Treatment with lebrikizumab did not impact response to non-live vaccines Tdap and MCV in this study. Lebrikizumab treatment had a significant degree of efficacy compared to placebo across multiple endpoints. ClinicalTrials.gov identifier NCT04626297.

EFFECT OF LEAD AND CADMIUM ON IMMUNITY OF TWO VACCINES

This study was performed to investigate the effect of lead exposure on resistance of mice immunized against haemorrhagic septicaemia and challenged with virulent organisms. Lead treated mice showed greater susceptibility to challenge with P. multucida than control especially if lead nitrate is administered orally. this result showed that treatment with lead initials resistance of mice and might interferes with the vaccination programs. Cadmium chloride (cd) injected into rabbits at various time intervals in relation to tetanus toxoid injection was found to have some effect on the immune response. A reduction in the primary immune response was detected in case if (cd) is given two weeks prior to toxoid injection. On the other hand, enhancement of secondary antibody titers was detected. Cadmium reduced both primary and secondary antibody response if it is given seven days before immunization.

1086 Tetanus Bedside Immuno-Assay. A Quality Improvement Study

Abstract Aim ProTetanus immunoassay is a bedside test used to determine if a patient has tetanus antibodies. It has been proven to be sensitive and specific at determining tetanus vaccination status. Although it is available on NHS Supply Chain, it is not widely used. Our aim was to prevent unnecessary Revaxis booster administrations as well as reduce the associated cost. Method Using a visual protocol based on trust and NICE guidelines, we determined which patients with tetanus prone wounds would otherwise require vaccination due to uncertainty of their previous immunisation. ProTetanus test was used to assess their immune status. If no immunity was shown, a booster was administered. A simple questionnaire was used to collect data on the test result, ease of use, and time required to perform the test. Results 18 responses were recorded over 2 months. 2 patients were unnecessarily tested but all patients were treated correctly. In terms of cost efficiency, Revaxis costs £10.16 per vial and ProTetanus £4.15 per test. Therefore, a negative test costs £14.31 and a positive test costs £4.15. In our unit, without ProTetanus, 17 doses of Revaxis would have been administered, costing £172.72. With ProTetanus, 8 doses were prevented, dropping the cost to £161.99. Conclusions The introduction of ProTetanus, prevents unnecessary tetanus booster administrations for our patients, improves the level of clinical care, and provides a cost reduction. We have demonstrated that the use of the immunoassays becomes easier with use and minimise reliance on registered nurses. We strongly advocate its use into other departments and units.

A POLYMYOSITIS AFTER mRNA COVID-19 VACCINATION CASE REPORT

Polymyositis is a rare, acquired, and inflammatory muscular disease, which is characterized by the inflammation of muscles and has no known etiology. The autoimmunity created by the vaccine arose from molecular mimicking or directly by vaccine adjuvants. Polymyositis cases were reported after hepatitis B, influenza A (H1N1), tetanus toxoid, and Bacille Calmette-Guerin (BCG) vaccinations. However, no relationship with COVID-19 vaccination has been reported yet. Myositis and dermatomyositis cases have been seen after covid-19 vaccine. m-RNA COVID-19 vaccines might cause abnormal activation of the immune system due to a strong t-cell-mediated immune activation by vaccinesin the present case, without any additional triggering factor, a case diagnosed with polymyositis developing 10 days after the second dose of messenger RNA (mRNA) COVID-19 vaccine is presented. The findings suggest a potential association between mRNA COVID-19 vaccination and the development of polymyositis, prompting further investigation into this rare occurrence.

Selective non–operative treatment of gunshot penetrating abdominal wounds

Objective. To analyse own experience and determine the feasibility and tactics of selective non–operative treatment of gunshot penetrating abdominal wounds. Materials and methods. The study involved 74 servicemen (all men) with gunshot shrapnel penetrating abdominal wounds, who were divided into two groups: the main group – 26 (35.2% ± 0.2%) wounded who received non–surgical treatment, and the control group – 48 (64.8% ± 0.3%) wounded who received surgical treatment in the form of diagnostic laparotomy or laparoscopy. Non–surgical treatment included pain relief, antibiotic prophylaxis, tetanus toxoid administration and dressings. Results. In general, selective nonoperative treatment of gunshot penetrating abdominal wounds was used in 1% of the wounded. Isolated abdominal wounds were present in 32 (43.2% ± 0.2%) and thoracoabdominal wounds in 42 (56.8% ± 0.3%) patients. In terms of the number of foreign bodies, wounds were single in 66 (89.2% ± 0.3%) and multiple (liver and retroperitoneal space) in 8 (10.8% ± 0.1%) patients. In the main group, there were no surgical interventions or complications, in the control group, 8 (16.7% ± 0.1%) diagnostic laparotomies and 40 (83.3% ± 0.3%) diagnostic laparoscopies were performed, and there were 2 (4.2% ± 0.1%) complications – seroma and pneumonia. The average treatment period was (5 ± 0.3) days in the main group and (8 ± 0.4) days in the control group. Conclusions. Selective non–surgical treatment of gunshot penetrating abdominal wounds is indicated in haemodynamically stable patients without reduced level of consciousness and signs of peritonitis and intra–abdominal bleeding, abdominal pain syndrome with a follow–up period of 24 – 48 hours. The tactic of selective non–operative treatment of gunshot penetrating abdominal wounds is advisable mainly in case of damage to parenchymal organs. This tactic can be used in the presence of expert–class equipment, experienced specialists in the conditions of the third level of medical care and interaction between the second and third levels of medical care.