Tetanus immunity in individuals aged 50 years or older in Kashan, Iran

Tetanus can be only prevented by vaccination because immunity against this disease is rarely acquired, even by natural infections. To maintain long-term protective immunity against tetanus, booster immunization is essential for adolescents and adults. Most hospitalized cases and virtually all deaths occur in people over 60 years of age. The purpose of this study was to investigate the degree of protective tetanus immunity among 50 years of age and older people in Kashan city, Iran. This cross-sectional study carried out on 180 randomly individuals aged 50 years or older who were visiting a central laboratory for health examinations in 2008. Participants' serum levels of tetanus antitoxin were measured by enzyme linked immunosorbent assay. A standard questionnaire was used to collect demographic data and information about risk factors. The prevalence of protective tetanus immunity in various age groups was described and sociodemographic factors that potentially influenced the degree of tetanus immunity were analyzed. Overall, 180 persons were included. Of these, 72 [40%] had never received a toxoid booster, while 47 [26.1%] had received a booster at least once. Among all participants, 30 [16.7%] had protective tetanus antitoxin levels [>/= 0.11 IU/mL], and 34 [18.9%] had protective antitoxin levels without the need of an immediate booster >/= 0.51 IU/mL. Among 86 participants aged>60 years, 6 [7%] had protective antitoxin levels >/= 0.1-1 IU/mL, and 5[5.8%] had protective antitoxin levels >/= 1 IU/mL. Male gender and prior receipt of toxoid booster[s] were associated with protective tetanus immunity. Tetanus antitoxin levels declined with age. It appears that most 50 years of age and older adults do not have protective levels of tetanus antitoxin because of inadequate vaccination coverage. There is a need to improve the immunity levels of this age group. It is recommended to vaccinate elderly people against tetanus

Antitoxin response to tetanus toxoid [TT] versus combined tetanus -reduced diphtheria [TD] vaccination in pregnant women: clinical trial

Outbreaks of diphtheria in 1990s primarily involved adults. This reflects the decline of immunity with age. It is recommended to use the combined tetanus-diphtheria toxoid [Td] instead of the monovalent tetanus toxoid [TT] whenever tetanus toxoid is indicated. The protective efficacy following the new vaccinations schedule needs to be tested. The present study aimed to compare serum levels of diphtheria and tetanus antitoxin in pregnant women receiving [Td] vaccine and those receiving [TT] tetanus toxoid vaccine. As well as, to compare the frequency of adverse events following immunization between both groups. randomized, double blind controlled trial strategy was adopted. The reference population was pregnant women attending four rural health units in Abu Homos District, Egypt. A simple randomized procedure was used to allocate enrolled subjects [n = 130] to a study group [receiving Td vaccine] and a control group [receiving TT group] in a ratio of 1:1. The study revealed that before the vaccine administration, the mean values of tetanus antitoxin level in the experimental group [who received two doses of Td vaccine] and the control group [who received two doses of TT vaccine] did not differ significantly. After the first dose of vaccination, the mean tetanus antibody level was significantly lower in the Td group than in the TT group [t = 5.51, p < 0.001]. However, after the second dose, the mean tetanus antibody liter for Td group rise to 5.83 +/- 3.99 lU/ml and was still lower than that for the TT group [6.9 +/- 3.27 IU/ml] but this difference was not statistically significant, [t = 1.68, P = 0.096]. There were no significant differences between the two groups as regards the occurrence of systemic adverse events following either the first dose or second dose of Td or TT vaccine. On the other hand, the frequency of local adverse events following the first dose and second dose of Td vaccine were higher than that following TT vaccine. However, the difference was not statistically significant except for occurrence of local pain. The study concluded that tetanus-diphtheria toxoid [Td] can be used instead of single tetanus toxoid [TT] to protect against both tetanus and diphtheria. The local reactions associated with Td are usually self limited and require no therapy

Tetanus antitoxin levels and cutaneous anergy in hemodialysis patients in two University Hospitals in Iran

The global incidence of tetanus is about I million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodiaksis patients. A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1 ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48 - 72h and 7 - 9 days after the injection. Twenty-eight [64%] patients had induration /= 0.1 IU/ml. There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations [48 - 72h and 7 - 9 days after the test] [p < 0.05]. Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required. Keywords: Anergy test, Anti-tetanus antibody, Hemodialysis

Quantitation of tetanus and diphtheria antitoxins in mouse sera by indirect haemagglutination.

Serum samples obtained from 75 groups of mice immunized with various doses of adsorbed tetanus vaccine, adsorbed diphtheria-tetanus vaccine and adsorbed diphtheria-tetanus-pertussis vaccine were titrated for tetanus antitoxin content by an in-vitro indirect haemagglutination (IHA) and by toxin neutralization test (TN) in mice. From these serum samples of 49 groups of mice which were immunized with combined vaccine containing diphtheria toxoid were titrated for their diphtheria antitoxin content by IHA and by i.d. toxin neutralization test (TN) in guinea pigs. Good correlations were found between the estimates obtained by in-vitro IHA and in vivo TN tests in both tetanus and diphtheria antitoxin titrations. The minimum level of tetanus or diphtheria antitoxin detectable by IHA was 0.00039 IU/ml. It is concluded that IHA is a simple, sensitive and reproducible alternative test which can replace the animal TN tests for the estimation of tetanus and diphtheria antitoxins and could reliably be used in the potency assay of tetanus and diphtheria toxoids of combined vaccines based on antibody induction in mice.