Ocorrência de eventos adversos após o uso da vacina adsorvida difteria, tétano e pertussis (acelular) - dTpa -, São Paulo, SP, 2015-2016 / Aparecimiento de eventos adversos después del uso de la vacuna adsorbida difteria, tétanos y tosferina (acelular) - dTpa -, São Paulo, SP, Brasil, 2015-2016 / Adverse event occurrence following use of tetanus, diphtheria and acellular pertussis adsorbed vaccine - Tdap -, São Paulo, SP, Brazil, 2015-2016

Objetivo: descrever a ocorrência de eventos adversos pós-vacinação (EAPV) com a vacina dTpa durante a gestação. Métodos: estudo descritivo, com dados de relatos das participantes de estudo de efetividade e imunogenicidade realizado em dois hospitais de São Paulo, SP, Brasil, entre 2015 e 2016. Resultados: das 201 mães incluídas no estudo, 48 (23,9%) apresentaram pelo menos um EAPV; foram identificados 60 sintomas relacionados ao uso da dTpa - dor (22,4%), inchaço (2,5%), febre (1,5%), sono (1,0%), vermelhidão (0,5%), vômito (0,5%), dor de cabeça (0,5%), reação local (0,5%) e cansaço (0,5%); não foram registrados eventos adversos raros, muito raros ou extremamente raros; todos os eventos foram considerados esperados e estão descritos em bula; todos tiveram desfecho para cura sem sequelas. Conclusão: a dTpa, na forma adotada pelo Programa Nacional de Imunizações (PNI), é segura; não foram identificados eventos adversos inesperados entre as gestantes imunizadas com a vacina.

Objetivo: describir el aparecimiento de eventos adversos posvacunación (EAPV) con la vacuna dTpa durante el embarazo. Métodos: estudio descriptivo con datos de relatos de las participantes del estudio de efectividad e inmunogenicidad realizado en dos hospitales de São Paulo, SP, Brasil, entre 2015 y 2106. Resultados: de las 201 madres del estudio, 48 (23,9%) tuvieron al menos un EAPV; se identificaron 60 síntomas relacionados al uso de dTpa - dolor (22.4%), hinchazón (2.5%), fiebre (1.5%), somnolencia (1.0%), enrojecimiento (0.5%), vómitos (0.5 %), dolor de cabeza (0.5%), reacción local (0.5%) y cansancio (0.5%) -; no se informaron eventos adversos raros, muy raros o extremadamente raros; todos los eventos se consideraron esperados y se describen en el prospecto; todos tuvieron resultados curativos sin secuelas. Conclusión: el estudio mostró que la vacuna dTpa utilizada por el Programa Nacional de Inmunización (PNI) es segura y no se identificaron eventos adversos inesperados entre las mujeres embarazadas vacunadas.

Objective: to describe occurrence of adverse events following immunization (AEFI) with Tdap vaccine during pregnancy. Methods: this was a descriptive study using data from reports by participants in an effectiveness and immunogenicity study conducted in two hospitals in São Paulo, SP, Brazil, from 2015 to 2016. Results: of the 201 mothers included in the study, 48 (23.9%) had at least one AEFI; 60 symptoms related to Tdap use were identified - pain (22.4%), swelling (2.5%), fever (1.5%), somnolence (1.0%), redness (0.5%), vomiting (0.5%), headache (0.5%), local reaction (0.5%), and fatigue (0.5%); no rare, very rare, or extremely rare adverse events were reported; all events were considered to be expected, as they are described in the vaccine package insert; outcome of all events was recovery without sequelae. Conclusion: Tdap vaccine in the form adopted by the National Immunization Program is safe; no unexpected adverse events were identified among vaccinated pregnant women.

Aspects épidémiologiques, cliniques et évolutifs du tétanos au CHR de Maradi au Niger

Introduction : Le tétanos est caractérisé par un tableau clinique fait des spasmes musculaires sévères faisant suite à des blessures. La bactérie en cause, Clostridium tétani, a été découverte en 1884 et mise en culture pour la première fois en 1889. C'est une maladie totalement évitable et d'ailleurs quasiment éliminée des pays développés grâce à la vaccination généralisée et à une rigoureuse prophylaxie post-exposition, toutes deux parfaitement codifiées. Objectif : Cette étude rétrospective avait pour but de décrire les aspects épidémiologiques, cliniques et évolutifs du tétanos au CHR de Maradi au Niger. Matériel et méthodes : Les dossiers de malades hospitalisés au service des maladies contagieuses du CHR de janvier 2011 à aout 2018 ont été évalués. Résultats : Nous avions colligé 49 cas de tétanos sur un total de 2930 malades hospitalisés dans le service soit un taux de prévalence de 1,67 %; 32,65 % des patients étaient âgés de 0 à 15 ans. La porte d'entrée tégumentaire a été la plus fréquemment retrouvée (vingt huit cas). D'autres portes d'entrée ont été notées : fracture ouverte (5 cas), injection intramusculaire (1 cas), ombilicale (2 cas), brulure corporelle (2cas). 57,14% des malades étaient au stade II de la classification de Mollaret. On a enregistré 19 décès sous traitement, soit un taux de létalité de 38,78 %. Le stade clinique des patients à l'admission a été associé au décès avec une P = 0,0030.Conclusion: La sensibilisation des populations, le renforcement du programme élargi de vaccination et l'amélioration de la prise en charge des malades devraient permettre de réduire encore davantage la mortalité liée au tétanos

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de enfermedades inmunoprevenibles. No. 06 / Protocol of the National Epidemiological Surveillance System of immunoprevenible diseases. No. 06

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. La vigilancia epidemiológica de las enfermedades prevenibles con vacuna, busca reducir la mortalidad y morbilidad por infecciones inmunoprevenibles. La vigilancia epidemiológica, es fundamental para evaluar el impacto de las intervenciones y la toma de decisiones de acuerdo al análisis permanente de la situación de salud.

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil? / Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil?

ABSTRACT The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

RESUMO O exitoso Programa Nacional de Imunizações do Brasil tem vivenciado grande desafio com relação às coberturas vacinais infantis, que têm apresentado queda. Diversos aspectos estão relacionados, mas certamente a hesitação vacinal vem se fortalecendo como uma das principais preocupações dos gestores e pesquisadores brasileiros. Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas quando elas estão disponíveis nos serviços de saúde, sendo um fenômeno que varia ao longo do tempo, do local e dos tipos de vacinas. Indivíduos hesitantes situam-se entre os dois polos de aceitação e recusa total da vacinação. A hesitação vacinal não é novidade em países europeus e norte-americanos e, mesmo no Brasil, ela já vem sendo estudada ainda que sob outra denominação. A queda das coberturas vacinais observadas a partir de 2016 reitera a relevância do tema, que deve ser mais bem compreendido por meio de investigações científicas.

Informe especial: Tétanos otras edades (No neonatal) / Special report: Tetanus other ages (Nonneonatal)

Entre las Semanas Epidemiológicas (SE) 51 del año 2016 y 5 del 2017 (período comprendido entre el 18/12/2016 y el 04/02/2017), la Gerencia Operativa de Epidemiología recibió la notificación de 3 casos de tétanos otras edades a través de alertas del módulo C2 del Sistema Nacional de Vigilancia de la Salud (SNVS). Se trató de 3 pacientes asistidos en el Departamento de Atención Intensiva del Paciente Infeccioso Crítico (D.A.I.P.I.C.), del Hospital de Infecciosas Francisco Muñiz, de la Ciudad de Buenos Aires. Dos casos correspondieron a residentes de Provincia de Buenos Aires y el restante a un residente de la Ciudad. Este informe resume estos tres casos, los cuales destacan la necesidad que los médicos y quienes están encargados de los cuidados de salud, constaten en oportunidad de toda consulta, la cobertura de vacunación antitetánica e indiquen la vacuna a pacientes no vacunados, incompletamente vacunados o con vacunación desconocida.(AU)

Evaluation of Immunogenicity and Safety of the New Tetanus-Reduced Diphtheria (Td) Vaccines (GC1107) in Healthy Korean Adolescents: A Phase II, Double-Blind, Randomized, Multicenter Clinical Trial

This phase II clinical trial was conducted to compare the immunogenicity and safety of a newly developed tetanus-reduced diphtheria (Td) vaccine (GC1107-T5.0 and GC1107-T7.5) and control vaccine. This study was also performed to select the proper dose of tetanus toxoid in the new Td vaccines. Healthy adolescents aged between 11 and 12 yr participated in this study. A total of 130 subjects (44 GC1107-T5.0, 42 GC1107-T7.5 and 44 control vaccine) completed a single dose of vaccination. Blood samples were collected from the subjects before and 4 weeks after the vaccination. In this study, all subjects (100%) in both GC1107-T5.0 and GC1107-T7.5 groups showed seroprotective antibody levels (> or = 0.1 U/mL) against diphtheria or tetanus toxoids. After the vaccination, the geometric mean titer (GMT) against diphtheria was significantly higher in Group GC1107-T5.0 (6.53) and GC1107-T7.5 (6.11) than in the control group (3.96). The GMT against tetanus was 18.6 in Group GC1107-T5.0, 19.94 in GC1107-T7.5 and 19.01 in the control group after the vaccination. In this study, the rates of local adverse reactions were 67.3% and 59.1% in GC1107-T5.0 and GC1107-7.5, respectively. No significant differences in the number of adverse reactions, prevalence and degree of severity of the solicited and unsolicited adverse reactions were observed among the three groups. Thus, both newly developed Td vaccines appear to be safe and show good immunogenicity. GC1107-T5.0, which contains relatively small amounts of tetanus toxoid, has been selected for a phase III clinical trial.

Factors Associated with Vaccination among Inflammatory Bowel Disease Patients in Korea / 대한소화기학회지

BACKGROUND/AIMS: Vaccinations are generally recommended in patients with inflammatory bowel disease (IBD). However, several studies showed low rates of vaccinations in IBD patients. Furthermore, vaccination rate among IBD patients in Korea has never been investigated. We investigated the vaccination rate among IBD patients in Korea and evaluated some factors that might affect the vaccination rate. METHODS: From November 2011 to February 2012, a total of 192 patients with IBD who visited Samsung Medical Center (Seoul, Korea) answered the IRB-approved questionnaire. The questionnaire included their sex, age, residence, past medical history, type of IBD, duration of illness, medications, history of vaccination about measles-mumps-rubella (MMR), varicella, tetanus-diphtheria (Td), influenza, hepatitis A and B, pneumococcus and human papilloma virus (HPV). RESULTS: One hundred twenty one (63.0%) male and 71 (37.0%) female answered the questionnaire. The mean age of the enrolled patients was 39.7 (18-76) years. Eighty four patients (43.8%) had ulcerative colitis and 108 patients (56.3%) had Crohn's disease (CD). The percentage of the patients who had got vaccination was 42.2% for MMR, 34.9% for varicella, 15.6% for Td, 37.5% for influenza, 15.6% for hepatitis A, 52.6% for hepatitis B, 6.3% for pneumococcus and 11.3% for HPV respectively. Not knowing the necessity or the existence were the common reasons for non-vaccination. Age less than 40 years, CD patients and duration of illness less than 10 years were associated with a higher vaccination rate (p=0.002, 0.015 and 0.020, respectively). CONCLUSIONS: Immunization rates for recommended vaccinations were very low in patients with IBD. Efforts to improve vaccination rate are needed.

Modifica decreto Nº 6, de 2010, que dispone vacunación obligatoria contra enfermedades inmunoprevenibles de la población del país / Amending Decree No. 6 of 2010, which provides compulsory vaccination against preventable diseases of the country's population

Modifícase el decreto Nº6, de 2010, del Ministerio de Salud, que dispone la vacunación obligatoria de la población contra las enfermedades inmunoprevenibles que se indican, reemplazando en su punto Nº 1, los numerales 3, 4, 5 y 11, respectivamente, en la forma que se indica.

Situação vacinal contra o tétano em trabalhadores da Empresa Municipal de Obras Públicas do Município de Divinópolis, Estado de Minas Gerais, Brasil, 2009 / Tetanus immunization status among workers of the Municipal Company of Public Works in the municipality of Divinopolis, state of Minas Gerais, Brazil, 2009

Objetivo: investigar a situação vacinal contra o tétano em trabalhadores da Empresa Municipal de Obras Públicas, município de Divinópolis, estado de Minas Gerais, Brasil. Métodos: a população de estudo compreendeu 205 trabalhadores, incluindo pedreiros, serventes de pedreiro, varredores de rua, de capina e roçagem, de rede de esgoto e de asfaltamento; os dados foram coletados entre março e outubro de 2009, mediante aplicação de questionário. Resultados: 22,9 por cento dos trabalhadores não souberam informar quando receberam vacinação; 17,6 por cento foram vacinados há mais de dez anos; 28,7 por cento relataram nunca haver recebido vacina contra o tétano; e apenas 35,1 por cento dos entrevistados possuíam cartão de vacina. Conclusão: a prevalência da vacinação contra o tétano foi baixa entre os trabalhadores estudados, expostos ao risco de contrair o tétano acidental em sua atividade de trabalho.

Objective: to investigate tetanus vaccination status in Municipal workers of the Municipal Company of Public Works in the municipality of Divinópolis, state of Minas Gerais, Brazil. Methods: the study population consisted of 205 workers, including masons, hodmen, street-sweepers, and workers of weeding, sewage and paving; data were collected from March to October 2009, through a questionnaire. Results: 22.9 per cent of workers could not say when they received vaccination; 17.6 per cent were vaccinated more than ten years ago; 28.7 per cent reported never had received tetanus vaccine; and only 35.1 per cent of respondents had a vaccination card. Conclusions: prevalence of vaccination against tetanus was low among the studied workers, exposed to risk of contracting incidental tetanus during their work activities.

Cuidados com o cordão umbilical do recém-nascido, no século XIX / Care for the newborn’s navel-string in the nineteenth-century / Cuidado del cordón umbilical del recién nacido, en el siglo XIX

Estudo de abordagem na microanálise sobre cuidados para a prevenção do tétano do recém-nascido, no século XIX. Os documentos utilizados para análise foram as teses da Faculdade de Medicina do Rio de Janeiro que tratassem da temática sobre o cordão umbilical do recém-nascido, no século XIX. O resultado analítico dos documentos evidenciou o discurso médico embasado em referências nacionais e internacionais, no sentido de introjetar na prática do cuidado mudança na cultura da higiene, na maioria das vezes praticadas por parteiras leigas, direcionada para as mães como uma das maneiras de se prevenir o tétano do recém-nascido.

Microanalysis study on prevention care against neonatal tetanus in the nineteenth century. The theses of the Faculdade de Medicina do Rio de Janeiro (The University of Rio de Janeiro Medical School) addressing the newborn’s navel-string in nineteenth century provided the basis for the analysis. The analysis showed that medical discourses, relying on national and international references, signaled to the need of cultural changes in hygiene by lay midwives and mothers, as a way to prevent tetanus of the newborn.

Estudio de enfoque en el microanálisis sobre cuidados para la prevención del tétano del recién nacido, en el siglo XIX. Los documentos utilizados para análisis fueron las tesis de la Facultad de Medicina de Rio de Janeiro-Brasil teniendo como tema el cordón umbilical del recién nacido, en el siglo XIX. El resultado del análisis de los documentos mostró el discurso médico basado en referencias nacionales e internacionales, en el sentido de introjetar en la práctica del cuidado cambio en la cultura de la higiene, muchas veces ejercida por parteras laicas, dirigido para las madres como una de las maneras de prevenir el tétano del recién nacido.

Impacto epidemiológico y económico de la vacunación contra el tétanos en adultos de Colombia / Epidemiological and economic impact of tetanus vaccination in Colombian adults

OBJETIVO: Evaluar el potencial impacto epidemiológico y económico de la vacunación antitetánica en la población colombiana mayor de 15 años de edad, con dosis de refuerzo cada 10 años. MÉTODOS: Se realizó un análisis de costo-efectividad de la vacunación con refuerzo cada 10 años contra el tétanos en Colombia, comparándola con la actual estrategia (2, 4, 6, 18 y 60 meses). La carga de enfermedad se estimó con base en tres fuentes oficiales de datos. Se realizó un modelo de Markov desde la perspectiva del tercer pagador. El horizonte temporal fue el tiempo de vida de una persona. Se realizaron análisis de sensibilidad determinístico y probabilístico. RESULTADOS: En Colombia se notifican anualmente entre 30 y 48 casos de tétanos que ocasionan entre 9,6 y 10,1 muertes. Si bien la vacunación con refuerzo resultó costo-efectiva para toda la población (el costo por año de vida ajustado por discapacidad [AVAD] evitado fue de US$ 11 314 en toda la población), al discriminar los resultados por género no sería costoefectiva en las mujeres (el costo por AVAD evitado en hombres fue de US$ 4 903, y en mujeres de US$ 22 332). CONCLUSIONES: Este es el primer estudio que evalúa la costo- efectividad de una dosis de refuerzo cada 10 años de la vacuna contra el tétanos en un país en desarrollo. La aplicación de esta medida sería costo-efectiva en Colombia, especialmente para los hombres. Las diferencias en los resultados por género obliga a que cualquier decisión de implementación deba tener en cuenta la vacunación actual en mujeres en edad fértil.

OBJECTIVE: Assess the potential epidemiological and economic impact of vaccinating the over-15 Colombian population against tetanus with a booster dose every 10 years. METHODS: A cost-effectiveness analysis of tetanus vaccination with a booster dose every 10 years was conducted in Colombia and compared with the current strategy (2, 4, 6, 18, and 60 months). Estimates of the burden of disease were based on three official data sources. A Markov model from the perspective of the third party payer was developed. The time horizon was the lifetime of a person. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: In Colombia, 30 to 48 cases of tetanus resulting in 9.6 to 10.1 deaths are reported each year. Although booster vaccination for the entire population was cost-effective (the cost per disability-adjusted life year [DALY] avoided was US$ 11,314 in the entire population), gender-based differentiation of the results showed that it would not be cost-effective in women (cost per DALY avoided was US$ 4,903 in men and US$ 22,332 in women). CONCLUSIONS: This is the first study that evaluates the cost-effectiveness of a tetanus vaccine booster dose every 10 years in a developing country. Use of this measure would be cost-effective in Colombia, especially for men. As a result of the gender-based differences in the results, any decision about its use in women of childbearing age should take current vaccination into account.

Tétano acidental no idoso: situação em Minas Gerais / Accidental tetanus among the elderly: situation in Minas Gerais

O tétano é uma doença infecciosa, não contagiosa, causadapelo Clostridium tetani,que, embora atualmente seja apontadocomo passível de erradicação, ainda gera grandes impactoshumanos, sociais e econômicos principalmente sobre osidosos. Realizou-se um estudo de caráter descritivo, cujoobjetivo foi conhecer o perfil epidemiológico dos casosconfirmados de tétano acidental em idosos, comparado àpopulação geral, no Estado de Minas Gerais, nos anos de2001 a 2006, identificando variáveis associadas às diferençasna distribuição da incidência e letalidade da doença. Dos225 casos da doença notificados à Secretaria de Estado daSaúde de Minas Gerais por meio do Sistema de Informaçõesde Agravos de Notificação, 84 (37,3%) ocorreram emidosos, de modo que a incidência entre os idosos varioude 0,46 (2006) a 1,07 casos por 100.000 habitantes (2003),sendo a média 0,83 casos por 100.000 habitantes. A incidênciaentre os idosos mostrou-se superior à registradanas demais faixas etárias, exceto no ano 2006. O sexomasculino foi o grupo mais atingido em todas as faixasetárias. Nos idosos, observa-se que as atividades que maisse destacaram foram: aposentado, do lar e trabalhadoresrurais, e que 44,0% deles adquiriram o bacilo na própriaresidência. A letalidade da doença entre eles foi 46,4%,mostrando-se superior à média para o período estudadoque é de 36,9%. O coeficiente de mortalidade por tétanoacidental nos idosos (0,39 óbitos/ 100.000 hab.) é cerca deseis vezes maior do que a média na população total (0,07óbitos/100.000 hab.). Constatou-se que o idoso é o grupopopulacional mais susceptível a adoecer e morrer pelo tétanono Estado. É necessária a intensificação das ações deimunoprofilaxia, evitando-se as oportunidades perdidas devacinação de modo a obter a prevenção e o controle desseimportante agravo em saúde pública.

Tetanus is a non-contagious infectious disease caused by Clostridium tetani. Although there are now indications that eradication of tetanus is possible, it continues to have a large human, social and economic impact, particularly among the elderly. A descriptive study was conducted with the aims of ascertaining the epidemiological profile of confirmed cases of accidental tetanus among elderly individuals, compared with the general population, in the state of Minas Gerais between 2001 and 2006, and identifying variables possibly associated with the differences in the incidence and fatality rates of the disease. There were 225 cases of the disease registered in the Notifiable Disease Information System of the Minas Gerais State Health Authority. Of these 225 cases, 84 (37.3%) occurred among elderly people. The incidence among the elderly ranged from 0.46 to 1.07 cases per 100,000 inhabitants (2006 and 2003, respectively), with a mean of 0.83 cases per 100,000 inhabitants. The incidence among the elderly was greater than what was registered among other age groups, except in 2006. Males were the group most affected in all age groups. Among the elderly, most were retired, worked in their own homes or were rural laborers. 44.0% of them acquired the bacillus in their own homes. The case-fatality rate was 46.4% among the elderly people, which was higher than the general mean for the study period (36.9%). The mortality coefficient for accidental tetanus among the elderly (0.39 deaths/100,000 inhabitants) was around six times greater than that for the general population (0.07 deaths/100,000 inhabitants). We concluded that elderly people are the population group most susceptible to becoming ill with and dying from tetanus in the state of Minas Gerais. It is necessary to intensify the immunoprophylactic measures, in order to avoid missed opportunities for vaccination and achieve prevention and control of this important public health hazard.

Aspectos epidemiológicos do tetano acidental na regiâo metropolitana de Belo Horizonte, estado de Minas Gerais, Brasil – 2001-2006 / Aspectos epidemiologicos del tetanos accidental en la region metropolitana de Belo Horizonte, estado de Minas Gerais, Brasil – 2001-2006 / Epidemiological aspects of accidental tetanus infection in the metropolitan region of Belo Horizonte, state of Minas Gerais, Brazil – 2001-2006

O tétano é uma doença infecciosa não contagiosa, causada pelo Clostridium tetani. Mesmo sendo um agravo imunoprevinível de fácil controle, ainda constitui um importante problema de saúde pública. Realizou-se, aqui, um estudo descritivo, retrospectivo e transversal cujo objetivo foi conhecer o perfil epidemiológico dos casos confirmados de tétano acidental na região metropolitana de Belo Horizonte (RMBH) entre 2001 e 2006, identificando algumas variáveis que possam estar associadas à incidência, mortalidade e letalidade da doença. A coleta dos dados referentes aos 31 casos da doença, que correspondem à amostra, foi obtida na Secretaria de Estado da Saúde de Minas Gerais, por meio do Sistema de Informação de Agravos de Notificação. Os casos são oriundos de 23% das cidades que compõem a região, sendo a capital, Belo Horizonte, responsável por 38,7% dos casos. A maioria dos casos ocorreu em 2004 (0,21casos/100 mil habitantes), sendo a taxa média para o período do estudo de 0,11 casos/100 mil habitantes. A incidência entre o sexo masculino foi 2,88 vezes superior ao feminino. Quanto à distribuição etária, constatou-se que não houve acometimento do tétano acidental nos indivíduos menores de 20 anos e a faixa etária que registrou maior incidência foi a acima de 65 anos (0,41/100 mil habitantes). A área rural sobressaiu em termos de incidência (0,20 casos/100 mil habitantes). O domicílio e o ambiente de trabalho originaram 22,6% dos casos e a letalidade encontrada foi de 35,5%. Reforça-se, assim, a importância das ações de imunoprofilaxia do tétano pela atenção básica para desenvolver sua prevenção e controle.

Tetanus is a non-contagious infectious disease caused by the Clostridium tetany. Even though it is an easily controlled immunizable disease, it remains an important public health problem. This was a cross-sectional, retrospective and descriptive study whose intention was to determine the epidemiological profile of confirmed cases of accidental tetanus infection, and to identify the variables that might be associated with its incidence, mortality and lethalityin the metropolitan region of Belo Horizonte between 2001 and 2006. The sample was formed by data related to 31disease cases provided by the State Health Department of Minas Gerais via the Notifiable Diseases Information System.The cases came from 23.0% of the municipalities that comprise the region. The state capital of Belo Horizonte was responsible for 38.7% of the cases. The majority of them occurred in the year 2004 (0.21 cases/100,000 inhabitants),with an average rate during that period of 0.11 cases/100,000 inhabitants. The incidence among males was 2.88 times higher than females. Regarding age distribution, there were no cases of accidental tetanus among individuals under20 years of age and the age group with the highest incidence was the over-65s (0.41/100,000 inhabitants). Rural are ashad the most cases (0.20 cases/100,000 inhabitants). 22.6% of the cases were originated at home and at work with a 35.5% lethality rate. This research highlights the importance of prophylactic immunization actions against tetanus within primary health care system, in order to prevent and control its incidence.

El tétanos es una enfermedad infecciosa no contagiosa causada por el Clostridium tetani que, incluso siendo un agravioimunoprevenible de fácil control, aún constituye un importante problema de salud pública. Se realizó un estudiodescriptivo retrospectivo transversal cuyo objetivo fue conocer el perfil epidemiológico de los casos confirmados detétanos accidental en la Región Metropolitana de Belo Horizonte entre 2001 y 2006, identificándose algunas variablesque puedan estar asociadas a la incidencia, a la mortalidad y letalidad de la enfermedad. La recogida de datos referentesa los 31 casos de la enfermedad que corresponden a la muestra fue obtenida en la Secretaría de Estado de Salud deMinas Gerais por medio del Sistema de Información de Agravios de Notificación. Los casos son provenientes de 23,0% de las ciudades que componen la región cuya capital, Belo Horizonte, es responsable del 38,7% de los casos. La mayoría de los casos ocurrió en 2004 (0,21 casos/100.000 hab.) con un índice promedio de 0,11 casos/100.000 habitantes duranteel período del estudio. La incidencia entre los varones fue 2,88 veces superior a las mujeres. En lo que se refiere a la distribución por edades se constató que no se produjeron casos de tétanos accidental en los individuos menores de 20 años y el rango de edad que registró mayor incidencia fue superior a los 65 años (0,41/100.000 hab.). La zona rural se destacó en términos de incidencia (0,20 casos/100.000 hab.). La vivienda y el ambiente de trabajo originaron 22,6%de los casos y la letalidad encontrada fue del 35,5%. Se refuerza así la importancia de las acciones de imunoprofilaxis del tétanos por la atención básica para su control y prevención.

Tétano: quando a imunoprevenção falha / Tetanus: when vaccine prevention fails

O tétano é doença adquirida do sistema nervoso central pela contaminação de feridaspelo bacilo Gram positivo Clostridium tetani, presente em fezes de animais, solo, poeirae objetos enferrujados. O tétano, apesar de passível de imunoprevenção, ainda persistenos países em desenvolvimento, devido à cobertura vacinal incompleta e ao tratamentoinadequado de lesões traumáticas. Este trabalho descreve a evolução de pacienteatendido no Hospital Risoleta Tolentino Neves, com manifestações clínicas de tétano,caso em que a adequada abordagem terapêutica garantiu a cura. Alerta para a persistênciado tétano como doença grave e para a importância da observação do esquemavacinal e da correta abordagem de feridas.

Tetanus is a central nervous system disease, acquired by contamination of wounds by Clostridium tetani, a Gram positive bacillus present in animal feces, soil, dust and rusty objects. Although vaccine-preventable, the disease persists in developing countries, due to incomplete vaccine-coverage and inadequate treatment of traumatic injuries. This paper describes a case of a patient treated at Hospital Risoleta Tolentino Neves, with typi-cal clinical manifestations of tetanus, in whom the institution of an appropriate treatment contributed effectively to his healing. This case report highlights the persistence of tetanus in Brazilian context and aims to draw attention to the importance of observation of the immunization schedule and the correct approach to wound treatment.

Frequency of tetanus toxoid immunization among college/university female students of Karachi

Tetanus is a deadly infectious disease for which immunisation is available in EPI at both infant level and for females of reproductive age. More than 95% of patients who develop tetanus have not been previously immunised. Objectives of the study were to determine the frequency of tetanus vaccination and to access the awareness of immunisation among females studying in 11 girls' colleges of Karachi and University of Karachi. A cross sectional study was conducted among 1,407 females studying in colleges and University of Karachi from April to August 2007 using a prescribed questionnaire. Among 1,407 female students who were interviewed for the study, 232 [16.48%] were not aware about tetanus immunisation program for females of reproductive age. Only 560 students [39.80%] received at least 1 of 5 recommended doses. Only 41 female students [2.91%] received complete course of 5 doses. Coverage of tetanus immunisation among literate females in most populous city of the country is far behind satisfactory. There is need for awareness and crash programs of tetanus immunisation

Immunogenicity and Safety of Diphtheria-tetanus Vaccine in Adults

This study was conducted to evaluate the immunogenicity and safety of diphtheria-tetanus (Td) vaccine in adults over 40 yr old who had never received a diphtheria-tetanus-pertussis (DTP) vaccination. A total of 242 subject completed three-doses of Td vaccination and subsequent assays for immunogenicity. Before vaccination, 33.9% and 96.7% participants showed antibody levels of diphtheria and tetanus, respectively, which were below protective level ( or =0.1 U/mL) for diphtheria and tetanus, with an increase to 99.6% and 100% after the third dose. Local and systemic adverse events occurred in 37.9% and 15.5% of the subjects. No serious adverse event requiring an unscheduled hospital visit occurred. In conclusion, three-doses of Td vaccination to unimmunized adults are safe and effective in inducing protective immunity against diphtheria and tetanus.

Aspectos epidemiológicos do tétano acidental no Estado de Minas Gerais, Brasil, 2001–2006 / Epidemiological features of injury-related tetanus in the State of Minas Gerais, Brazil, 2001 - 2006

O artigo descreve o perfil epidemiológico dos casos de tétano acidental notificados à Secretaria de Estado de Saúde de Minas Gerais. Os dados analisados são do período de 2001 a 2006, totalizando 225 casos confirmados da doença, obtidos pelo Sistema de Informação de Agravos de Notificação do Sistema Único de Saúde (Sinan/SUS). A maior parte ocorreu entre homens (0,30 casos por 100.000 habitantes/ano), sendo o tipo de lesão mais observada a perfuro cortante (39,1 por cento) e os membros inferiores a região mais acometida (62,2 por cento). A faixa etária com maior incidência foi acima de 65 anos (0,89 casos por 100.000 habitantes) e o maior coeficiente de incidência ocorreu na área rural (0,31 casos por 100.000 habitantes/ano). Somente 6,3 por cento tinham esquema vacinal completo, enquanto 21,3 por cento informaram nunca terem sido vacinados. A letalidade no período estudado foi de 36,9 por cento. Conclui-se que, apesar de ser imunoprevenível, o tétano ainda constitui-se um importante problema de saúde pública em Minas Gerais.

This article describes the epidemiological features of injury-related tetanus cases notified by the Health Department of the State of Minas Gerais, Brazil at the Information System for Notifiable Diseases (Sinan). Data from 2001 to 2006 were analyzed, which includes 225 confirmed cases of the disease. Most cases occurred in men (0.30 cases per 100,000 population per year). The main source of infection were cut and puncture wounds (39.1 percent). Legs were the most frequently injured body part (62.2 percent). The highest incidence occurred in the age group of >65 years old (0.89 cases per 100,000 population per year) and in people living in rural areas (0.31 cases per 100,000 population per year). Only 6.3 percent of patients stated having completed their vaccination schedule and 21.3 percent informed that they had never been vaccinated against tetanus. The lethality rate found in this study was 36.9 percent. Results show that, despite being a vaccine-preventable disease, injury-related tetanus is an important public health problem in the State of Minas Gerais.

Reacciones adversas a vacuna DPT del Programa Nacional de Inmunizaciones / Adverse reactions to diphtheria-pertussis-tetanus vaccine in the Chilean Immunization Program

Background: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidentiy with a change in the vaccine manufacturer. Aim: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. Material and methods: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same área. The formulation of DPT received by all participants was verífied, as well as the temporal relation with consultation or symptoms referred by their caregivers. Results: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidentiy, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. Conclusions: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decisión. The usefulness of observational studies in vaccine adverse reactions is confirmed.

Tetanus: presentation and outcome in adults

Tetanus is still a common clinical entity, especially in developing countries. The purpose of this study was to evaluate the presenting features as well as the outcome of tetanus in adult patients admitted to the hospital. This was a hospital based descriptive study conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates from Jan. 2003 to Dec. 2008. The study was designed to include demographics, clinical information and outcome observed in the patients admitted with clinical diagnosis of tetanus. Patients with malignancy, immunosuppression [AIDS/Drugs], significant cardiac dysfunction and renal impairment were excluded. The patients were treated as per the standard protocol for the management of tetanus. A total of 44 patients were enrolled into the study. The mean age+SD of the patients were 26.3+5.8 years and all of the study patients were males. Thirty six [81.81%] patients gave the history of injury prior to onset of the symptoms, whereas eight [18.18%] patients were unable to recall any history of injury. All the study patients were laborers working in construction companies except for four who were gardeners. Body stiffness/spasm, difficulty in opening the mouth, difficulty in swallowing, body pain, neck pain and backache were the main presenting complaints. The patients with upper limb injuries had shorter incubation period and more severe disease with high frequency of autonomous nervous system insufficiency. Overall, hospital stay was 46.6+11.4 days. Forty [90.9%] patients required mechanical ventilation. The mean+SD ICU stay was 26.4+5.8 days and on weaning all the ventilated patients required tracheostomy. Eight [18.18%] patients died as a result of ventilator associated complications [Pneumonia] and autonomic nervous system dysfunction. Tetanus still carries high morbidity and mortality rate despite the available advanced management facilities including ICU care. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients

Priority communicable diseases in Gaza

The recent war and the prolonged blockade on the Gaza Strip, occupied Palestine territories [oPt] have resulted in an immeasurable deterioration in the medical and humanitarian situation. The risk of diseases outbreaks is becoming an added public health concern on an already over-tasked heath situation