1
|
Boer M, de Voogd M, Niemeijer ND, van Hoeven L. Tetanus- a case report highlighting the challenges in diagnosis and treatment. Trop Dis Travel Med Vaccines 2024; 10:10. [PMID: 38822438 PMCID: PMC11143707 DOI: 10.1186/s40794-024-00220-5] [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: 12/31/2023] [Accepted: 03/14/2024] [Indexed: 06/03/2024] Open
Abstract
Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus.
Collapse
Affiliation(s)
- Menno Boer
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Martijn de Voogd
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | | | - Lonneke van Hoeven
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
| |
Collapse
|
2
|
Gao J, Yu X, Cao G, He X, Zhang P, Walline J, Wang Y, Yu X, Xu J, Thach TQ, Liu Y. Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study. PeerJ 2023; 11:e16032. [PMID: 37692124 PMCID: PMC10484204 DOI: 10.7717/peerj.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023] Open
Abstract
Background Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. Methods From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. Results The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Conclusions Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.
Collapse
Affiliation(s)
- Junling Gao
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong SAR, China
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Guanghui Cao
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
| | - Pingde Zhang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuanxi Wang
- Department of Cardiac and Vascular Interventional Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xingjuan Yu
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Jun Xu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Thuan-Quoc Thach
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Yong Liu
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
| |
Collapse
|
3
|
Gou Y, Li SM, Zhang JF, Hei XP, Lv BH, Feng K. 6084 Cases of Adult Tetanus from China: A Literature Analysis. Infect Drug Resist 2023; 16:2007-2018. [PMID: 37038478 PMCID: PMC10082574 DOI: 10.2147/idr.s404747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Objective To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Methods Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. Results In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). Conclusion The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.
Collapse
Affiliation(s)
- Yi Gou
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Sheng-Ming Li
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Jun-Fei Zhang
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Xiao-Ping Hei
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Bo-Hui Lv
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Ke Feng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- Correspondence: Ke Feng, Department of Emergency Medical, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, People’s Republic of China, Tel +86 18709676586, Email
| |
Collapse
|
4
|
Gebeyehu NA, Asmare Adela G, Dagnaw Tegegne K, Birhan Assfaw B. Vaccination dropout among children in Sub-Saharan Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2145821. [PMID: 36459433 PMCID: PMC9762788 DOI: 10.1080/21645515.2022.2145821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Immunization is cost-effective preventive strategy for child morbidity and mortality. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Data were extracted by Microsoft excel. Begg's rank test, and Egger's regression test was done. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. A total of 12 articles were included in this study. The pooled prevalence of vaccination dropout was 26.06% (95% CI: 11.59, 30.53), I2 =91.2%. In sub-group analysis, Nigeria had the highest prevalence of immunization dropouts (33.59%). It was 18.01% and 29.25%, respectively, for published and unpublished research. Community-based studies and institutional-based studies also yield a prevalence of dropout 39.04% and 13.73% respectively. Dropout rate was 22.66% for sample sizes under 500 and 18.01% for sample sizes beyond 500. In Sub-Saharan Africa, the prevalence of vaccination dropout was high. Community education about vaccinations importance should be prioritized.
Collapse
Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia,CONTACT Natnael Atnafu Gebeyehu Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, 02, My street, Sodo 138, Ethiopia
| | - Getachew Asmare Adela
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Belete Birhan Assfaw
- Department of Psychiatric Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| |
Collapse
|
5
|
Dhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med 2021; 12:247-261. [PMID: 34849046 PMCID: PMC8627318 DOI: 10.2147/rrtm.s201989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.
Collapse
Affiliation(s)
- Shashi Kant Dhir
- Department of Pediatrics, Guru Gobind Singh Medical College, Punjab, India
| | - Pooja Dewan
- Department of Pediatrics, University College of Medical Sciences, Delhi, India
| | - Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences, Delhi, India
| |
Collapse
|
6
|
Pirazzini M, Grinzato A, Corti D, Barbieri S, Leka O, Vallese F, Tonellato M, Silacci-Fregni C, Piccoli L, Kandiah E, Schiavo G, Zanotti G, Lanzavecchia A, Montecucco C. Exceptionally potent human monoclonal antibodies are effective for prophylaxis and treatment of tetanus in mice. J Clin Invest 2021; 131:151676. [PMID: 34618682 DOI: 10.1172/jci151676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
We used human monoclonal antibodies (humAbs) to study the mechanism of neuron intoxication by tetanus neurotoxin and to evaluate these antibodies as a safe preventive and therapeutic substitute for hyperimmune sera to treat tetanus in mice. By screening memory B cells from immune donors, we selected 2 tetanus neurotoxin-specific mAbs with exceptionally high neutralizing activities and extensively characterized them both structurally and functionally. We found that these antibodies interfered with the binding and translocation of the neurotoxin into neurons by interacting with 2 epitopes, whose identification pinpoints crucial events in the cellular pathogenesis of tetanus. Our observations explain the neutralization ability of these antibodies, which we found to be exceptionally potent in preventing experimental tetanus when injected into mice long before the toxin. Moreover, their Fab derivatives neutralized tetanus neurotoxin in post-exposure experiments, suggesting their potential for therapeutic use via intrathecal injection. As such, we believe these humAbs, as well as their Fab derivatives, meet the requirements to be considered for prophylactic and therapeutic use in human tetanus and are ready for clinical trials.
Collapse
Affiliation(s)
- Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | | | | | - Oneda Leka
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Francesca Vallese
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marika Tonellato
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Chiara Silacci-Fregni
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Luca Piccoli
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Giampietro Schiavo
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology and.,UK Dementia Research Institute, University College London, London, United Kingdom
| | - Giuseppe Zanotti
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonio Lanzavecchia
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland.,Fondazione Istituto Nazionale Genetica Molecolare, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy.,Institute of Neuroscience, National Research Council, Padova, Italy
| |
Collapse
|
7
|
Zanetti G, Mattarei A, Lista F, Rossetto O, Montecucco C, Pirazzini M. Novel Small Molecule Inhibitors That Prevent the Neuroparalysis of Tetanus Neurotoxin. Pharmaceuticals (Basel) 2021; 14:ph14111134. [PMID: 34832916 PMCID: PMC8618345 DOI: 10.3390/ph14111134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 01/22/2023] Open
Abstract
Tetanus neurotoxin (TeNT) is a protein exotoxin produced by Clostridium tetani that causes the deadly spastic neuroparalysis of tetanus. It consists of a metalloprotease light chain and of a heavy chain linked via a disulphide bond. TeNT binds to the neuromuscular junction (NMJ) and it is retro-axonally transported into vesicular compartments to the spinal cord, where it is released and taken up by inhibitory interneuron. Therein, the catalytic subunit is translocated into the cytoplasm where it cleaves its target protein VAMP-1/2 with consequent blockage of the release of inhibitory neurotransmitters. Vaccination with formaldehyde inactivated TeNT prevents the disease, but tetanus is still present in countries where vaccination coverage is partial. Here, we show that small molecule inhibitors interfering with TeNT trafficking or with the reduction of the interchain disulphide bond block the activity of the toxin in neuronal cultures and attenuate tetanus symptoms in vivo. These findings are relevant for the development of therapeutics against tetanus based on the inhibition of toxin molecules that are being retro-transported to or are already within the spinal cord and are, thus, not accessible to anti-TeNT immunoglobulins.
Collapse
Affiliation(s)
- Giulia Zanetti
- Department of Biomedical Sciences, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy; (G.Z.); (O.R.)
| | - Andrea Mattarei
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Via F. Marzolo 5, 35131 Padova, Italy;
| | - Florigio Lista
- Scientific Department, Army Medical Center, Via Santo Stefano Rotondo 4, 00184 Rome, Italy;
| | - Ornella Rossetto
- Department of Biomedical Sciences, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy; (G.Z.); (O.R.)
- Italian Research Council, Institute of Neuroscience, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy
- CIR-Myo, Centro Interdipartimentale di Ricerca di Miologia, University of Padova, Via U. Bassi 58/B, 35131 Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy; (G.Z.); (O.R.)
- Italian Research Council, Institute of Neuroscience, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy
- Correspondence: (C.M.); (M.P.)
| | - Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Via U. Bassi 58/B, 35121 Padova, Italy; (G.Z.); (O.R.)
- CIR-Myo, Centro Interdipartimentale di Ricerca di Miologia, University of Padova, Via U. Bassi 58/B, 35131 Padova, Italy
- Correspondence: (C.M.); (M.P.)
| |
Collapse
|
8
|
Mackin DW, Walker SP. The historical aspects of vaccination in pregnancy. Best Pract Res Clin Obstet Gynaecol 2020; 76:13-22. [PMID: 33168428 PMCID: PMC7550856 DOI: 10.1016/j.bpobgyn.2020.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 01/09/2023]
Abstract
As we live through the history-making pandemic of coronavirus disease 2019 (COVID-19), it is timely to consider the lessons that history has taught us about vaccine-preventable disease in pregnancy. Vaccinations have earned an established place in pregnancy care to prevent communicable disease in the mother, fetus and newborn. The improvements in maternal and perinatal outcome have been achieved through the evolution and application of new knowledge in many areas. These include recognition of the unique pathogenic consequences of diseases in pregnancy; improved understanding of the maternal immune system and its interplay with the fetus; optimizing safe vaccine development; ensuring pregnant women are included in appropriately designed trials of efficacy, and public health engagement to optimize uptake. As the world eagerly awaits an effective vaccine for COVID 19, these lessons of history help signpost the way, to ensure the potential of vaccinations to reduce morbidity for pregnant women and their newborns is fully realized.
Collapse
Affiliation(s)
- David William Mackin
- Mercy Perinatal, Mercy Hospital for Women, Level 3, 163 Studley Rd, Heidelberg, Victoria 3084, Australia.
| | - Susan P Walker
- Mercy Perinatal, Mercy Hospital for Women, Level 3, 163 Studley Rd, Heidelberg, Victoria 3084, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Level 4, 163 Studley Rd, Heidelberg, Victoria 3084, Australia.
| |
Collapse
|
9
|
Yaya S, Kota K, Buh A, Bishwajit G. Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone. BMC Public Health 2020; 20:855. [PMID: 32503478 PMCID: PMC7273659 DOI: 10.1186/s12889-020-08985-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/24/2020] [Indexed: 12/30/2022] Open
Abstract
Background Immunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone. Methods This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods. Results The overall prevalence of receiving TT immunization during women’s last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639,2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well. Conclusion Higher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.
Collapse
Affiliation(s)
- Sanni Yaya
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, The University of Oxford, Oxford, UK.
| | - Komlan Kota
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Amos Buh
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON, K1N 6N5, Canada
| |
Collapse
|
10
|
Raza SA, Avan BI. Eliminating Maternal and Neonatal Tetanus and Promoting Clean Delivery Practices Through Disposable Clean Birth Kits. Front Public Health 2019; 7:339. [PMID: 31824909 PMCID: PMC6886002 DOI: 10.3389/fpubh.2019.00339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/29/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Syed Ahsan Raza
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Bilal Iqbal Avan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
11
|
Liu Y, Mo X, Yu X, Wang J, Tian J, Kuang J, Peng J. Insufficient knowledge and inappropriate practices of emergency doctors towards tetanus prevention in trauma patients: a pilot survey. Hum Vaccin Immunother 2019; 16:349-357. [PMID: 31625792 PMCID: PMC7062443 DOI: 10.1080/21645515.2019.1653745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
China has a shocking number of tetanus cases in the world, but little research has investigated doctors’ knowledge of and practices in tetanus prophylaxis, especially tetanus vaccination. To this end, we conducted a pilot study on 197 emergency doctors using a mixed method of web-based (163; 82.8%) and paper-based (34; 17.2%) surveys. There was no difference between the two groups except for the percentage of doctors receiving a tetanus booster in the past 10 years and the responses to question 11. Surprisingly, only 28.9% of doctors had received formal training on tetanus immunization and only 21.3% had themselves received a tetanus vaccine booster in the past 10 years. Furthermore, only 14.2% of the respondents confirmed the availability of the tetanus vaccine in their respective institutions. Finally, the correct rates and Tetanus-immune-globulin (TIG)-only option rates for questions 11–15 were unsatisfactory. Our results showed that most emergency doctors’ knowledge and practices strayed from the recommendations of Advisory Committee on Immunization Practices (ACIP): 1) TIG alone for most trauma patients instead of vaccine was an overused treatment approach. 2) Most of the emergency doctors lacked formal training on and knowledge of tetanus vaccination. 3) Even the emergency doctors themselves were not properly vaccinated. 4) The tetanus vaccine was only available in a small number of the respondents’ institutions. The findings of this study suggest an urgent need to improve this dire situation.
Collapse
Affiliation(s)
- Yong Liu
- Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Xichao Mo
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Xiaxia Yu
- Department of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, PR China
| | - Jinxin Wang
- Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Jinfei Tian
- Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Jun Kuang
- Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| |
Collapse
|
12
|
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)
Collapse
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.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Álvarez‐Larrotta C, Agudelo O, Duque Y, Gavina K, Yanow S, Maestre A, Carmona‐Fonseca J, Arango E. Submicroscopic Plasmodium infection during pregnancy is associated with reduced antibody levels to tetanus toxoid. Clin Exp Immunol 2019; 195:96-108. [PMID: 30194852 PMCID: PMC6300694 DOI: 10.1111/cei.13213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022] Open
Abstract
Submicroscopic Plasmodium infections in pregnancy are common in endemic areas, and it is important to understand the impact of these low-level infections. Asymptomatic, chronic infections are advantageous for parasite persistence, particularly in areas where the optimal eco-epidemiological conditions for parasite transmission fluctuate. In chronic infections, the persistence of the antigenic stimulus changes the expression of immune mediators and promotes constant immune regulation, including increases in regulatory T cell populations. These alterations of the immune system could compromise the response to routine vaccination. This study aimed to evaluate the effect of submicroscopic plasmodial infection with P. falciparum and P. vivax during pregnancy on the immune response to the tetanus toxoid vaccine in Colombian women. Expression of different cytokines and mediators of immune regulation and levels of anti-tetanus toxoid (TT) immunoglobulin (Ig)G were quantified in pregnant women with and without submicroscopic plasmodial infection. The anti-TT IgG levels were significantly lower in the infected group compared with the uninfected group. The expression of interferon (IFN)-γ, tumour necrosis factor (TNF) and forkhead box protein 3 (FoxP3) was significantly higher in the infected group, while the expression of cytotoxic T lymphocyte antigen 4 (CTLA-4) and transforming growth factor (TGF)-β was lower in the group of infected. In conclusion, submicroscopic Plasmodium infection altered the development of the immune response to the TT vaccine in Colombian pregnant women. The impact of Plasmodium infections on the immune regulatory pathways warrants further exploration.
Collapse
Affiliation(s)
- C. Álvarez‐Larrotta
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| | - O.M. Agudelo
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| | - Y. Duque
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| | - K. Gavina
- Department of Medical Microbiology and Immunology, Faculty of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - S.K. Yanow
- Department of Medical Microbiology and Immunology, Faculty of MedicineUniversity of AlbertaEdmontonAlbertaCanada
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
| | - A. Maestre
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| | - J. Carmona‐Fonseca
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| | - E. Arango
- Grupo Salud y Comunidad, Facultad de MedicinaUniversidad de AntioquiaMedellínColombia
| |
Collapse
|
14
|
Mihret MS, Limenih MA, Gudayu TW. The role of timely initiation of antenatal care on protective dose tetanus toxoid immunization: the case of northern Ethiopia post natal mothers. BMC Pregnancy Childbirth 2018; 18:235. [PMID: 29907139 PMCID: PMC6003212 DOI: 10.1186/s12884-018-1878-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, tetanus toxoid protective dose immunization of the mothers is one of the strategies of maternal and neonatal tetanus prevention. Ethiopia has planned the national tetanus protection at birth coverage to reach 86% by the year 2015. However, there is still low coverage with less identified associated factors. Therefore; the purpose of this study was to assess tetanus toxoid protective dose immunization at last birth and associated factors among mothers who gave birth within one year prior to the study in Debretabor town, Northwest Ethiopia, 2016. METHODS A community based cross sectional study was conducted from May 1 to June 10 / 2016. A total of 511 mothers were included in the study. Structured questionnaire and checklists were used to collect the data. Face to face interview with cross checking documented record were employed. A systematic random sampling technique was used. The data were entered in to Epinfo version 7.0 and then exported to SPSS version 20.0 for analysis. Both bivariate and multivariable logistic regression model were fitted and crude and Adjusted Odds ratio with 95% confidence interval were computed. Finally, statistically significant association of variables was determined based on Adjusted Odds ratio with its 95% confidence interval and p-value ≤0.05. RESULT The proportion of tetanus toxoid protective dose immunization among mothers was 56.2% (95% CI: 52-60%). In the multivariable analysis; formal education (AOR = 2.09; 95%CI: 1.12, 3.90), planned last pregnancy (AOR = 6.63; 95%CI: 2.36, 18.63), four or more antenatal care visits (AOR = 5.16; 95%CI: 2.93, 11.14), timely antenatal care visit (AOR = 4.29; 95%CI: 1.94, 9.49), and perceived good quality of service (AOR = 2.20; 95% CI: 1.26, 3.84) were positively associated with tetanus toxoid protective dose immunization. CONCLUSION In this study, protective dose tetanus toxoid immunization is lower than the national target. Strengthening information education communication regarding tetanus and its prevention and encouraging timely initiation of and complete attendance of antenatal care is recommended.
Collapse
Affiliation(s)
- Muhabaw Shumye Mihret
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
| | - Miteku Andualem Limenih
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia
| | - Temesgen Worku Gudayu
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
| |
Collapse
|
15
|
Measles, Rubella, and Tetanus Vaccinations: a Brief Global Review. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Protein Structure Facilitates High-Resolution Immunological Mapping. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00275-17. [PMID: 29046310 DOI: 10.1128/cvi.00275-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Select agents (SA) pose unique challenges for licensing vaccines and therapies. In the case of toxin-mediated diseases, HHS assigns guidelines for SA use, oversees vaccine and therapy development, and approves animal models and approaches to identify mechanisms for toxin neutralization. In this commentary, we discuss next-generation vaccines and therapies against ricin toxin and botulinum toxin, which are regulated SA toxins that utilize structure-based approaches for countermeasures to guide rapid response to future biothreats.
Collapse
|
17
|
Riccardo F, Réal A, Voena C, Chiarle R, Cavallo F, Barutello G. Maternal Immunization: New Perspectives on Its Application Against Non-Infectious Related Diseases in Newborns. Vaccines (Basel) 2017; 5:E20. [PMID: 28763018 PMCID: PMC5620551 DOI: 10.3390/vaccines5030020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022] Open
Abstract
The continuous evolution in preventive medicine has anointed vaccination a versatile, human-health improving tool, which has led to a steady decline in deaths in the developing world. Maternal immunization represents an incisive step forward for the field of vaccination as it provides protection against various life-threatening diseases in pregnant women and their children. A number of studies to improve prevention rates and expand protection against the largest possible number of infections are still in progress. The complex unicity of the mother-infant interaction, both during and after pregnancy and which involves immune system cells and molecules, is an able partner in the success of maternal immunization, as intended thus far. Interestingly, new studies have shed light on the versatility of maternal immunization in protecting infants from non-infectious related diseases, such as allergy, asthma and congenital metabolic disorders. However, barely any attempt at applying maternal immunization to the prevention of childhood cancer has been made. The most promising study reported in this new field is a recent proof of concept on the efficacy of maternal immunization in protecting cancer-prone offspring against mammary tumor progression. New investigations into the possibility of exploiting maternal immunization to prevent the onset and/or progression of neuroblastoma, one of the most common childhood malignancies, are therefore justified. Maternal immunization is presented in a new guise in this review. Attention will be focused on its versatility and potential applications in preventing tumor progression in neuroblastoma-prone offspring.
Collapse
Affiliation(s)
- Federica Riccardo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino 10126, Italy.
| | - Aline Réal
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino 10126, Italy.
| | - Claudia Voena
- Department of Molecular Biotechnology and Health Sciences, Center for Experimental Research and Medical Studies, University of Torino, Torino 10126, Italy.
| | - Roberto Chiarle
- Department of Molecular Biotechnology and Health Sciences, Center for Experimental Research and Medical Studies, University of Torino, Torino 10126, Italy.
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
| | - Federica Cavallo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino 10126, Italy.
| | - Giuseppina Barutello
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino 10126, Italy.
| |
Collapse
|
18
|
Thuy DB, Campbell JI, Thanh TT, Thuy CT, Loan HT, Hao NV, Minh YL, Tan LV, Boni MF, Thwaites CL. Tetanus in Southern Vietnam: Current Situation. Am J Trop Med Hyg 2016; 96:93-96. [PMID: 27821690 PMCID: PMC5239717 DOI: 10.4269/ajtmh.16-0470] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/09/2016] [Indexed: 11/12/2022] Open
Abstract
In Vietnam, there are no accurate data on tetanus incidence to allow assessment of disease burden or vaccination program efficacy. We analyzed age structure of 786 tetanus cases admitted to a tertiary referral center in Vietnam for three separate years during an 18-year period to examine the impact of tetanus prevention programs, namely the Expanded Program on Immunization (EPI) and the Maternal and Neonatal Tetanus (MNT) initiative. Most cases were born before the initiation of EPI. Median age increased from 33 (interquartile range: 20–52) in 1994, to 46 (32–63) in 2012 (P < 0.001). Birth-year distribution was unchanged, indicating the same birth cohorts presented with tetanus in 1994, 2003, and 2012. Enzyme-linked immunosorbent assay measurements in 90 men and 90 women covered by MNT but not EPI showed 73.3% (95% confidence interval [CI]: 62.9–82.1%) of women had anti-tetanus antibody compared with 24.4% (95% CI: 15.9–34.7%) of men, indicating continued tetanus vulnerability in older men in Vietnam.
Collapse
Affiliation(s)
- Duong Bich Thuy
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Cao Thu Thuy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Maciej F Boni
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - C Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| |
Collapse
|
19
|
Abu-Raya B, Smolen KK, Willems F, Kollmann TR, Marchant A. Transfer of Maternal Antimicrobial Immunity to HIV-Exposed Uninfected Newborns. Front Immunol 2016; 7:338. [PMID: 27630640 PMCID: PMC5005931 DOI: 10.3389/fimmu.2016.00338] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
The transfer of maternal immune factors to the newborn is critical for protection from infectious disease in early life. Maternally acquired passive immunity provides protection until the infant is beyond early life's increased susceptibility to severe infections or until active immunity is achieved following infant's primary immunization. However, as reviewed here, human immunodeficiency virus (HIV) infection alters the transfer of immune factors from HIV-infected mothers to the HIV-exposed newborns and young infants. This may relate to the immune activation in HIV-infected pregnant women, associated with the production of inflammatory cytokines at the maternofetal interface associated with inflammatory responses in the newborn. We also summarize mother-targeting interventions to improve the health of infants born to HIV-infected women, such as immunization during pregnancy and reduction of maternal inflammation. Maternal immunization offers the potential to compensate for the decreased transplacentally transferred maternal antibodies observed in HIV-exposed infants. Current data suggest reduced immunogenicity of vaccines in HIV-infected pregnant women, possibly reducing the protective impact of maternal immunization for HIV-exposed infants. Fortunately, levels of antibodies appear preserved in the breast milk of HIV-infected women, which supports the recommendation to breast-feed during antiretroviral treatment to protect HIV-exposed infants.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, Division of Infectious Diseases, University of British Columbia , Vancouver, BC , Canada
| | - Kinga K Smolen
- Institute for Medical Immunology, Université Libre de Bruxelles , Charleroi , Belgium
| | - Fabienne Willems
- Institute for Medical Immunology, Université Libre de Bruxelles , Charleroi , Belgium
| | - Tobias R Kollmann
- Department of Pediatrics, Division of Infectious Diseases, University of British Columbia , Vancouver, BC , Canada
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles , Charleroi , Belgium
| |
Collapse
|