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Okuda M, Morizane A, Asaba S, Tsurui S, Tsuno R, Hatakenaka M, Sugimura T, Saisaka Y. An unexpected case of tetanus in a fully immunized 20-year-old female: a case report. Int J Emerg Med 2024; 17:59. [PMID: 38658846 PMCID: PMC11040956 DOI: 10.1186/s12245-024-00633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Widespread vaccinations have significantly decreased the number of tetanus cases in developed countries. Today, most cases of tetanus affect the elderly and those with inadequate immunization in developed countries such as Japan. As vaccinations were believed to be nearly 100% effective in preventing tetanus, tetanus in young, immunized individuals were considered unlikely. However, unexpected tetanus infection has been reported in young adequately immunized individuals. CASE We herein describe a 20-year-old immunized female who visited our emergency department with trismus and painful muscle spasms that started after receiving a puncture wound to her right foot. A physical examination revealed an elevated body temperature (38°C), trismus, muscle spasms in her right leg and neck, and a puncture wound at the sole of her right foot. Following the development of dyspnea after admission to the intensive care unit, the patient was intubated and mechanically ventilated. She fully recovered after six days in intensive care. CONCLUSION The present case serves as a stark reminder that tetanus may still occur in young, immunized individuals. Patients with a history of immunization may have a better prognosis than those with no immunizations.
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Affiliation(s)
- Mitsutoshi Okuda
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan.
| | - Atsushi Morizane
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Sunao Asaba
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Saika Tsurui
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Ryutaro Tsuno
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Mariko Hatakenaka
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Tomoko Sugimura
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
| | - Yuichi Saisaka
- Critical Care and Emergency Center, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi, 781-8555, Japan
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Tong L, Jia Q, Li B, Li Z, Qi J, Guo Z, Liu Y. Investigation of the baseline tetanus antibody level and its persistence in a military unit. Vaccine 2021; 39:4328-4334. [PMID: 34147291 DOI: 10.1016/j.vaccine.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine tetanus antibody levels in army recruits and evaluate the persistence of immunity following tetanus booster immunization in adults. METHODS A total of 680 recruits were selected for observation of their tetanus antibody levels. From 2005 to 2015, 691 peacekeepers with tetanus vaccination were included in the questionnaire-based and serological survey based on cluster stratification. The tetanus antibody-positive rate, geometric mean concentration (GMC), and their respective changes over time were analyzed in different age groups, regions, and years after tetanus booster immunization. RESULTS The positivity rates of tetanus antibodies in the recruits and peacekeepers were 74.85% and 99.86%, respectively (χ2 = 193.00, P < 0.05) and the antibody GMCs were 0.05 and 0.70 IU/mL (t = 15.73, P < 0.05). The antibody positivity rates of recruits from 12 provinces ranged from 47.62% (Hubei) to 100% (Inner Mongolia) (χ2 = 37.24, P < 0.05) and the antibody GMCs ranged from 0.02 (Hubei) to 0.09 IU/mL (Heilongjiang) (F = 5.19, P < 0.01). Among the 691 peacekeepers, no statistically significant difference in antibody positivity rate was detected between men and women. After administration of one booster dose of the tetanus vaccine, a protective antibody level was calculated to persist up to 22 years; a significant difference in antibody levels was observed within 10 years between one and two or more booster doses. CONCLUSION The rate at which recruits tested positive for tetanus antibodies was low. Thus, it is necessary to screen for tetanus antibodies during military recruitment and implement a precision-based booster immunization protocol for tetanus vaccine. Moreover, one dose of the tetanus vaccine booster has been calculated to maintain a protective antibody level up to 22 years, without the need for repeated reinforcements during this period.
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Affiliation(s)
- Libo Tong
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Qingshuai Jia
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Bing Li
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Zijian Li
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Jinrong Qi
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Zuiyuan Guo
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China
| | - Yuandong Liu
- Center for Disease Control and Prevention of Northern Theater Command, No. 6 Longshan Road, Huanggu District Shenyang, Liaoning 110034, China.
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Riccò M, Vezzosi L, Cella C, Pecoraro M, Novembre G, Moreo A, Ognibeni EM, Schallenberg G, Maranelli G. Tetanus vaccination status in construction workers: results from an institutional surveillance campaign. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:269-278. [PMID: 31125007 PMCID: PMC6776203 DOI: 10.23750/abm.v90i2.6759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
Background: Since 1963 Italian law (Law 292/1963, Legislative Decree n.81/2008), defines Tetanus Vaccination (TeV) as mandatory for defined occupational categories, including Construction Workers (CWs). Materials and Methods: An institutional survey on of CWs was performed in the Autonomous Province of Trento (Oct. 2016 - Apr. 2017). Vaccination booklets/certificate were retrieved recalling: TeV status (1), and TeV settings (2), i.e. basal schedule; year of last shot, healthcare providers who performed TeV, and TeV formulate(s). Results: Data about 205 CWs were collected (mean age 40.6±10.3 years; 78.0% <50 year-old, 71.7% born in Italy). Overall, 38.5% of CW had received last vaccination shot >10 years before the survey (mean: 8.8 ± 8.2 years). The majority of boosters had been administered by Vaccination Services of the Local Health Unit (47.3%), followed by Occupational Physicians (20.0%) and General Practitioners (11.2%). In 85.9% of CWs, a monovalent formulation was used. Combined TeV were mainly reported in CW who had received last vaccination shot in Vaccination Services (96.2%; p<0.001). Conclusions: TeV coverage rates in CWs are insufficient, and vaccination shots are frequently performed with inappropriate, monovalent formulates. As only professionals from Vaccination Services systematically employ combined vaccines and particularly Tdap, our results not only stress the opportunity for promoting TeV among CWs, but also the importance of improving reception of up to date official recommendations in Occupational Physicians, General Practitioner and professionals of Emergency Departments. (www.actabiomedica.it)
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Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio Emilia V.le Amendola n.2 - 42122 RE Servizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL) Dip. di Prevenzione.
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Moura S, Martins MDRO. Determinants of Tetanus Vaccination among Adult Immigrants: Findings from the Portuguese National Health Survey 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1619. [PMID: 31075829 PMCID: PMC6539381 DOI: 10.3390/ijerph16091619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 05/07/2019] [Indexed: 01/02/2023]
Abstract
Vaccination is an effective strategy to prevent tetanus, and in Portugal this service is provided free of charge. Despite this, immigrants reported lower tetanus vaccination coverage than did Portuguese natives. The objective of this study was to identify sociodemographic, migration-related, and access-to-care factors associated with tetanus vaccination coverage among adult immigrants, using data from the Portuguese National Health Survey 2014. For the sample of 1277 immigrants aged ≥18 years, we estimated self-reported tetanus vaccination within the preceding 10 years and its determinants using complex samples logistic regression. The overall self-reported tetanus vaccination coverage was 79.5% (95% CI: 75.8-82.8). Age (adjusted odd ratio (aOR) per 1 year age increase = 0.97, 95% CI: 0.95-0.99), higher household income per adult (aOR = 0.42, 95% CI: 0.19-0.96), having Portuguese citizenship (aOR = 2.30, 95% CI: 1.25-4.24), having private health insurance (aOR = 1.99, 95% CI: 1.06-3.71), and contact with family/general physician in the last 12 months (aOR = 1.59, 95% CI: 1.01-2.51) were associated with self-reported tetanus vaccination coverage among adult immigrants. We also found significant disparities in coverage between regions of residence. This study identified several determinants associated with self-reported tetanus vaccination coverage among adult immigrants in Portugal. These findings may help policymakers to design specific interventions to increase tetanus vaccination coverage among this population.
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Affiliation(s)
- Sofia Moura
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
- Global Public Health Doctoral Programme, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Maria do Rosário O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
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Multivariate profiling of African green monkey and rhesus macaque T lymphocytes. Sci Rep 2019; 9:4834. [PMID: 30886198 PMCID: PMC6423277 DOI: 10.1038/s41598-019-41209-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022] Open
Abstract
The complexity of immune responses limits the usefulness of univariate methods in answering complex immunology questions. To demonstrate the utility of a multivariate approach, we employ such approach to compare T cells of African green monkeys (AGMs) and rhesus macaques (RMs). Among the most prominent distinguishing features we found were lower CD3 and higher CD28 surface expression in AGMs compared to RMs. After in vitro stimulation, a larger proportion of AGM T cells secreted cytokines, especially those producing more than one cytokine (i.e. multifunctional cells). To find out whether multifunctional responses associate with protection in other species, we compared T cells of cynomolgus macaques (CMs) infected with wild-type Simian Immunodeficiency Virus (SIV) to those of CMs infected (vaccinated) with a replication-defective virus. Wild-type SIV infection in macaques leads to simian Acquired Immunodeficiency Syndrome (AIDS), which does not happen in animals previously vaccinated with a replication-defective virus. Interestingly, after in vitro stimulation, multifunctional cells were more abundant among T cells of vaccinated CMs. Our results propose T-cell multifunctionality as a potentially useful marker of immunity, although additional verification is needed. Finally, we hope our multivariate model and its associated validation methods will inform future studies in the field of immunology.
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Skogmar S, Tham J. Severe diphtheria with neurologic and myocardial involvement in a Swedish patient: a case report. BMC Infect Dis 2018; 18:359. [PMID: 30064365 PMCID: PMC6069954 DOI: 10.1186/s12879-018-3264-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Diphtheria is caused by Corynebacterium diphtheriae. Although waning in incidence diphtheria can cause severe disease as in this rare Swedish case with several complications. Case presentation A 55-year old male presented to the emergency room with severe respiratory symptoms and greyish membranes in the airways, which turned positive for C. diphtheriae. He was put on ventilator support and remained hospitalized for three months. During care he developed myocarditis and severe neurological disease and he was also co-infected with tuberculosis. The patient was discharged with a favorable outcome. Conclusions Diphtheria should be suspected in patients with life-threatening pneumonia especially if the patient has a history of travelling. Our patient was not treated with diphtheria anti-toxin (DAT) which may have contributed to the severity of the disease.
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Affiliation(s)
- Sten Skogmar
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Johan Tham
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Skåne University Hospital, Malmö, Sweden. .,Infectious Diseases Unit, Skånes University hospital, 205 02, Malmö, Sweden.
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Stefansson M, Askling HH, Rombo L. A single booster dose of diphtheria vaccine is effective for travelers regardless of time interval since previous doses. J Travel Med 2018; 25:5042126. [PMID: 29931363 DOI: 10.1093/jtm/tay041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
Our study showed the immune response before and after a booster against diphtheria given within the 20-year interval recommended in Sweden or after a prolonged interval. Of 40 travellers, 10/13 in recommended interval group were immune before booster and 19/27 with a delayed interval. After booster, 13/13 versus 26/27 were protected. One booster was sufficient to achieve immunity regardless of the interval.
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Affiliation(s)
- M Stefansson
- Centre for Clinical Research Sormland County Council and Uppsala University, Kungsgatan 41, Eskilstuna, Sweden
| | - H H Askling
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Rombo
- Department Infectious Diseases, Mälarsjukhuset, Eskilstuna, Sweden
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Koivisto K, Puhakka L, Lappalainen M, Blomqvist S, Saxén H, Nieminen T. Immunity against vaccine-preventable diseases in Finnish pediatric healthcare workers in 2015. Vaccine 2017; 35:1608-1614. [PMID: 28233625 DOI: 10.1016/j.vaccine.2017.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 11/19/2022]
Abstract
Healthcare workers (HCWs) pose a risk to themselves and their patients if not protected against vaccine-preventable diseases. Alarmingly, lacking immunity has been reported in several studies. We assessed the immunity against vaccine-preventable diseases in 157 pediatric HCWs in Helsinki Children's Hospital. The HCWs enrolled answered a questionnaire and gave a serum sample. Antibodies were measured with EIA against MMR-diseases, tetanus and diphtheria toxins, Hepatitis B (HBV), Hepatitis A (HAV), varicella zoster and pertussis toxin. Neutralizing antibodies against poliovirus 1, 2 and 3 were measured. All of the HCWs had antibodies against tetanus and 89.8% against diphtheria. All had measurable levels of polio antibodies to all three polioviruses. 41% had suboptimal levels of antibodies against at least one of the antigens tested: MMR-viruses, diphtheria, HBV or polio. Measles, mumps and rubella antibodies were detectable in 81.5%, 89.2% and 93%, respectively. Only one HCW had no varicella-antibodies. Hepatitis B surface antibodies (HBsAb) were detected in 89.8% of the nurses. 67.5% had HAV-antibodies. A poor correlation between detected antibody levels and reported vaccination history was noticed, indicating a need for a universal record system for registering the vaccines given to each individual.
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Affiliation(s)
- Karoliina Koivisto
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Laura Puhakka
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Lappalainen
- Laboratory Services (HUSLAB), Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Finland
| | - Soile Blomqvist
- National Institute for Health and Welfare, The Viral Infections Unit, Finland
| | - Harri Saxén
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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RICCÒ M, CATTANI S, VERONESI L, COLUCCI ME. Knowledge, attitudes, beliefs and practices of construction workers towards tetanus vaccine in Northern Italy. INDUSTRIAL HEALTH 2016; 54:554-563. [PMID: 27251030 PMCID: PMC5136613 DOI: 10.2486/indhealth.2015-0249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 05/26/2023]
Abstract
Construction workers (CWs) are both more exposed to tetanus and at higher risk to be inadequately immunized. Our aim was to evaluate tetanus immunization status and knowledge/attitudes towards tetanus vaccination in CWs in Italy. In this field report, the immunization status of 554 unskilled CWs (i.e. labourers). Immunization status was assessed recalling immunization booklets/certificates. Attitudes and knowledge were collected through a standardized questionnaire. In 240/554 CWs, immunization status was inadequate/not documented: in 184 subjects (33.2%), the last vaccination shot was older than 10 years, whereas basal immunization was incomplete in 20 cases, more frequently in foreign-born people (FBP) than in Italian born (IBP) (OR=7.116). In 198 cases (35.7%), an Occupational Physician (OPh) performed last booster, usually with monovalent (T, n=173) vaccine. The main reason for inadequate immunization was having forgotten the periodic booster (148/554; 26.7%), whereas 42 subjects (7.6%) deliberately avoided tetanus vaccine because of personal/religious beliefs, more frequently in FBP than in IBP (OR=3.182). In summary, the prevalence of inadequate immunization status was relatively high (43.4%): the high prevalence of "forgotten boosters" enlightens the key role of OPh in recalling and promoting vaccination policies. Moreover, the inappropriate use of Td vaccine points out the opportunity for educational campaigns in OPh.
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Affiliation(s)
- Matteo RICCÒ
- Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento Unità Operativa di Prevenzione e Sicurezza degli Ambienti di Lavoro, Italy
| | - Silvia CATTANI
- Department of Clinical Surgery, General Surgery and Surgical Therapy, School of Nursing Sciences, Parma University Hospital, Italy
| | - Licia VERONESI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
| | - Maria Eugenia COLUCCI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
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Schistosoma mansoni Infection Can Jeopardize the Duration of Protective Levels of Antibody Responses to Immunizations against Hepatitis B and Tetanus Toxoid. PLoS Negl Trop Dis 2016; 10:e0005180. [PMID: 27926921 PMCID: PMC5142771 DOI: 10.1371/journal.pntd.0005180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Schistosomiasis is a disease of major public health importance in sub-Saharan Africa. Immunoregulation begins early in schistosome infection and is characterized by hyporesponsiveness to parasite and bystander antigens, suggesting that a schistosome infection at the time of immunization could negatively impact the induction of protective vaccine responses. This study examined whether having a Schistosoma mansoni infection at the time of immunization with hepatitis B and tetanus toxoid (TT) vaccines impacts an individual's ability to achieve and maintain protective antibody levels against hepatitis B surface antigen or TT. METHODS Adults were recruited from Kisumu Polytechnic College in Western Kenya. At enrollment, participants were screened for schistosomiasis and soil transmitted helminths (STHs) and assigned to groups based on helminth status. The vaccines were then administered and helminth infections treated a week after the first hepatitis B boost. Over an 8 month period, 3 blood specimens were obtained for the evaluation of humoral and cytokine responses to the vaccine antigens and for immunophenotyping. RESULTS 146 individuals were available for final analysis and 26% were S. mansoni positive (Sm+). Schistosomiasis did not impede the generation of initial minimum protective antibody levels to either hepatitis B or TT vaccines. However, median hepatitis B surface antibody levels were significantly lower in the Sm+ group after the first boost and remained lower, but not significantly lower, following praziquantel (PZQ) treatment and final boost. In addition, 8 months following TT boost and 7 months following PZQ treatment, Sm+ individuals were more likely to have anti-TT antibody levels fall below levels considered optimal for long term protection. IL-5 levels in response to in vitro TT stimulation of whole blood were significantly higher in the Sm+ group at the 8 month time period as well. CONCLUSIONS Individuals with schistosomiasis at the start the immunizations were capable of responding appropriately to the vaccines as measured by antibody responses. However, they may be at risk of a more rapid decline in antibody levels over time, suggesting that treating schistosome infections with praziquantel before immunizations could be beneficial. The timing of the treatment as well as its full impact on the maintenance of antibodies against vaccine antigens remains to be elucidated.
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Hammarlund E, Thomas A, Poore EA, Amanna IJ, Rynko AE, Mori M, Chen Z, Slifka MK. Durability of Vaccine-Induced Immunity Against Tetanus and Diphtheria Toxins: A Cross-sectional Analysis. Clin Infect Dis 2016; 62:1111-1118. [PMID: 27060790 PMCID: PMC4826453 DOI: 10.1093/cid/ciw066] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/03/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many adult immunization schedules recommend that tetanus and diphtheria vaccination be performed every 10 years. In light of current epidemiological trends of disease incidence and rates of vaccine-associated adverse events, the 10-year revaccination schedule has come into question. METHODS We performed cross-sectional analysis of serum antibody titers in 546 adult subjects stratified by age or sex. All serological results were converted to international units after calibration with international serum standards. RESULTS Approximately 97% of the population was seropositive to tetanus and diphtheria as defined by a protective serum antibody titer of ≥0.01 IU/mL. Mean antibody titers were 3.6 and 0.35 IU/mL against tetanus and diphtheria, respectively. Antibody responses to tetanus declined with an estimated half-life of 14 years (95% confidence interval, 11-17 years), whereas antibody responses to diphtheria were more long-lived and declined with an estimated half-life of 27 years (18-51 years). Mathematical models combining antibody magnitude and duration predict that 95% of the population will remain protected against tetanus and diphtheria for ≥30 years without requiring further booster vaccination. CONCLUSIONS These studies demonstrate that durable levels of protective antitoxin immunity exist in the majority of vaccinated individuals. Together, this suggests that it may no longer be necessary to administer booster vaccinations every 10 years and that the current adult vaccination schedule for tetanus and diphtheria should be revisited.
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Affiliation(s)
- Erika Hammarlund
- Division of Neuroscience, Oregon National Primate Research Center, Department of Molecular Microbiology and Immunology, Oregon Health & Science University
| | - Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Department of Molecular Microbiology and Immunology, Oregon Health & Science University
| | | | | | - Abby E Rynko
- Division of Neuroscience, Oregon National Primate Research Center, Department of Molecular Microbiology and Immunology, Oregon Health & Science University
| | - Motomi Mori
- Biostatistics Shared Resource, Knight Cancer Institute
- Division of Biostatistics, Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland
| | - Zunqiu Chen
- Division of Biostatistics, Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Department of Molecular Microbiology and Immunology, Oregon Health & Science University
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Patris S, Vandeput M, Kenfack GM, Mertens D, Dejaegher B, Kauffmann JM. An experimental design approach to optimize an amperometric immunoassay on a screen printed electrode for Clostridium tetani antibody determination. Biosens Bioelectron 2016; 77:457-63. [DOI: 10.1016/j.bios.2015.09.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/14/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
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Long-Term Protection against Diphtheria in the Netherlands after 50 Years of Vaccination: Results from a Seroepidemiological Study. PLoS One 2016; 11:e0148605. [PMID: 26863307 PMCID: PMC4749226 DOI: 10.1371/journal.pone.0148605] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS To evaluate the National Immunisation Programme (NIP) a population-based cross-sectional seroepidemiological study was performed in the Netherlands. We assessed diphtheria antitoxin levels in the general Dutch population and in low vaccination coverage (LVC) areas where a relatively high proportion of orthodox Protestants live who decline vaccination based on religious grounds. Results were compared with a nationwide seroepidemiological study performed 11 years earlier. METHODS In 2006/2007 a national serum bank was established. Blood samples were tested for diphtheria antitoxin IgG concentrations using a multiplex immunoassay for 6383 participants from the national sample (NS) and 1518 participants from LVC municipalities. A cut-off above 0.01 international units per ml (IU/ml) was used as minimum protective level. RESULTS In the NS 91% of the population had antibody levels above 0.01 IU/ml compared to 88% in the 1995/1996 serosurvey (p<0.05). On average, 82% (vs. 78% in the 1995/1996 serosurvey, p<0.05) of individuals from the NS born before introduction of diphtheria vaccination in the NIP and 46% (vs. 37% in the 1995/1996 serosurvey, p = 0.11) of orthodox Protestants living in LVC areas had antibody levels above 0.01 IU/ml. Linear regression analysis among fully immunized individuals (six vaccinations) without evidence of revaccination indicated a continuous decline in antibodies in both serosurveys, but geometric mean antibodies remained well above 0.01 IU/ml in all age groups. CONCLUSIONS The NIP provides long-term protection against diphtheria, although antibody levels decline after vaccination. As a result of natural waning immunity, a substantial proportion of individuals born before introduction of diphtheria vaccination in the NIP lack adequate levels of diphtheria antibodies. Susceptibility due to lack of vaccination is highest among strictly orthodox Protestants. The potential risk of spread of diphtheria within the geographically clustered orthodox Protestant community after introduction in the Netherlands has not disappeared, despite national long-term high vaccination coverage.
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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Sung H, Jang MJ, Bae EY, Han SB, Kim JH, Kang JH, Park YJ, Ma SH. Seroepidemiology of tetanus in Korean adults and adolescents in 2012. J Infect Chemother 2014; 20:397-400. [PMID: 24802766 DOI: 10.1016/j.jiac.2014.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/03/2013] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Hyunwoo Sung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Jin Jang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - E Young Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyuk Ma
- Department of Pediatrics, Changwon Fatima Hospital, Changwon, Republic of Korea
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Herzog C. Influence of parenteral administration routes and additional factors on vaccine safety and immunogenicity: a review of recent literature. Expert Rev Vaccines 2014; 13:399-415. [DOI: 10.1586/14760584.2014.883285] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Filia A, Bella A, von Hunolstein C, Pinto A, Alfarone G, Declich S, Rota MC. Tetanus in Italy 2001-2010: a continuing threat in older adults. Vaccine 2013; 32:639-44. [PMID: 24370712 DOI: 10.1016/j.vaccine.2013.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/28/2013] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
Abstract
Despite being a completely preventable disease, tetanus cases continue to occur in Italy and notification and hospitalization rates have been reported to be higher with respect to European and other industrialized countries. We examined statutory notification, hospitalization, mortality and seroprevalence data to describe tetanus epidemiology in Italy from 2001 to 2010. A total of 594 tetanus cases were notified, with an average annual incidence of 1.0/1,000,000 population. Most cases were unvaccinated or incompletely vaccinated. Eighty percent of cases occurred in subjects aged >64 years and a higher proportion of females with respect to males were reported in this age group. The annual number of hospital admissions was 1.4-1.7 times greater than the number of notifications in the same year. The mean annual number of reported deaths was 21. Seroprevalence data show progressively higher susceptibility levels with increasing age. Over 50% of persons aged 45-64 years and over two thirds of subjects ≥65 years had tetanus antibody levels <0.01 IU/ml. Results show that tetanus is a continuing problem in Italy and, as in other countries, most cases occur in older adults, especially elderly women. The observed differences in notification and hospitalization rates suggest underreporting by physicians. In recent years, Italy has accounted for most cases reported annually in the European Union (EU) but different case definitions are used. In Italy, a confirmed case is one that meets the clinical case definition while the EU case definition classifies confirmed cases as those with laboratory confirmation of disease. The incidence of clinical tetanus in Italy is ten-fold higher than in other industrialized countries, like Australia and Canada, likely due to higher susceptibility levels in Italy. In view of the low prevalence of tetanus antibodies in adults ≥45 years, strategies to improve vaccine uptake in this population group need to be implemented.
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Affiliation(s)
- Antonietta Filia
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Antonino Bella
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Christina von Hunolstein
- National Center for Research and Evaluation of Immunobiologicals, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonella Pinto
- National Center for Research and Evaluation of Immunobiologicals, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Giovanna Alfarone
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Silvia Declich
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Maria Cristina Rota
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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Lang P. Vaccine policies and standards for older subjects in Switzerland. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2012.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Csuka D, Czirják L, Hóbor R, Illes Z, Bánáti M, Rajczy K, Tordai A, Füst G. Effective humoral immunity against diphtheria and tetanus in patients with systemic lupus erythematosus or myasthenia gravis. Mol Immunol 2013; 54:453-6. [DOI: 10.1016/j.molimm.2013.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
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Esteve M, Domínguez A, Urbiztondo L, Borrás E, Costa J, Broner S, Campins M, Bayas JM. Prevalence of susceptibility to tetanus and diphtheria in health care workers in Catalonia. Am J Infect Control 2012; 40:896-8. [PMID: 22386155 DOI: 10.1016/j.ajic.2011.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 11/27/2022]
Abstract
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.
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Dias AADSDO, Santos LS, Sabbadini PS, Santos CS, Silva Junior FC, Napoleão F, Nagao PE, Villas-Bôas MHS, Hirata Junior R, Guaraldi ALM. Corynebacterium ulcerans diphtheria: an emerging zoonosis in Brazil and worldwide. Rev Saude Publica 2012; 45:1176-91. [PMID: 22124745 DOI: 10.1590/s0034-89102011000600021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/27/2011] [Indexed: 11/21/2022] Open
Abstract
The article is a literature review on the emergence of human infections caused by Corynebacterium ulcerans in many countries including Brazil. Articles in Medline/PubMed and SciELO databases published between 1926 and 2011 were reviewed, as well as articles and reports of the Brazilian Ministry of Health. It is presented a fast, cost-effective and easy to perform screening test for the presumptive diagnosis of C. ulcerans and C. diphtheriae infections in most Brazilian public and private laboratories. C. ulcerans spread in many countries and recent isolation of this pathogen in Rio de Janeiro, southeastern Brazil, is a warning to clinicians, veterinarians, and microbiologists on the occurrence of zoonotic diphtheria and C. ulcerans dissemination in urban and rural areas of Brazil and/or Latin America.
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Abstract
The number of patients with impaired immune response has been steadily increasing within the last years, not only with the onset of the AIDS epidemic, but also due to increasing numbers of subjects on immunosuppressive therapies. These patients are at an increased risk for infections, many of which are preventable by immunization. Inactivated vaccines are generally safe in subjects with underlying immunosuppression. However, immune response and protection may be hampered, depending on the extent of immunosuppression. In contrast, live vaccines such as yellow fever, measles, rubella, herpes zoster, and cholera may lead to severe reactions in immunocompromised patients and have been shown to deteriorate some immune-mediated diseases such as multiple sclerosis. Data on the efficacy of vaccines in biological therapies is scarce. Where necessary vaccines should be updated before immunosuppressive therapies are started. To improve the vaccination status several guidelines exist for immunosuppressed patients at risk such as those with rheumatic diseases, asplenia or solid organ and hematopoietic stem cell transplantation.
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Are we hitting immunity targets? The 2006 age-specific seroprevalence of measles, mumps, rubella, diphtheria and tetanus in Belgium. Epidemiol Infect 2010; 139:494-504. [PMID: 20587123 DOI: 10.1017/s0950268810001536] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Susceptibility to vaccine-preventable diseases in Belgium in 2006 was estimated from a serum survey. Immunoglobulins against measles, mumps, rubella (MMR) and diphtheria at all available ages (1-65 years), and against tetanus in >40-year-olds, were measured by ELISA. Age-standardized overall seronegativity for MMR was low (3·9%, 8·0%, 10·4%, respectively). However, the World Health Organization's targets for measles elimination were not met in 5- to 24-year-olds and about 1 in 7 women at childbearing age (15-39 years) were seronegative for rubella. In adults >40 years, tetanus immunity (87·2%, >0·16 IU/ml) largely exceeded diphtheria immunity (20-45%, >0·1 IU/ml). Despite free universal vaccination against MMR for more than 20 years and against diphtheria and tetanus for almost 60 years, our study revealed specific age groups remaining at risk for infection with these pathogens.
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