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Savioli G, Ceresa IF, Giordano M, Ferrari I, Varesi A, Floris V, Esposito C, Croesi B, Ricevuti G, Calvi M, Bressan MA, Oddone E. The Reliability of Anamnestic Data in the Management of Clostridium Tetani Infection in Elderly. Front Med (Lausanne) 2021; 8:684594. [PMID: 34778280 PMCID: PMC8581164 DOI: 10.3389/fmed.2021.684594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Tetanus infection remains a significant complication of wounds. Because most tetanus treatment guidelines rely on anamnestic data collected directly from patients, the congruence between anamnesis and laboratory evidence must be verified, especially in the elderly population. Aim: Assess, in both the geriatric population (>65) and the non-geriatric one, the reliability of anamnestic data for managing patients with tetanus-risk wounds, identified categories of populations most exposed to non-vaccination coverage, and assessed the agreement of the Tetanos Quick Stick (TQS) results with the therapy performed (administration of tetanus vaccine or immunoglobulin). Methods: In this retrospective single-center observational study, patients were asked their immunization status against tetanus vaccination. The decision to administer a vaccine or immunoglobulin was therefore clinical and based on anamnestic criteria. The TQS test was then given to patients who were unaware of their immunity status. Patients who thought they knew it but were not sure were given the TQS test to determine whether the anamnestic collection was supported by the test. The TQS test results were compared with the anamnestic data. Results: Most patients, geriatric and not geriatric, did not know their immune status. Among those who reported knowing their immune status, there was no agreement between the vaccine coverage declared by patients and the TQS test results (p < 0.001), mainly in geriatric patients but also in the control group. Elderly and women had significantly lower positive TQS test results (p < 0.001). There was a statistically significant discrepancy (p < 0.001) between the therapy based on anamnestic data and the TQS test results. Conclusion: The reliability of anamnestic data for the management of patients with tetanus-risk wounds is low and decreases with age, becoming minimal in geriatric patients. Elderly and women are less likely to have an effective vaccination status against tetanus.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.,Ph.D University of Pavia, Pavia, Italy
| | - Iride Francesca Ceresa
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mauro Giordano
- Internal Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ilaria Ferrari
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Angelica Varesi
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Valentina Floris
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Ciro Esposito
- University of Pavia Department of Internal Medicine and Maugeri Unit of Nephrology and Dialysis, ICS Maugeri, Pavia, Italy
| | - Barbara Croesi
- Pharmacy, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Giovanni Ricevuti
- School of Pharmacy, Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Monica Calvi
- Pharmacy, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Maria Antonietta Bressan
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental, University of Pavia, Pavia, Italy
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Weinberger B. Adult vaccination against tetanus and diphtheria: the European perspective. Clin Exp Immunol 2016; 187:93-99. [PMID: 27279025 DOI: 10.1111/cei.12822] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/27/2022] Open
Abstract
Besides immunizations against influenza, Streptococcus pneumoniae and herpes zoster, which are recommended specifically for elderly people, regular booster vaccinations against tetanus, diphtheria and in some cases pertussis and polio are recommended in many European countries for adults, including elderly people. Vaccination recommendations for adults differ greatly between individual countries and coverage data is scarce. Tetanus-specific antibody concentrations are generally higher than diphtheria-specific antibodies, and a substantial proportion of adults, and particularly of elderly people, do not have protective antibody concentrations against diphtheria. Antibody levels increase upon booster vaccination in all age groups, but diphtheria-specific antibody concentrations remain below protective levels in some older individuals, even immediately after vaccination and long-term protection is frequently not achieved. Future vaccination strategies should therefore include regular and well-documented booster shots, e.g. against tetanus and diphtheria, throughout life.
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Affiliation(s)
- B Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
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Tooher R, Griffin T, Shute E, Maddern G. Vaccinations for waste-handling workers. A review of the literature. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2005; 23:79-86. [PMID: 15751399 DOI: 10.1177/0734242x05048037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A review of the literature relating to the need for vaccination against infectious disease in the solid waste industry was conducted, focusing on hepatitis A, hepatitis B and tetanus. Databases (Medline, PreMedline, EMBASE, CINAHL, Current Contents, Cochrane Database, HTA Database, DARE, OSHROM) were searched up to and including August 2003. Articles were included in the review if they reported the prevalence of immunity to hepatitis A, hepatitis B or tetanus in solid waste workers or the incidence of clinical infection with any of these diseases. Papers about hazardous or medical waste, incineration or other infectious diseases were excluded. Forty-four papers constituted the evidence database. Only one paper studied the prevalence of antibodies to hepatitis A and hepatitis B in solid waste workers compared with sewage plant workers and office workers, and no difference was found between these groups of workers. There was some evidence to support a theoretical risk of infection with hepatitis A, B and tetanus; however, no studies could be found of the risk of these diseases in solid waste workers. No single cases of these diseases being acquired occupationally in solid waste management were identified in the literature. Workers in the solid waste industry may theoretically be at increased risk of acquiring infectious diseases occupationally. However, at present no studies could be found which have documented this risk.
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Affiliation(s)
- Rebecca Tooher
- ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia
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Van Damme P, Burgess M. Immunogenicity of a combined diphtheria–tetanus–acellular pertussis vaccine in adults. Vaccine 2004; 22:305-8. [PMID: 14670310 DOI: 10.1016/j.vaccine.2003.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Two clinical studies were undertaken to evaluate the immunogenicity of an adult-type dTpa booster vaccine (Boostrix by GlaxoSmithKline Biologicals). Blood samples taken prior to vaccination showed that 24.4 and 13.0% of subjects were seronegative for diphtheria and tetanus antibodies, respectively. Moreover, about one-third of the vaccinees had no detectable levels of antibodies to pertussis toxoid (PT) or pertactin (PRN). One month post-vaccination, more than 93% of all individuals, regardless of age or type of vaccine received, had seroprotective antibody levels for diphtheria and tetanus (> or = 0.1IU/ml). In those individuals vaccinated with the adult-type dTpa vaccine (Boostrix), more than 98% were found to be seropositive for antibodies to all three pertussis antigens (PT, filamentous haemogluttin (FHA), and PRN). These data suggest that immunity to diphtheria, tetanus and pertussis (DTP) in adults wanes and that booster vaccination with an adult-type combined dTpa vaccine would boost the serological response to diphtheria antitoxin, tetanus antitoxin and antibodies to Bordetella pertussis PT, FHA and PRN.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Faculty of Medicine, University of Antwerp, Universiteitsplein, 1 B-2610 Antwerp, Belgium.
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Oztürk A, Göahmetoğlu S, Erdem F, Mýsgüroğlu Alkan S. Tetanus antitoxin levels among adults over 40 years of age in Central Anatolia, Turkey. Clin Microbiol Infect 2003; 9:33-8. [PMID: 12691540 DOI: 10.1046/j.1469-0691.2003.00469.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine tetanus antitoxin levels in adults and the aged. METHODS This study was conducted on 249 adults over 40 years of age who applied to a blood-withdrawal unit in Kayseri, Central Anatolia. Tetanus toxoid-specific antibodies were measured in serum by enzyme-linked immunosorbent assay (ELISA). RESULTS In the research group, only 63 persons (25.3%) were found to have protective levels (>0.1 IU/mL) of tetanus antitoxin. Antibody levels were significantly higher in educated people (30.7%), in those under 50 years of age (38.2%), in those who had been vaccinated at least twice (47.6%), and in those vaccinated not more than 10 years previously (58.3%). There was no association between antibody level and sex, occupation or place of residence. CONCLUSION Our findings indicated that tetanus antibody values were under the protective level for most adults over 40 years of age, and vaccination programs directed at the adult population should be developed.
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Affiliation(s)
- A Oztürk
- Erciyes Universitesi Tip, Fakültesi Halk Sagligi Anabilim Dali, Kayseri, Turkey.
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Ergönül O, Sözen T, Tekeli E. Immunity to tetanus among adults in Turkey. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 33:728-30. [PMID: 11728035 DOI: 10.1080/003655401317074491] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In 100 individuals > 18 y of age, living in urban or rural regions of Ankara, antitetanus immunoglobulin levels were determined using enzyme-linked immunosorbent assay and a brief questionnaire was administered. In total, 68% of subjects showed protective levels (> 0.01 IU/ml). Differences between rural (64%) and urban (72%) areas and between males (71.4%) and females (61.1%) were not significant (p > 0.05). Protective levels were found in 93.1% of subjects aged 18-30 y, 77.3% of those aged 30-40 y, 58.3% of those aged 40-50 y, 41.7% of those aged 50-60 y, 36.4% of those aged 60-70 y and 20% of those aged > 70 y. Only 35.7% of individuals aged > 50 y of age were found to be protected against tetanus (p = 0.004). The levels of antitetanus antibody in individuals vaccinated in the last 10 y were significantly higher than those in individuals vaccinated > 10 y ago and in those who did not remember the vaccination date (p = 0.009). Poor immunity against tetanus is a problem in elderly people in Turkey.
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Affiliation(s)
- O Ergönül
- Clinic of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Turkey
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Rix BA, Zhobakas A, Wachmann CH, Bakasenas V, Rønne T. Immunity from diphtheria, tetanus, poliomyelitis, measles, mumps and rubella among adults in Lithuania. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1994; 26:459-67. [PMID: 7984979 DOI: 10.3109/00365549409008620] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Health authorities have estimated a low immunity level against diphtheria, tetanus, poliomyelitis, measles, mumps and rubella among adults in Lithuania due to less than optimal vaccine quality. The aim of this study was to evaluate the level of immunity by blood sampling 100 young women, 50 young men and 50 middle-aged men and from the immunization history by questionnaire. Lack of protection against diphtheria was found in 0%, 2% and 46% of the young women, young men and middle-aged men respectively. The corresponding data for tetanus were 0%, 0% and 10%. It was found that 85% of the women had antibodies to all 3 types of polioviruses vs. 80% of the young men and 56% of the middle-aged men. A sub-protective antibody level against measles was found in 12% of the women, 22% of the young men, but in none of the middle-aged men. A protective titre of rubella antibodies was found among 94% of the young, pregnant women. It can be concluded that the level of immunity in Lithuania is comparable to that in Western Europe for the same age groups and that the launching of adult vaccination programs in Eastern Europe should be preceded by sero-epidemiological studies.
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Affiliation(s)
- B A Rix
- Department of Epidemiology, Statens Seruminstitut, Copenhagen, Denmark
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Rosmini F, Wirz M, Gentili G, Collotti C, Rossino Ricci M, Franco E, Terzi I, Pasquini P. Year of birth, sex and residence, as "determinants" of tetanus incidence and immunity in Italy. Eur J Epidemiol 1987; 3:377-80. [PMID: 3691747 DOI: 10.1007/bf00145648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Regional results of a seroepidemiological study and official notification data are evaluated to describe the situation of tetanus in Italy. Tetanus incidence has been decreasing during the past years. Vaccination has been the principal means of tetanus prevention. Trend analyses for sex- and age-specific rates suggest a change of exposure, presumably linked to the transformation of the Italian society after the World War II, a higher incidence among the elderly as a function of poor coverage and vanishing immunity. Regional data show remarkable variability in prevalence of susceptible population. Reported rates by region are different. Different degrees of regional underreporting in case notification is suggested.
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Affiliation(s)
- F Rosmini
- Department of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy
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Rosmini F, Gentili G, Wirz M, Collotti C, Panà A, Terzi I, Conti S, Pasquini P. Immunity to tetanus among Italians born between 1956 and 1963. Eur J Epidemiol 1987; 3:302-7. [PMID: 3308512 DOI: 10.1007/bf00149740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Systematic mandatory immunization of children against tetanus begun in Italy in 1968. Preceding birth cohorts, accounting for almost 80% of present Italian population, were poorly immune or totally non-immune; around 90% of cases of tetanus occurring in Italy in recent years are observed among them. In a national sample of 4770 young males born between 1956 and 1963, about one third was not protected. Prevalence of non-immune subjects was greater in the Southern Regions and the Islands, in rural areas, among the unemployed, among the older birth cohorts.
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Affiliation(s)
- F Rosmini
- Department of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy
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