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ABSTRACT Pediatric tetanus is a rare and forgotten disease in countries with high childhood tetanus toxoid vaccination rates. Therefore, the clinical manifestations, treatment and management of this potentially life-threatening disease are not well known. With a literature review and discussion of tetanus management in pediatric patients, we describe a clinical course of a rare and fatal but vaccine-preventable disease, the generalized tetanus, in an adolescent who was successfully treated.
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Objective@#To analyze the epidemiological characteristics of pertussis in Huzhou City, Zhejiang Province from 2012 to 2022, so as to provide insights into formulation of pertussis control measures.@*Methods@#The data of reported pertussis cases in Huzhou City from 2012 to 2022 were collected through the Infectious Disease Report Information System of Chinese Disease Prevention and Control Information System. The temporal, spatial and population distributions of pertussis cases in Huzhou City from 2012 to 2022 were analyzed using a descriptive epidemiological method.@*Results@#A total of 499 pertussis patients were reported in Huzhou City from 2012 to 2022, with mean annual reported incidence of 1.508/105, and no death was reported. The reported incidence of pertussis remained at a low level in Huzhou City from 2012 to 2021, all below 1/105, and increased to 12.625/105 in 2022. The reported incidence of pertussis appeared an overall tendency towards a rise in Huzhou City from 2012 to 2021 (Z=-29.261, P<0.001). The incidence of pertussis peaked from June to July, and a relatively higher incidence rate of pertussis was reported in Deqing (6.359/105) and Anji counties (1.725/105), while higher incidence was found among children at ages of <1 year (30.566/105), 4 years (31.896/105) and 5 years (29.485/105). @*Conclusion@#The reported incidence of pertussis was at a low level in Huzhou City from 2012 to 2021, and increased sharply in 2022. The incidence of pertussis peaked from June to July, was concentrated in Deqing and Anji counties and higher among infants under one year of age and preschool children at ages of 4 to 5 years.
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@#Objective To optimize the condition for prokaryotic expression of recombinant tetanus toxin heavy chain fragment C(rTTHc) protein.Methods The rTTHc gene fragment after optimization of codon was inserted into prokaryotic expression vector pET30a,low temperature expression vector pCold Ⅱ and high temperature expression vector pBV220separately.The constructed recombinant plasmids were transformed to E.coli BL21(DE3).The expression levels and solubility of recombinant protein at various temperatures were compared.Results The expression level of pBV220-rTTHc after induction at 42 ℃ for 4 h was relatively low,and the protein solubility was poor.The expression level of pET30a-rTTHc after induction at 37 ℃ for 4 h was equivalent to that of pCold-rTTHc after induction at 15 ℃ for 8 h,while the solubility of the former was slightly lower than that of the latter.However,both the expression level and solubility of pET30a-rTTHc after induction at 28 ℃ for 4 h were high,while the expression time was short.Conclusion The pET30a-rTTHc induced by2 mg/mL IPTG at 28℃ is optimal for high expression of rTTHc protein.
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@#Combined vaccine is a single vaccine preparation made by mixing two or more different organism or purified antigens by physical methods.The use of combined vaccine can reduce the number of immunization shots and improve the compliance of children and acceptance of parents;reduce the costs of transportation,storage and management;avoid missing vaccination and improve vaccination rate.At present,a variety of combined vaccines have been licensed abroad,which have good safety and immunogenicity;some combined vaccines have been put on the market in China,and many combined vaccines are in clinical trials.In recent years,with the successful development of component pertussis vaccine and inactivated poliovirus vaccines of Sabin strain Ⅰ,Ⅱ and Ⅲ in China,the combined vaccines based on diphtheria-tetanus-acellular pertussis vaccine(DTaP) have been greatly developed.In this paper,the research progress on combined vaccines based on DTaP,which have been licensed and in clinical trials at home and abroad,was reviewed,in order to provide ideas for the development of related combined vaccines in China.
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Objective@#To evaluate the immune persistence following intradermal(ID) vaccination with diphtheria-tetanusacellular component pertussis and Sabin-derived inactivated poliovirus vaccine(DTacP-sIPV).@*Methods@#40 wistar rats were randomly assigned into four groups.Two test groups were injected intradermally with fractional-doses(1/5 and 1/10dose) of DTacP-sIPV(1/5D ID and 1/10D ID group);The positive control group was intramuscularly injected with full dose of DTacP-sIPV(full-dose IM group);The negative control group was injected with PBS intradermally.Wistar rats were immunized 3 times at 0,1 and 2 months and the blood samples were collected via tail vein 12 months after the last immunization and the serum samples were isolated.The titer of neutralizing antibody against poliovirus was detected by micro-neutralization test,and the titers of IgG antibodies against diphtheria toxin(DT),tetanus toxin(TT),pertussis toxin(PT),filamentous hemagglutinin(FHA) and pertactin(PRN) in rat serum were detected by indirect ELISA.The geometric mean titer(GMT)and positive rate of antibody were calculated.The rats were challenged with aerosolized B.pertussis for 30 min 12 months after the last immunization and determined for the white blood cell(WBC) count and colony-forming unit(CFU) in lung,trachea and nose at day 2,5 and 14 after challenge.@*Results@#Compared with the full-dose IM group,there was no significant difference in the positive rates of poliovirus type Ⅰ,Ⅱ and Ⅲ neutralizing antibodies between 1/5D ID and 1/10D ID groups(each P> 0.05) and the positive rates of all types of antibodies in the control group were 0.The positive rates of IgG antibodies against DT,TT,PT,FHA and PRN in 1/5D ID,1/10D ID and full-dose IM groups were all 100%,and those in control group were all 0.Compared with 2 d after challenge,the WBC counts of rats in control group increased significantly 5 d after aerosol challenge with B.pertussis(F=3.48,P <0.05),and then began to decrease,while those in other groups remained stable with time(F=0.14～1.30,P> 0.05).After aerosol challenge,the CFU in lungs of rats in control group was significantly higher than that in the other three groups(F=19.00～206.00,P<0.05),and B.pertussis was still detected 14 d after challenge;Except for the control group,the bacterial load in lungs of rats in the other three groups reached the peak 5d after challenge,the B.pertussis was basically cleared on the 14d,and there was no significant difference among the groups at each time point(F=1.14～1.25,P> 0.05).The bacterial load of trachea and nose in the control group was slightly higher than that in other groups at each time point,but the difference was not significant(F=0.71～3.54,P> 0.05).Except for the control group,the bacterial load in the trachea and nose of the other three groups were similar,and no significant difference was observed(F=0.75～3.41,P>0.05).@*Conclusion@#ID immunization with1/5 dose of DTacP-sIPV induced persistent protective antibodies against various components of the vaccine in rats.This study provided an experimental basis for the formulation of immunization strategy of ID immunization with fractional dose of DTacP-sIPV.
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RESUMEN INTRODUCCIÓN: El tétanos es una enfermedad que afecta el sistema nervioso. Su presentación clínica se caracteriza por espasmos musculares en respuesta a la liberación de la neurotoxina producida por la formación de esporas de la bacteria Clostridium tetani. DESCRIPCIÓN DEL CASO: Presentamos el caso de un hombre de 70 años que luego de una caída presentó una herida en la región ocular. Al ingreso se evidenciaron signos de infección local y contracción involuntaria en los músculos maseteros, con imposibilidad de apertura oral. Posteriormente, presentó insuficiencia respiratoria, contracciones generalizadas y necesidad de traslado a unidad de cuidado intensivo. Debido a que entre los diagnósticos diferenciales se encontraba la presencia de crisis epilépticas motoras, se hicieron estudios complementarios para descartar esta posibilidad. DISCUSIÓN: El diagnóstico del tétanos es clínico, es importante sospecharlo en pacientes con antecedentes de lesión en piel e inmunización inadecuada. Por su amplia presentación clínica, puede llevar a confusión con otras patologías. Entre los diagnósticos diferenciales están las crisis epilépticas, sin embargo, el tétano no cumple con las características semiológicas, no compromete el estado de conciencia y no progresa a estado epiléptico, asociado con la normalidad de estudios complementarios como las neuroimágenes, el estudio de líquido cefalorraquídeo y el registro electroencefalográfico. CONCLUSIÓN: El tétanos es una enfermedad altamente prevenible y un reto diagnóstico para el profesional de la salud por su amplio debut de síntomas. Por ello, en el abordaje diagnóstico es importante reconocer los diagnósticos diferenciales, teniendo como base la historia clínica, lo que permite un diagnóstico temprano y oportuno.
ABSTRACT INTRODUCTION: Tetanus is a disease that affects the nervous system and its clinical presentation is characterized by muscle spasms caused by the release of a neurotoxin produced by the formation of spores of the Clostridium tetani bacteria. CASE DESCRIPTION: We present the case of a 70-year-old man who after a fall, presented an injury to the ocular region. On admission, signs of local infection and involuntary contraction of the masseter muscles were evident, with impossibility of oral opening. Subsequently, he presented respiratory failure, generalized contractions and transfer to the intensive care unit, due to its similarity to convulsive events, pathology at the level of the central nervous system is suspected, for which it requires complementary studies and clinical analysis to rule it out. DISCUSSION: The diagnosis of tetanus is clinical, it is important to suspect it in patients with a history of skin lesions and inadequate immunization, due to its extensive clinical presentation, it can lead to confusion with other pathologies. Among the differential diagnoses are epileptic seizures, however, tetanus does not meet the semiological characteristics, does not compromise the state of consciousness and does not progress to status epilepticus, associated with the normality of complementary studies such as neuroimaging, cerebrospinal fluid study and registry electroencephalographic. CONCLUSION: Tetanus is a highly preventable disease and a diagnostic challenge for the health professional due to its wide onset of symptoms. That is why the diagnostic approach is important to recognize the differential diagnoses based on the clinical history, which allows an early and timely diagnosis.
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Tetanus , Trismus , Vaccination , EpilepsyABSTRACT
Background: Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked. Methods: An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tet-anus, clinical features and the outcome of tetanus. Results: Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status. Conclusion: An early diagnosis, a proper wound management immediately after the injury, health edu-cation programs to create awareness among the public not to neglect even trivial injuries would definite-ly lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immuniza-tion beyond the age of 10 years.
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Haemophilus influenzae tipo b es un importante patógeno del hombre causante de varias de las enfermedades invasivas en niños menores de cinco años, contra el cual fueron autorizadas las vacunas glicoconjugadas a partir del polirribosilribitol fosfato. Quimi-Hib® es la primera y única vacuna contra este patógeno que utiliza el polisacárido obtenido por síntesis química. El Ingrediente Farmacéutico Activo es producido por el Centro de Ingeniería Genética y Biotecnología y se obtiene a partir de su conjugación al toxoide tetánico. En el presente reporte se hizo una caracterización del polirribosilribitol fosfato mediante la técnica de cromatografía de exclusión molecular de alta eficacia con detección ultravioleta a 215 nm. En el estudio se evaluaron tres lotes y se determinó el perfil de elución en una columna SuperdexTM 75 10/300 GL Increase con un porciento de pureza de 77,42 ± 8,97 y una masa molar promedio de 7.381 Da ± 210,93. La principal impureza presente en el polirribosilribitol fosfato es el dimetilsulfóxido, disolvente utilizado en la reacción de activación con el éster N-hidroxisuccinimidilo del ácido β-maleimidopropiónico. El polirribosilribitol fosfato se purificó por filtración con un Amicon Ultra-15 de 2.000 Da hasta una pureza de 99,1 por ciento y se conjugó al toxoide tetánico. El rendimiento de la reacción de conjugación con el polisacárido purificado fue de 30,0 por ciento 1,77 el cual no muestra diferencias significativas con el control que fue 33,7 por ciento ± 3,57 demostrándose que el dimetilsulfóxido no afecta el desempeño de la reacción de conjugación(AU)
Haemophilus influenzae type b is an important human pathogen causing some invasive diseases in children less than five years of age. Glycoconjugate vaccines based on polyribosylribitol phosphate have been licensed against this bacterium. Quimi-Hib® is the first and only vaccine against this pathogen using the chemically synthesized polysaccharide. The Active Pharmaceutical Ingredient is produced by the Center for Genetic Engineering and Biotechnology and is obtained from its conjugation to tetanus toxoid. In the present report a characterization of polyribosylribitol phosphate was performed by high performance molecular exclusion chromatography with ultraviolet detection at 215 nm. Three batches were evaluated in the study and the elution profile was determined on a SuperdexTM 75 10/300 GL Increase column with a purity percentage of 77.42 ± 8.97 and an average molecular weight of 7,381 Da ± 210.93. The main impurity present in polyribosylribitol phosphate was dimethylsulfoxide, the solvent used in the activation reaction with N-hydroxysuccinimidyl ester of β-maleimidopropionic acid. Polyribosylribitol phosphate was purified by filtration using a 2,000 Da cut-off Amicon Ultra-15 to a purity of 99.1 percent and conjugated to tetanus toxoid. The yield of the conjugation reaction with the purified polysaccharide was 30.0 percent ± 1.77 which shows no significant difference with the control which was 33.7 percent ± 3.57 demonstrating that dimethylsulfoxide does not affect the performance of the conjugation reaction(AU)
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Polysaccharides , Chromatography, Gel/methods , Vaccines, Conjugate/therapeutic use , Reference Drugs , Haemophilus Infections/epidemiology , Tetanus Toxoid/therapeutic useABSTRACT
Introdução: O tétano acidental é definido como uma doença não contagiosa e prevenível com vacinação, decorrente da ação de exotoxinas do Clostridium tetani, desencadeando um estado de hiperexcitabilidade do sistema nervoso central, em pacientes não neonatais. O número de casos no país está reduzindo; contudo, a mortalidade é elevada. Dessa forma, o presente estudo objetivou avaliar o perfil e a tendência temporal da ocorrência de tétano acidental no estado de Santa Catarina, no período de 2008 a 2018. Métodos: Estudo observacional do tipo ecológico com a população do estado de Santa Catarina, sendo excluídos os residentes com idade de 0 a 4 anos. O número de notificações e as variáveis clínico-epidemiológicas foram extraídos da base de dados da Diretoria de Vigilância Epidemiológica do estado de Santa Catarina (DIVE) e do Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: Observou-se uma maior ocorrência do tétano acidental em homens; faixa etária entre os 50 e 64 anos; residentes de zonas urbanas. O principal desfecho foi a cura. Notou-se uma correlação significativa (p<0,05) para a redução da incidência de casos nos seguintes grupos: sexo feminino e idosos a partir dos 80 anos. Conclusão: Denota-se que, apesar de possuir uma forma simples de profilaxia, o tétano acidental persiste como um problema de saúde pública e, portanto, deve-se investir em estratégias para aumentar a cobertura vacinal, em especial, nos grupos de maior incidência.
Introduction: Accidental tetanus is defined as a non-communicable disease preventable by vaccination; it is caused by exotoxins produced by Clostridium tetani, triggering a state of central nervous system hyperexcitability in non-neonatal patients. The number of cases in the country is decreasing, but mortality rates are high. This study thus aimed to evaluate the profile and temporal trend of the occurrence of accidental tetanus in the state of Santa Catarina between 2008 and 2018. Methods: This is an observational ecological study performed with the population of the state of Santa Catarina, excluding residents aged 4 years or less. The number of reported cases and clinical and epidemiological variables were extracted from databases of the Epidemiological Surveillance Department of the State of Santa Catarina (DIVE) and the Informatics Department of the Unified Health System (DATASUS). Results: We observed a higher occurrence of accidental tetanus among men, people aged between 50 and 64 years, and individuals living in urban areas. The main outcome observed in this study was cure. We noticed a significant correlation (p<0.05) for a reduction in cases among the following groups: women and older adults aged 80 years or older. Conclusion: Despite its simple prophylaxis, accidental tetanus remains a public health problem; investments should thus be made in strategies that increase vaccination coverage, especially considering groups with higher incidence rates.
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Objective:To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for adult severe tetanus by comparing the NLR in patients with severe and mild tetanus.Methods:A total of 65 adult tetanus patients from the Linyi Central Hospital from January 2009 to December 2020 were enrolled. The patients were divided into two groups including mild group and severe group according to the Ablett classification. The general conditions, laboratory data, and NLR of patients in two group were retrospectively compared using independent samples t test. Multivariate logistic regression analysis was used for the analysis of risk factors for severe tetanus. Spearman correlation method was used for the analysis of the correlation between risk factors and Ablett grades. Receiver operator characteristic (ROC) curve was used for the evaluation of the predictive value. Results:Among the 65 tetanus cases, 34 was in mild group and 31 in severe group. The latency period of patients in severe group was (7.00±3.19) d, which was shorter than that in mild group ((9.18±2.59) d), and the difference was statistically significant ( t=3.03, P=0.004). The NLR of patients in severe group was 4.251±1.936, which was higher than that of mild group (2.533±1.026) , and the difference was statistically significant ( t=4.41, P<0.001). Multivariate logistic regression analysis showed that NLR and latency period were independent risk factors for tetanus severity (odds ratio ( OR)=2.359, 95% confidence interval ( CI) 1.415 to 3.934, P=0.001 and OR=0.748, 95% CI 0.599 to 0.936, P=0.011, respectively). In tetanus patients, the NLR level was positively correlated with Ablett grade ( r=0.644, P<0.001). The ROC curve showed that NLR had good predictive value for adult severe tetanus at a cut-off value of 2.471 (area under the curve (AUC)=0.787), with the sensitivity and specificity of 87.1% and 61.8%, respectively. When combining NLR with latency period (cut-off value of 7.5 d), predictive efficiency was further improved (AUC=0.832) with the sensitivity of 87.1% and specificity of 67.6%( Z=3.43, P<0.001). Conclusions:NLR has a good predictive value for adult severe tetanus, and the predictive efficiency is further improved when combined with latency period.
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Introduction: Tetanus is a major health problem in developing countries, and is associated with high a morbidity and mortality. There are no recent local data in Kenya on the impact of the disease in terms of morbidity and mortality. The objective of this study was to describe the type, severity, risk factors, immunization history and outcome of tetanus patients at Kenyatta National Hospital (KNH). Method: This was a retrospective descriptive study of patients with a clinical diagnosis of tetanus admitted to KNH over ten years, who were aged 13 years and above. All available files with tetanus diagnosis were selected, and the patients' data were retrieved and analysed using SPSS Software version 21.0. Results: Out of 53 patients with tetanus, 50 (94.3%) were males and 3 (5.7%) were females. The mean age at presentation was 33.2 years (SD= 15.6). Only 4 (7.5%) patients had prior tetanus immunization. The commonest risk factor was acute injury - seen in 37 (69.8%) patients. The common site of injury was the lower limb - seen in 26 (49.1%) patients. The incubation period ranged from 3 to 90 days (IQR 7-17). Generalized tetanus was the commonest form found in 50 (94.3%) patients. Only 16 (30.2%) patients were managed in the Intensive Care Unit (ICU). The overall mortality was 49.1%. Conclusion: Tetanus mortality is still high as reported in many other studies. Most patients were males without prior immunization history. Only few patients were managed in Intensive Care Unit. We recommend advocacy on tetanus immunization and booster dosing
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Humans , Male , Female , Tetanus , Morbidity , Mortality , Developing Countries , Diagnosis , Medical Audit , PrevalenceABSTRACT
Resumen El tétanos continúa siendo un problema de salud pública, y que afecta a todas las edades. La mortalidad aumenta por bajas coberturas de vacunación y escasez de recursos para un tratamiento temprano. Es causado por la toxina de Clostridium tetani (tetanoespasmina) el cual ingresa al organismo a través de heridas contaminadas por cuerpos extraños. La clínica más frecuente del tétanos es del tipo generalizado y se caracteriza por la contracción tónica de músculos esqueléticos, espasmos musculares intensos, dolorosos, e hiperactividad autonómica. El diagnóstico es principalmente clínico. Se presenta el caso clínico de un tétanos generalizado en un niño con vacunación incompleta. Se discute la importancia de la vacunación y el diagnóstico y tratamiento precoz para mejorar el pronóstico de la enfermedad.
Abstract Tetanus continues to be a public health problem, which affects all age groups. Mortality increases when immunization programs have low coverage and there is a lack of resources for early treatment. This disease is caused by the toxin of Clostridium tetani (tetanospasmin) which enters the body via wounds contaminated by foreign bodies. The most common symptoms of tetanus are of the generalized type and are characterized by tonic contraction of skeletal muscles, intense, painful muscle spasms, and autonomic hyperactivity. The diagnosis is clinical and the previous vaccination history becomes important. We report the case of generalized tetanus in a child with incomplete immunizations. Highlight the importance of vaccination and early diagnosis and treatment.
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Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.
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Objective:To investigate the clinical characteristics and treatment of patients with refractory spasm tetanus.Methods:Tetanus patients admitted to the Affiliated Hospital of Zunyi Medical University from January 2011 to April 2021 were collected and divided into the refractory spasm group and general group according to whether they were refractory spasm. The general demographic characteristics, clinical characteristics, treatment and prognosis of the two groups were compared. The treatment and risk predictors of patients with refractory spasm tetanus were explored.Results:Among the 59 tetanus patients, 35 patients (59.32%) were in the refractory spasm group and 24 patients (40.68%) were in the general group. There were no significant differences in sex, age, latency and trauma site between the two groups ( P>0.05). All patients with refractory spasmodic tetanus were treated with mechanical ventilation, the length of hospital stay was significantly prolonged, and the rate of pulmonary infection was significantly increased ( P<0.05). The incidence of multiple sites muscular rigidity (spasm/limb stiffness, neck stiffness, and angular pedicle tension) in patients with refractory spasmodic on the first day of admission was higher than that in the general group ( P<0.05). The patients' initial symptoms (within 24 h after admission) were muscle spasm/limb stiffness + neck stiffness + angular pedicle inversion, which had the highest specificity for predicting the occurrence of refractory spasm. The proportion of Ablett grade Ⅳ in patients with refractory spasm was higher than that in the general group, and the difference was statistically significant ( P<0.05). The 48.75% patients with refractory spasm tetanus were treated with more than 3 sedatives combined with muscle relaxants, and the duration of sedative use was significantly prolonged ( P<0.05). Conclusions:The mechanical ventilation time and hospitalization time in tetanus patients with refractory spasm are significantly prolonged, and the incidence of pulmonary infection is significantly increased, which requires the combined application of a large number of sedative and muscle relaxants for a long time, and the incidence of refractory spasm is higher in patients with multi-site muscular rigidity at the early stage of the disease.
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Objective:To analyze the immune effect of tetanus toxoid (TT) and to provide reference for improving immunoprophylaxis strategies against tetanus.Methods:From 2019 to 2021, the TT-containing vaccine (TTCV) immunization history of patients treated for trauma in Luoshan Street Community Health Service Center of Jinjiang City were investigated. Serum tetanus antibody (TAB) levels were detected in 353 subjects (group A) 5-10 years after TTCV immunization, and the proportions of subjects with different TAB levels (<0.01 IU/ml, 0.01-0.10 IU/ml, >0.10 IU/ml) in different age groups were compared. Sixty-eight subjects (group B) aged 14-83 years with TTCV immunization history and TAB level of 0.01-0.10 IU/ml and 133 subjects (group C) aged 17-77 years without TTCV immunization history were inoculated with one dose and three doses of TT respectively, and the changes in TAB level were observed 28 d after immunization.Results:In group A, the proportions of subjects with different TAB levels in different age groups were statistically significant (χ 2=47.69, P<0.001). The proportions of subjects in which TAB levels were <0.01 IU/ml and 0.01-0.10 IU/ml increased with age. In group B, 66 out of the 68 subjects had TAB >0.10 IU/ml 28 d after one dose of TT immunization. There were statistically significant differences in the proportions of subjects whose TAB levels were 0.01-0.10 IU/ml and >0.10 IU/ml before and after TT immunization (χ 2=128.23, P<0.001). In group C, before three doses of TT immunization, 129 patients had TAB <0.01 IU/ml and four patients had TAB in the range of 0.01-0.10 IU/ml; 28 d after three doses of TT immunization, only one case had TAB in the range of 0.01-0.10 IU/ml and 132 cases had TAB >0.10 IU/ml. The proportions of group C subjects with different TAB levels before and after TT immunization were statistically significant (χ 2=262.80, P<0.001). Conclusions:Five years after TTCV immunization, the proportions of individuals with TAB <0.01 IU/ml and in the range of 0.01-0.10 IU/ml increased with age. For people without TTCV immunization history and those with decreased TAB protection after TTCV immunization, strengthening TT immunization could significantly improve the TAB protection.
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RESUMEN INTRODUCCIÓN: El tétanos es una enfermedad inmunoprevenible, ocasionada por la bacteria Clostridium tetani, desencadenando una enfermedad caracterizada por espasmos musculares, insuficiencia respiratoria y disautonomías, potencialmente mortal. MATERIALES Y MÉTODOS: Presentamos una serie de tres pacientes que consultaron al servicio de urgencias por presentar trismus, rigidez muscular generalizada y dificultad respiratoria, requiriendo manejo en la unidad de cuidados intensivos, con relajación muscular y administración intramuscular e intratecal de inmunoglobulina antitetánica, con evolución satisfactoria en todos los casos. DISCUSIÓN: Su tratamiento está divido en dos grandes secciones; la primera parte, el control de la infección y eliminación del agente causal, con lavado y desbridamiento de heridas, administración de antibióticos y neutralización de la neurotoxina. La segunda parte del tratamiento está en el soporte vital en la unidad de cuidados intensivos, con la administración de sedación, relajación muscular, control de disautonomías y manejo de complicaciones. CONCLUSIONES: El tétanos a pesar de los avances en vacunación aún es una enfermedad presente, cuyo diagnóstico y tratamiento rápido y adecuado, permite sobrevivir a los pacientes, como en los casos aquí reportados.
ABSTRACT INTRODUCTION: Tetanus is an immuno-preventable disease, produced by the bacterium Clostridium tetani, that causes a disease characterized by muscle spasms, respiratory insufficiency and life-threatening dysautonomia. MATERIALS AND METHODS: We present a series of three patients who consulted for trismus, muscle stiffness and respiratory failure, which required intensive care management, muscle relaxation, intramuscular and intrathecal administration of tetanus immu-noglobulin, with satisfactory outcomes in all the cases. DISCUSSION: Its treatment is divided into two main sections; the first part, the control of infection and elimination of the causative agent, with washing and debridement of wounds, administration of antibiotics and neutralization of the neurotoxin. The second part is life support in the intensive care unit, with the administration of sedation, muscular relaxation and control of dysautonomia and the management of complications. CONCLUSIONS: Despite the advances in vaccination, tetanus is still a present disease, whose diagnosis and rapid and adequate treatment allows patients to survive, as in the cases reported here.
Subject(s)
Tetanus , Tetanus Toxin , Case Reports , Tetanus Antitoxin , Review , Clostridium tetaniABSTRACT
Abstract Objective: To assess the protective effect of exclusive breastfeeding and the effectiveness of maternal vaccination in reducing pertussis-like illness. Method: This was a case-control study conducted in sentinel hospitals for pertussis in Recife between July 2016 and July 2018. Cases included children aged under six months with symptoms compatible with pertussis (pertussis-like illness). Controls included children aged under six months, living in the metropolitan region of Recife with no diagnosis of pertussis-like illness and matched by the same hospital and birth date. Results: Seventy-three cases and 194 controls were included. The diagnosis of pertussis-like illness was predominantly clinical (97,2%). Amongst the main symptoms, paroxysmal cough was observed in 95.89% of cases and vomiting in 53.4%. There were 29 hospitalized cases and no deaths. Out of the 73 cases, 47 were born to mothers vaccinated against pertussis during pregnancy, and the mothers of 144 of the 194 controls had been vaccinated. The protective effect of breastfeeding was of 74% (95% CI;38%, 89%). Children younger than six months, who were exclusively breastfed and with mothers vaccinated against pertussis during pregnancy were 5 times less likely to develop pertussis-like illness, corresponding to a protection of 79% (95% CI;31%, 94%). The effectiveness of maternal vaccination against pertussis-like illness in children under six months was low (27%) and not statistically significant (CI 95%; −34% a 60%). Conclusions: Exclusive breastfeeding protects children under six months from pertussis-like illness and may be enhanced when associated with maternal vaccination. These strategies should be encouraged because they also protect against pertussis-like illnesses.
Subject(s)
Humans , Female , Pregnancy , Infant , Child , Breast Feeding , Whooping Cough/prevention & control , Case-Control Studies , Vaccination , MothersABSTRACT
INTRODUCCIÓN: Desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. OBJETIVOS: Conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. MÉTODOS: Estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. RESULTADOS: Se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). DISCUSIÓN: La mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.
BACKGROUND: Since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. AIM: To study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. METHODS: We conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. RESULTS: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). DISCUSSION: Most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pertussis Vaccine/administration & dosage , Whooping Cough/prevention & control , Uruguay , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Surveys and Questionnaires , Patient Compliance , Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Pregnant Women , Vaccination Coverage , Treatment Adherence and ComplianceABSTRACT
Introducción: desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. Objetivos: conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. Métodos: estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. Resultados: se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). Discusión: la mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.
Background: since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. Aim: to study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. Methods: we conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. Results: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). Discussion: most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.
Subject(s)
Humans , Female , Pregnancy , Child , Adolescent , Adult , Whooping Cough/prevention & control , Diphtheria-Tetanus-acellular Pertussis Vaccines , Uruguay , Pertussis Vaccine , Cross-Sectional Studies , Vaccination , Pregnant WomenABSTRACT
La uveítis anterior no infecciosa es una enfermedad inflamatoria del ojo que afecta al tracto uveal y que puede causar ceguera total y otras discapacidades visuales. Esta enfermedad se ubica en el espectro de enfermedades autoinmunes y autoinflamatorias. Se han descrito respuestas no adecuadas a la vacunación en enfermedades mediadas por el sistema inmune, por lo que se evaluaron los niveles de antitoxina tetánica y diftérica en pacientes cubanos con uveítis anterior no infecciosa, relacionada con el alelo HLA-B27. Se determinaron los niveles de antitoxina tetánica y diftérica mediante ELISA en 190 pacientes con uveítis anterior no infecciosa y controles supuestamente sanos. El 97,37 por ciento de los pacientes con uveítis mostraron niveles de protección de antitoxina tetánica mayor o igual a 0,1 UI/mL, similar a lo observado en los controles sanos (98,95 por ciento) (p=0,4385). Las proporciones de pacientes con uveítis anterior no infecciosa y sus controles en los diferentes niveles de protección de antitoxina tetánica fueron similares (p>0,05), al igual que los títulos medios geométricos (p=0,2907). En los pacientes con uveítis, de 65 años o más, se detectó una mayor proporción de individuos con títulos protectores de larga duración (>1,0 UI/mL) de antitoxina diftérica (p=0,0065). En los pacientes con uveítis no se observó asociación entre la presencia del alelo HLA-B27 y la respuesta de anticuerpos frente al toxoide tetánico (p=0,6196) y diftérico (p=0,1917). El 37,9 por ciento de los pacientes con uveítis y el 42 por ciento de los controles, presentaron títulos no protectores (<0,1 UI/mL) de antitoxina diftérica (0,1148). La mayoría de los pacientes con uveítis anterior no infecciosa y los controles supuestamente sanos presentaron protección frente al toxoide tetánico; mientras que, en los pacientes con uveítis, así como en los controles supuestamente sanos, con edad igual o más de 18 años, se debe reevaluar incluir refuerzos con toxoide diftérico para alcanzar mayores niveles de protección frente a la difteria(AU)
Non-infectious anterior uveitis is an inflammatory disease of the eye that affects the uveal tract and can cause total blindness and other visual disabilities. Autoimmune and inflammatory diseases are associated with qualitative and quantitative alterations in the immune response; therefore, the levels of tetanus and diphtheria antitoxin related to the HLA-B27 allele were evaluated in Cuban patients with non-infectious anterior uveitis. Tetanus and diphtheria antitoxin levels were determined by ELISA in 190 patients with non-infectious anterior uveitis and healthy control individuals. 97.37 percent of patients with uveitis showed protective tetanus antitoxin levels greater than and equal to 0.1 IU/mL as well as healthy controls (98.95 percent) (p=0.4385). The proportions of patients with non-infectious anterior uveitis and presumably healthy controls in the different levels of protective tetanus antitoxin were similar (p>0.05) at all levels of protection, as were the geometric mean titers for this antitoxin (p=0.2907). Patients with uveitis aged 65 years or older had a higher proportion of individuals with long-term reliable protective titers (>1.0 IU/mL) of diphtheria antitoxin (p=0.0065). In uveitis patients, no association was observed between the presence of the HLA-B27 allele and the antibody response against tetanus toxoid (p=0.6196) and diphtheria (p=0.1917). Similarly, 37.9 percent of patients with uveitis and 42 percent of their controls had non-protective titers (<0.1 IU/mL) of diphtheria antitoxin (0.1148). Most patients with anterior uveitis and control subjects were protected against tetanus (p>0.05), while in patients with uveitis and supposedly healthy controls, aged 18 years or older, the administration of booster doses with diphtheria toxoid should be reevaluated to achieve higher levels of protection against diphtheria(AU)