ABSTRACT
No Brasil, especialmente no Estado da Bahia, o tétano tem incidência anual ainda elevada, apesar das medidas imuno-preveníveis disponíveis. Também, a literatura especializada tem carência de estudos, avaliando aspectos clínicos e terapêuticos. Em vista disto, foram estudadas as características clínicas, terapêuticas, epidemiológicas e evolutivas dos casos de tétano neonatal e acidental, internados de 01/01/1986 a 31/12/1997, no Hospital Couto Maia, hospital de referência de doenças infecto-contagiosas de Salvador, Bahia. Foram estudados 1.024 pacientes, sendo 156 casos de tétano neonatal (15,2%) e 868 (84,8%) de tétano acidental. No tétano neonatal, houve predomínio do sexo masculino, a letalidade foi de 61,0%, a freqüência de casos mostrou redução significativa no período de 1994 a 1997, provavelmente decorrente da implantação, em 1992, do PETNN (Plano de Eliminação do Tétano Neonatal). A queixa mais freqüente foi a dificuldade da criança "sugar" ou "mamar"; o tempo de doença à internação, os períodos de incubação e progressão foram significativamente menores no grupo que evoluiu para o óbito houve predominância de casos no 2° trimestre do ano. Quanto ao tétano acidental, predominou também no sexo masculino, ocorreu mais nos 14 adolescentes e adultos jovens, agricultores e a letalidade foi de 35,4%, sendo maior, entre os adultos, especialmente os de 51 anos ou mais. Também entre os casos de tétano acidental, houve decréscimo do número de casos entre 1994 e 1997, mas, não foi observado nenhum período de maior incidência durante o ano. Os casos de tétano acidental referiram como queixa mais freqüente o trismo. As lesões perfurantes foram significativamente mais freqüentes se a área afetada foi em membros inferiores. Em 76 casos de...
Subject(s)
Humans , Male , Female , Infant, Newborn , Adolescent , Tetanus/epidemiology , Tetanus Toxoid/pharmacology , Epidemiology , Therapeutics/methodsABSTRACT
Active mouse protection test (AMPT) and enzyme linked immunosorbent assay (ELISA) were used to determine the immunogenicity of whole cell typhoid vaccine when administered in conjunction with either tetanus toxoid (TT) or DEAE-Dextran (DD). Immunization of mice with whole cell typhoid vaccine showed enhanced potency either when administered in conjunction with TT or DD and values were statistically significant (p < 0.05) in comparison to conventional or standard typhoid vaccines. For ELISA, the mice were immunized with 2 different schedules, one in which a single dose of 0.25 ml subcutaneously (s/c) was administered and in another two doses of 0.25 ml each s/c, 14 days apart. In case of single dose schedule of immunization D vaccine (Whole cell typhoid + 5 mg/ml DD) showed significant increase of immune response (3.201 log10) as compared to plain vaccine (2.550 log10). Two dose schedule further increased the titres to 3.856 log10. DD adjuvanted vaccine showed higher potency by AMPT as compared to the TT adjuvanted vaccine or plain vaccine. The present study clearly demonstrates that a single dose of 0.25 ml which is equivalent to half of the conventionally used single human dose of typhoid vaccine adjuvanted with DD can significantly improve the immunogenicity of the vaccine.
Subject(s)
Adjuvants, Immunologic/pharmacology , Animals , DEAE-Dextran/pharmacology , Enzyme-Linked Immunosorbent Assay , Female , Male , Mice , Mice, Inbred Strains , Tetanus Toxoid/pharmacology , Typhoid-Paratyphoid Vaccines/classification , Vaccines, Inactivated/metabolismABSTRACT
OBJECTIVES: To determine if anti-idiotype antibodies and circulating immune complexes in individuals before and after immunisation with tetanus toxoid play a role in the immune response. DESIGN: A study of individuals who were administered a single dose of tetanus toxoid (TT) and who were unimmunized. SETTING: Out patient departments of a large public hospital in Bombay, India. SUBJECTS: Thirty eight individuals pre-immunisation and forty five individuals post-immunisation with tetanus toxoid, tested at 1, 3, 6, and 12 months. MAIN OUTCOME MEASURE: Development of anti-tetanus anti-idiotype antibodies and circulating immune complexes. RESULTS: Pre-immunisation cases did show presence of anti-tetanus antibodies but in lower titres than post-immunisation up to six months, after which there was a reduction. Specific anti-idiotype antibodies were detected in 19 cases. One and three months after immunisation more cases had high titre antibodies and circulating immune complexes, though after six months, there was a fall in anti-tetanus antibody titres. Circulating immune complexes were seen in those samples having anti-idiotype antibodies. CONCLUSIONS: Though a significant rise in anti-tetanus antibody anti-idiotype antibodies, protective levels in mice and circulating immune complexes are seen after immunisation with TT it lasts for six months. When followed up for a period of one year it is observed that in cases having auto anti-idiotype antibodies, the anti-tetanus antibodies are maintained for a longer period.