The seroepidemiology of tetanus in Catalonia, Spain

Epidemiological Study of Tetanus Seropositivity Levels in Different Age Groups in Ankara Province, Turkey, 2017

The aim of this study was to determine the seropositivity levels of tetanus vaccine by age group in Ankara province, identify possible factors that affect immune status, and develop public health recommendations, especially for those 50 years and older. This cross-sectional epidemiological study covered individuals aged 3 years and older who are registered in the Family Medicine Information System. We received blood samples from 992 individuals and included 968 surveys in the analysis. Protective tetanus antibody levels were 80.5% in the 3-5 years age group, 92.0% in the 6-12 years age group, 94.3% in the 13-20 years age group, 95.2% in the 21-39 years age group, 84.4% in the 40-49 years age group, and 57.3% in the 50 years and older age group. Tetanus seropositivity decreased with age. Awareness of the importance of tetanus vaccine boosters for adults should be increased by providing training, ensuring booster vaccination against tetanus at 10-year intervals, and if necessary, considering mandatory tetanus vaccination for those 50 years and older.

Determination of Tetanus Antibody Levels in Trauma Patients Referred To Shahid Beheshti Hospital in Kashan, Iran, 2014

BACKGROUND

There is a noticeable difference in serologic immune status against tetanus among different age and social groups in various countries due to different national vaccination policies and methods.

OBJECTIVES

Considering that the immunization status of trauma patients against tetanus is not-known or uncertain and they may need to receive the vaccine and tetabulin, this study was conducted to determine the tetanus antibody levels in patients referred to the trauma emergency ward of Shahid Beheshti Hospital in Kashan City, Iran.

PATIENTS AND METHODS

This cross-sectional study was performed on 204 trauma patients referred to the trauma emergency ward of Shahid Beheshti hospital in Kashan City, Iran, in 2014. After obtaining a written informed consent from the patients, a questionnaire consisted of demographic information and tetanus vaccination record was completed by the patients. Afterwards, a 4 - 5 mL venous blood sample was taken from each patient and the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. The tetanus antibody levels equal or more than 0.1 IU/mL were considered protective. Data were analyzed using chi-square test, independent t-test and one-way ANOVA with SPSS software version 16.

RESULTS

From a total of 204 patients, 35 cases (16.7%) were females and 169 (83.2%) were males with the mean age of 40.9 ± 3.7 years. There was no statistically significant difference in the tetanus antibody levels between both sexes (P = 0.09). Moreover, there was no significant difference in immunization status between the patients who had a history of tetanus vaccination and those who had not received the vaccine before (P = 0.67). The antibody levels were significantly reduced with the passage of time since the last vaccination (P < 0.001). Also, 87.3% of the patients had the high protective level of immunity to tetanus.

CONCLUSIONS

The findings of the present study show a high level of tetanus antibody among trauma patients in this hospital; so, taking the tetanus vaccine history can be misleading. It is suggested that further studies be performed in different regions of our country and with larger sample sizes and detection of the immunization status of patients by measuring anti-tetanus antibody levels among trauma patients is recommended to make suitable policy for a national vaccine protocol in the future.

Seroepidemiology of tetanus in Korean adults and adolescents in 2012

This seroepidemiologic study was performed to evaluate the immune status against tetanus in Korean adolescents and adults and to provide evidence to develop strategies for tetanus prevention. Between July 2012 and December 2012, serum samples were collected from adults and adolescents 11 years of age and older, and serum anti-tetanus IgG titers were determined using a commercial ELISA kit. Subjects were divided into six age groups: 11-20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, and ≥61 years. The mean anti-tetanus IgG titers and tetanus seroprevalence of the age groups were compared. A total of 1193 adults and adolescents were enrolled. Mean anti-tetanus IgG titer and tetanus seroprevalence of all subjects were 1.20 ± 3.58 IU/mL and 56.4%, respectively. The mean anti-tetanus IgG titer decreased with an increase in age (p < 0.001). Tetanus seroprevalence increased from 92.0% in the 11-20 year age group to 95.7% in the 21-30 year age group, and then decreased with a further increase in age (p < 0.001). These results reflected an appropriate Td booster vaccine coverage at 11-12 years of age. However, the tetanus seroprevalence of adults older than 41 years was as low as the levels in previous studies: therefore, adults should be more encouraged to acquire decennial Td booster vaccinations recommended by the National Immunization Program.

Prevalence of susceptibility to tetanus and diphtheria in health care workers in Catalonia

A seroprevalence study of tetanus and diphtheria was carried out in a sample of 537 health care workers in Catalonia. The prevalence of protective antibodies against tetanus was 93.9% (95% confidence interval: 91.5-95.7). The prevalence of protective antibodies against diphtheria was 46.4% (95% confidence interval: 42.1-50.7). Tetanus protection should be improved in health care workers born before 1975. The immune status against diphtheria was poor, with less than half of people born before 1975 correctly immunized.

Evaluation of the establishment of herd immunity in the population by means of serological surveys and vaccination coverage

The necessary herd immunity blocking the transmission of an infectious agent in the population is established when the prevalence of protected individuals is higher than a critical value, called the herd immunity threshold. The establishment of herd immunity in the population can be determined using the vaccination coverage and seroepidemiological surveys. The vaccination coverage associated with herd immunity (V(c)) can be determined from the herd immunity threshold and vaccine effectiveness. This method requires a vaccine-specific effectiveness evaluation, and it can be used only for the herd immunity assessment of vaccinated communities in which the infectious agent is not circulating. The prevalence of positive serological results associated with herd immunity can be determined from the herd immunity threshold, in terms of prevalence of antibodies (p(c)) and serological test performance. The herd immunity is established when the prevalence of antibodies is higher than pc. This method can be used to assess the establishment of herd immunity in different population groups, both when the infectious agent is circulating and when it is not possible to assess vaccine effectiveness. The herd immunity assessment in Catalonia, Spain, showed that the additional vaccination coverage required to establish herd immunity was 3-6% for measles, mump and varicella and 11% poliovirus type III in school children, 17-59% for diphtheria in youth and adults and 25-46% for persussis in school children, youth and adults.

Tetanus and Pertussis vaccines: their usefulness in the aging population

Immunization is a safe, effective and simple way of preventing life-threatening tetanus infection in children and adults, and is therefore recommended for all age groups in all European countries. In older persons, despite waning immunity with increasing age, the majority of vaccinees attain protective tetanus immunity under a proper vaccination schedule. Based on the scientific evidence, decennial boosters are recommended for elderly persons who have received primary tetanus vaccination in the past. Until recently, pertussis vaccination was understood as an early childhood intervention. Due to decreasing immunity, re-vaccination of youngsters and adults is recommended and is also considered for seniors 60 years and over. Routine immunization of seniors against pertussis every ten years yields a high level of protection of older individuals, and at the same time contributes to epidemiological control of pertussis in the population.

Did we forget tetanus?

Introduction. Currently, in our country (Republic of Serbia) tetanus is a rarely occurring disease, mainly affecting people older than 65 years of age. A small number of reported cases is mainly due to appropriate immunization. Therefore, each case of tetanus may be considered as failure of health care system to provide adequate immunization. Case outline. A 71-year-old woman was injured in her garden. She sustained laceration in the left coccygeal region. The next day the wound was treated by a surgeon, but tetanus postexposure prophylaxis was not administrated. On the fifth day following the incident, the symptoms and signs of tetanus became apparent, and the patient died two days later. Postmortem examination revealed the wound that was not adequately treated, since there was a foreign body and a dressing inserted in the wound. Signs of acute (aerobic) infection were also present. Conclusion. Tetanus is a severe, potentially lethal disease that is absolutely preventable. Mistakes in immunization and surgical treatment of the wound can be considered as medical malpractice.