Effect of different immunization schedules on diphtheria antibody level among preschool children in Shenzhen / 中国学校卫生

Objective@#To evaluate the immunity and influencing factors of diphtheria among preschool children in Shenzhen,to provide reference for effective monitoring of diphtheria IgG antibody level in preschool children.@*Methods@#Serum samples were collected from 296 preschool children aged 4-6 who were recruited in Shenzhen. The diphtheria antibody titer in serum was determined by enzyme linked immunosorbent assay, and the effect of different immumuzation schedule including types of vaccine and vaccination timing, on the geometric mean concentration (GMC) of diphtheria IgG antibody and antibody positive rate were analyzed.@*Results@#The GMC of diphtheria IgG antibody was 0.71 IU/mL, and the positive conversion rate was 33.1%. There were significant differences in antibody GMC and antibody positive conversion rate of diphtheria in different age groups( F/χ 2=11.77, 27.45, P < 0.01 ). The GMC and antibody positive conversion rate showed significant differences by diphtheria antibodies, vaccine types and end dose vaccination intervals( F=49.53, 12.95，11.61, P <0.01). There were statistically significant differences in the positive conversion rate of diphtheria antibodies in children with different types of diphtheria antibodies, vaccine types of diphtheria antibodies, and diphtheria antibodies at the time interval of final vaccination (Fisher exact probability method, P <0.01).@*Conclusion@#The overall positive conversion rate of diphtheria antibody in preschool children in Shenzhen is high. Timely completion of full diphtheria vaccination can improve the antibody level and plays a better role in protecting preschool children.

Status of epidemic and immunization of diphtheria / 中国生物制品学杂志

@#Abstract：The infection rate and incidence of diphtheria have been controlled effectively under the large⁃scale immunization projects. However，in recent years，cases of diphtheria have occurred frequently at home and abroad. Except for common infection in children，the number of middle⁃aged and elderly patients also increased，indicating that the prevention and control of diphtheria still should not be ignored. This paper reviewed the etiological characteristics，pathogenic mechanism as well as the epidemic and immunization status at home and abroad of diphtheria and looked forward to the above problems.

Evaluation of immune effect of diphtheria toxoid vaccine with chitosan as adjuvant on mice / 中国生物制品学杂志

@#Objective To evaluate the immune effect of the diphtheria toxoid(DT)vaccine using chitosan as adjuvant on mice,so as to provide an experimental basis for the preparation of novel adjuvant vaccines of DT.Methods A total of 30 male C57BL/6 mice were divided into mucosal immunization group and humoral immunization group,and each group was randomly divided into 6 groups:negative control group(PBS),positive control group(DT),aluminum adjuvant group,chitosan adjuvant group(final solution with 0.5% chitosan),aluminum adjuvant vaccine group and chitosan adjuvant vaccine group,with 5 mice in each group. Mucosal immunization group and humoral immunization group were inoculated with 500 μL PBS buffer,10 μg DT,500 μg aluminum adjuvant and 500 μL chitosan adjuvant per mouse by nasal drip and intraperitoneal injection respectively. The mice were observed for the status,collected for the eyeball serum before inoculation(0 d)and 7,21,35 d after inoculation,and collected for the nasal lotion simultaneously. The levels of IgG antibody in serum and sIgA antibody in nasal lotion were detected by ELISA.Results After intraperitoneal injection and nasal drip of chitosan adjuvant vaccine,the mental and behavioral state of mice was normal. Chitosan adjuvant vaccine effectively induced the IgG antibody against diphtheria in mice with not significant difference,compared with the classic aluminum adjuvant vaccine group(F = 127.926 > F_(0.05(1,8)),P > 0.05);It also induced the production of sIgA in mice,which was significantly higher than that in the classical aluminum adjuvant vaccine group 21 d after immunization(F =127.926 > F_(0.05(1,8)),P < 0.05).Conclusion Chitosan adjuvant DT vaccine can effectively stimulate the mucosal immunity and humoral immunity in mice with good safety,and has the potential to be an alternative to aluminum adjuvant for vaccine preparation,which can be considered as nasal drop vaccines.

Epidemiological characteristics of pertussis in Huzhou City from 2012 to 2022 / 预防医学

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.

Development and verification of a sulfosalicylic acid spectrophotometric method for determination of iron ion in medium for producing diphtheria toxin / 中国生物制品学杂志

@#Objective To develop and verify a sulfosalicylic acid spectrophotometric method for the determination of trace iron ions in diphtheria toxin medium,and apply it preliminarily.Methods The maximum absorbance of the complex of iron and sulfosalicylic acid was scanned by full spectrum;A method for the determination of iron ion in culture medium was developed by linear regression between the absorbance of the complex and the content of iron ion,and the stability,accuracy and precision of the method were verified.The effects of Ca~(2+),Mg~(2+),K~+,Na~+ and reactants on the method were investigated.Spectrophotometric method with sulfosalicylic acid was used to determine trace iron in the self-made and commercial medium for diphtheria toxin production.Sulfosalicylic acid spectrophotometry,ferrizine colorimetry and o-phenanthroline spectrophotometry were used to detect iron content in two kinds of culture media(beef trypsin digestion liquid and 5% polypeptone),and the detection results of the three methods were compared.Results The complex of iron and sulfosalicylic acid showed the maximum absorbance at the wavelength of 425 nm;There was a good linear relationship between the absorbance and concentration of iron ion in the range of 1～0.05 μg/mL,the detection limit was 0.05 μg/mL,and the standard equation was:Y=0.027 9 X+0.046 1,R~2> 0.99;The coefficients of variation(CVs) of A_(425) value of each concentration of standards measured every 5 min were less than 5%;Low(0.05 μg/mL),medium(0.5 μg/mL)and high concentration(1 μg/mL) of Fe~(3+) standard solutions were continuously determined for 3 times.The CVs of 9groups of each concentration measured in parallel were all less than 5% and the recovery rates were higher than 95%;Ca~(2+),Mg~(2+),K~+,Na~+,15 μL of sulfo salicylic acid(20%) and 50 μL of ammonia hydroxide(1:1) showed no interference in the method;The results of toxin-producing medium were consistent with those of diphtheria bacteria;The results of the three detection methods were consistent.Conclusion The developed spectrophotometric method with sulfo salicylic acid can determine the content of trace iron ions in diphtheria toxin medium accurately and effectively.

Research progress on combined vaccines based on diphtheria-tetanus and acellular pertussis vaccine / 中国生物制品学杂志

@#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.

Immune persistence following intradermal vaccination with fractional dose of diphtheria-tetanus-acellular component pertussis and Sabin-derived inactivated poliovirus vaccine / 中国生物制品学杂志

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.

Tétanos generalizado en un niño parcialmente inmunizado

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.

Protective effect of exclusive breastfeeding and effectiveness of maternal vaccination in reducing pertussis-like illness

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.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

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.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

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.

Niveles de antitoxina tetánica y diftérica relacionadas con el alelo HLA-B27 en pacientes cubanos con uveítis anterior no infecciosa / Tetanus and diphtheria antitoxin levels related to the HLA-B27 allele in Cuban patients with non-infectious anterior uveitis

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)

Adult Diphteria: Possible Transmission of Corynebacterium diphtheriae from Unvaccinated Child?

@#A case of a toxigenic strain of Corynebacterium diphtheriae in an immunocompetent adult is presented, with the possibility of the adult acquiring the infection from her unvaccinated child. The abovementioned adult is a 29-year-old housewife who was previously immunised with diphtheria, tetanus, and pertussis (DTaP) vaccination in childhood, who presented fever, cough, sore throat, hoarseness of voice, odynophagia, and bilaterally enlarged tonsils. A throat swab confirmed the presence of toxigenic Corynebacterium diphtheriae. The patient was given 80,000 international units (IU) dose of diphtheria antitoxin (DAT) and treated with 2.4 million units (MU) QID intravenous penicillin and oral erythromycin 800 mg twice daily for two weeks. The patient responded well to the treatment and recovered with no cardiovascular or neurotoxicity.

A 'nice to have' or a 'non-negotiable': South African healthcare workers' knowledge, attitudes, practices and perceptions of vaccination

Background: Non-immune healthcare workers (HCWs) are at high risk of contracting and transmitting vaccine-preventable diseases. Data on the knowledge, attitudes and practices (KAP) of African HCWs regarding the World Health Organization (WHO)-recommended vaccinations is limited. Objectives: We aimed to describe the KAP of HCWs regarding the WHO-recommended vaccinations, namely, those against hepatitis B, polio, diphtheria, measles, rubella, meningococcus, influenza, varicella and pertussis, and to assess the facilitators of, and barriers to, HCW vaccine uptake. Methods: This was a cross-sectional study. A self-administered KAP survey was completed by 300 clinical (nurses, doctors, allied health) and non-clinical (laboratory, pharmacy, administrative, household staff and porters) HCWs at Tygerberg Hospital, Cape Town, from June to October 2018. Data were analysed using Stata Statistical Software version 13.0 IC to generate mean scores for KAP. Individual question scores were compared across job categories (clinical vs non-clinical) using Pearson's chi-square test. Results: Most of the study participants were female (n = 228, 76.0%), aged 18­40 years (n = 190, 63.3%) and employed as clinical staff (n = 252, 84.0%). The overall mean KAP scores were 57.1%, 68.4% and 39.9%, respectively; clinical HCWs scored significantly higher than non-clinical HCWs in all three topics (p < 0.001). HCWs believed vaccines to be effective (n = 254, 84.7%) and safe with few side effects (n = 219, 73.0%). Vaccine uptake was highest for hepatitis B (n = 247, 82.3%), followed by measles (n = 159, 53.0%) and diphtheria/tetanus (n = 101, 33.7%), and lowest for influenza (n = 68, 22.7%). Common reasons for vaccination included HCWs wanting to protect themselves, their families and their patients. Fear of side effects and lack of workplace access were common reasons for not vaccinating. Conclusion: Clinical HCWs had better KAP regarding vaccination than non-clinical HCWs. Strategies to improve HCW vaccine uptake should focus on vaccination education and facilitation of workplace access to vaccination.

Resurgence of diphtheria: clinical profile and outcome in a tertiary care hospital of South India

Background: Diphtheria is a potentially fatal acute disease caused by Corynebacterium diphtheria. It was one of the leading causes of mortality in the pre vaccination era. This study is an attempt to highlight the clinical profile, outcome and demographic characteristics, immunization status of pediatric diphtheria cases in South India. Objective of the study was to analyze the clinical profile, immunization status and outcome in children with diphtheria admitted to the PICU in a tertiary care hospital.Methods: This retrospective study was conducted in a tertiary care hospital in South India. The case records of all children admitted to the hospital between January 1st, 2014 to December 31st, 2018 with clinically suspected diphtheria were analyzed. The data was analyzed with respect to clinical features, demographic characteristics, immunization status, complications and outcome using appropriate statistical methods.Results: 18 cases were clinically suspected to have diphtheria. The average age of children presenting with diphtheria was 9 years. Out of the 18 cases, 11 were male, 7 were female. 16 out of 18 cases were from rural areas, whereas only 2 cases were from urban areas. Fever, sore throat and dysphagia were the presenting complaints in all cases. Neck swelling, white patch over tonsil and tender cervical lymphadenopathy were the other findings noted. Out of 18 cases, 7 were completely immunized, 8 were incompletely immunized and 3 were not immunized. Antidiphtheritic serum was given in 14 cases. Myocarditis, airway compromise and neurological deficits were the complications noted. Case fatality rate was 50%.Conclusions: Diphtheria still remains a major public health problem in developing countries like India. Mortality and morbidity due to diphtheria continues to be high despite ready availability of vaccines and antitoxin. Childhood immunization program, especially follow up and administration of booster doses must be prioritized.

Resurgence of diphtheria and its outcome among children in western Uttar Pradesh: a battle to conquer

Background: Considered as a rare clinical entity in immediate post-vaccination era, diphtheria has now started gaining surface in India for last few years, with an epidemiological shift involving older children owing to poor immunization coverage and waning immunity. Thus, it is imperative to quantify disease burden, analyses the clinical profile and factors affecting the outcome of diphtheria in children.Methods: A prospective observational study conducted in the Pediatric department of a teaching hospital where all children admitted with clinical diagnosis of diphtheria during the study period were included. Demographic data and clinically relevant information along with complications and outcome were recorded. Cases were managed as per standard treatment protocol providing intensive care support wherever required. Complications and factors affecting the outcome in all diphtheria cases were analysed.Results: Total 53 children were enrolled into study, and the mean age of study population was 7.55'2 years. Fever, pseudo membrane and throat pain were observed in all the cases. Palatal palsy was the earliest and the commonest complication (60.4%) followed by myocarditis (55%). Case fatality rate was 33.9% and myocarditis (77%) was the commonest complication attributing to it. Poor immunization status, late presentation and delayed ADS administration were associated with increased complication rate and unfavorable outcome.Conclusions: Robust immunization activity coupled with improved case-based surveillance would go a long way in preventing further diphtheria outbreaks in community. Sensitization about this re-emerging disease and high index of suspicion in diagnosing it, amongst primary care physicians and peripheral health workers would promote early referral and prompt management thereby reducing morbidity and high mortality associated with diphtheria.

Antibody levels against diphtheria monitored in Jiading District, Shanghai / 上海预防医学

Objective To investigate the antibody levels against diphtheria among healthy population in Jiading District of Shanghai, and to make evaluation of the effect of diphtheria toxoid vaccination strategy. Methods Serum samples were collected from healthy population in Jiading District of Shanghai in 2010-2013.Antibody against diphtheria was tested by the enzyme-linked immunosorbent assay (ELISA).Geometric mean titer (GMT) of diphtheria antibody was compared between different population characteristics. Results A total of 1 029 serum samples were collected from the healthy population.With 1 003 of 1 029 diphtheria antibody titer of IgG (over 0.01 IU/mL), the positive rate was 97.47%, reaching the level of security protection (over 0.1 IU/mL) that accounted for 70.36%, and achieving the long-term protection level (over 1 IU/mL) that accounted for 35.57%;IgG GMT 0.325 IU/mL.There was significant difference in the positive rates and antibody levels between city residents and floating population in the field of diphtheria antibodies (χ2=4.708, P < 0.05;t=2.787, P < 0.05).There were statistically significant differences between different age groups in diphtheria antibody positive rates (χ2=30.262, P < 0.001) and statistically significant differences in GMT diphtheria antibody levels between different age groups (F=99.500, P < 0.001), GMT ranged in 0.029 IU/mL (30 years age group)~1.526 IU/mL (5 years age group). Conclusion The investigation of diphtheria antibody levels in Shanghai Jiading District truly reflects the effect of routine diphtheria immunization in Jiading District.DT (diphtheria & tetanus) vaccination for third grade junior is effective.We suggest a booster dose of diphtheria-containing vaccine for adolescents or adults so as to maintain immune levels.

Arytenoid chondritis in two calves / Condrite aritenóide em duas bezerras

ABSTRACT: Although, calf diphtheria and necrotic laryngitis are common infections in the oral cavity's soft tissues, arytenoid chondritis is addressed as a serious but rarely diagnosed complication in cattle. This paper aimed to describe clinical, laboratory, imaging, and pathological findings in two calves with arytenoid chondritis. A 2-month-old Jersey calf and a 3-month-old Girolando calf presented 40-days history of respiratory distress. In the former, oral endoscopy revealed enlarged and immobile arytenoids with major involvement of the left arytenoid, causing severe distortion and partial obstruction of the rima glottidis. In the latter, latero-lateral radiography of the head revealed radiolucent areas and thickening at the level of the larynx to the dorsal trachea. Pathological examination of one calf showed neutrophilic multifocal inflammatory infiltrate and areas of necrosis in the cricoarytenoid cartilage, surrounded by abscessation. Definitive diagnosis of arytenoid chondritis in these two calves was established on the basis of clinical, laboratory, imaging (endoscopy and radiography), and pathological findings. Daily and careful observation of the herds and the use of ancillary diagnostic methods allowed the early diagnosis of the disease, and accurate diagnosis can improve prognosis and increase treatment success rate.

RESUMO: Embora a difteria em bezerros e a laringite necrótica sejam infecções comuns nos tecidos moles da cavidade oral, a condrite aritenoide é considerada uma complicação grave, mas raramente diagnosticada em bovinos. Este trabalho tem como objetivo descrever os achados clínicos, laboratoriais, de imagem e patológicos em duas bezerras apresentando condrite aritenoide. Uma bezerra Jersey de dois meses de idade e uma bezerra Girolando de três meses de idade apresentavam dificuldades respiratórias por 40 dias. Na primeira, a endoscopia oral revelou aritenoides aumentadas e imóveis, com grande envolvimento da aritenoide esquerda, causando distorção grave e obstrução parcial de rima glottidis. Na segunda, a radiografia látero-lateral da cabeça revelou áreas radioluscentes e espessamento ao nível da laringe até a traqueia dorsal. O exame patológico de uma bezerra revelou infiltrado inflamatório multifocal neutrofílico e áreas de necrose na cartilagem cricoaritenóide, circundadas por abscessos. O diagnóstico definitivo de condrite aritenoide nessas duas bezerras foi estabelecido com base nos achados clínicos, laboratoriais, de imagem (endoscopia e radiografia) e patológicos. O monitoramento diário e minucioso dos rebanhos e o uso de métodos auxiliares de diagnóstico permitem o diagnóstico precoce da enfermidade, sendo que o diagnóstico preciso pode melhorar o prognóstico e aumentar a taxa de sucesso do tratamento.

Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in São Paulo, Brazil: need for continuous surveillance and implementation of active strategies

Abstract Introduction: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. Objective: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. Methods: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. Results: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. Conclusions: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.

Difteria en Venezuela: análisis de las manifestaciones clínicas y evolución de una serie de casos

Objetivo: Analizar las manifestaciones clínicas y evolución de los casos sospechosos o confirmados de Difteria en Venezuela. Materiales y Métodos: Se realizó un estudio prospectivo, observacional, descriptivo, longitudinal y multicentrico en los estados Anzoátegui, Bolívar, Carabobo, Distrito Capital, Lara, Mérida, Miranda y Zulia, se siguieron 48 pacientes sospechosos o confirmados para difteria y se describieron sus características clínicas. Resultados: 54,2 % fueron de sexo femenino, 2 de ellas embarazadas, 1 de ellas falleció. La localización más frecuente de lesiones fue la faríngea, sin embargo se observaron otras como la tonsilar, laringotraqueal, nasal y cutánea. Todos los pacientes recibieron antibióticos pero solo 32 toxina antidiftérica. Solo 11 pacientes tenían esquema vacunal completo y 18 presentaron complicaciones. El 18,8 % de la muestra falleció y el resto egresó sin secuelas. Conclusiones: El brote de difteria en Venezuela sigue activo, las cifras de pacientes afectados invitan a implementar estrategias de control a través de la inmunización de susceptibles, erradicación de portadores asintomáticos, diagnóstico temprano, reporte obligatorio, atención y manejo adecuado de los infectados.

Objective: To analize the clinical manifestations and evolution of suspected or confirmed cases of Diphtheria in Venezuela. Methods: A prospective, observational, descriptive, longitudinal and multicentric study was conducted in the Venezuelan's states of Anzoategui, Bolivar, Carabobo, Capital District, Lara, Merida, Miranda and Zulia. The time 1 of the investigation was at the hospital admission and the final time was at discharge. During the hospitalization, the follow-up was performed. Results: 48 patients were followed and all of them had suspected or confirmed Diphtheria. 45,5 % were men and 54.2 % were female, 2 of them were pregnant, and 1 of them died. The most frequent location of lesions was the pharyngeal, however other location were observed such as tonsillar, laryngotracheal, nasal and cutaneous. All patients received antibiotics but only 32 diphtheria antitoxin. Only 11 patients had a complete vaccination scheme and 18 (36 %) had complications. 18.8 % of the sample died and the rest withdrew without sequelae. Conclusions: The diphtheria outbreak in Venezuela is still active, the number of affected patients invite to implement strategies of control through the immunization of susceptibles, eradication of asymptomatic carriers, early diagnosis, mandatory reporting, care and adequate management of the infected.