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Shi W, Wang B, Meng Q, Zhang X, Li Z, He F, Ying F, Cong L, Yao K. Seroprevalence of tetanus and pertussis antibodies among health care workers in Wuhu, China. Hum Vaccin Immunother 2024; 20:2318892. [PMID: 38465707 PMCID: PMC10936590 DOI: 10.1080/21645515.2024.2318892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to elucidate the seroprevalence of antibodies to tetanus and pertussis among Chinese health care workers. Blood specimens from health care workers were collected during the 2021 annual medical examination at the First People's Hospital of Wuhu. Commercial ELISA kits were employed to quantify serum IgG antibodies against tetanus toxin (anti-TT IgG) and both IgG and IgA antibodies against pertussis toxin (anti-PT IgG, anti-PT IgA). A concentration of anti-TT IgG exceeding 0.1 IU/ml was deemed seroprotective against tetanus, while concentrations of anti-PT IgG ≥ 50 IU/ml or anti-PT IgA ≥ 15 IU/ml were indicative of a prior pertussis infection. The overall seroprotective rate for anti-TT IgG stood at 10.43% (92/882), with the highest seroprotective rate (13.91%) in the 20-29 age group, followed by the 30-39 age group (10.57%), 40-49 age group (5.80%), and 50-59 age group (5.63%). Eighteen (2.04%) of the studied subjects were positive to anti-PT IgG, and the positive rate in 20-39 age group and 40-59 age group was 1.19% (8/673) and 4.78% (10/209), respectively. Thirty (3.40%) subjects displayed anti-PT IgG levels ≥100 IU/ml and/or anti-PT IgA ≥ 15 IU/ml, suggesting a recent pertussis infection within the preceding year. Over half (503/882, 57.03%) had undetectable anti-PT IgG antibodies. The majority of health care workers in China appear susceptible to tetanus and pertussis, and a significant subset has experienced pertussis infection. The implementation of booster vaccinations against these diseases for Chinese health care workers is recommended.
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Affiliation(s)
- Wei Shi
- MOE Key Laboratory of Major Diseases in Children,National Key Discipline of Pediatrics, National Clinical Research Center for Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Bingsong Wang
- MOE Key Laboratory of Major Diseases in Children,National Key Discipline of Pediatrics, National Clinical Research Center for Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Qinghong Meng
- MOE Key Laboratory of Major Diseases in Children,National Key Discipline of Pediatrics, National Clinical Research Center for Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Xianlai Zhang
- Pediatric Respiratory Department, The First People’s Hospital of Wuhu, Wuhu, China
| | - Zhen Li
- Department of Laboratory Medicine, The First People’s Hospital of Wuhu, Wuhu, China
| | - Fang He
- Medical Centre, The First People’s Hospital of Wuhu, Wuhu, China
| | - Fei Ying
- Department of Laboratory Medicine, The First People’s Hospital of Wuhu, Wuhu, China
| | - Linyan Cong
- Pediatric Respiratory Department, The First People’s Hospital of Wuhu, Wuhu, China
| | - Kaihu Yao
- MOE Key Laboratory of Major Diseases in Children,National Key Discipline of Pediatrics, National Clinical Research Center for Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
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Dutta M, Panja T, Dutta I. Craniocervical Tetanus: A Practical Consideration During Work-up of Acute-Onset Trismus. Ear Nose Throat J 2024:1455613231223895. [PMID: 38366878 DOI: 10.1177/01455613231223895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
This clinical record revisits the classical and pathognomonic features of craniocervical tetanus in a 65-year-old farmer who presented with acute-onset trismus, multiple cranial nerve pareses (III, IX, and X), risus sardonicus, and spasm of the head-neck musculature. This paper explores the relevant literature and presents a brief pictorial analysis of the global epidemiologic data. With most countries successfully adopting the maternal and neonatal tetanus elimination (MNTE) program, the incidence and mortality of tetanus across age groups have sharply reduced in high-income and most middle-income nations. In adults, tetanus is now encountered in specialized situations like waning immunity and incomplete vaccination, in the resource-poor and low-income nations, in countries achieving MNTE recently, and as cluster cases in the aftermath of natural disasters involving human settlements. Therefore, present-day practicing otolaryngologists and residents who have limited exposure to the tell-tale clinical features of craniocervical tetanus should consider it during work-up of acute-onset trismus in adults in susceptible situations and with a conducive background. The clinical spectrum of craniocervical tetanus as depicted in this report, including the demonstration of the pathognomonic positive spatula test, provides valuable learning points for otolaryngologists in this regard.
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Affiliation(s)
- Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, WB, India
| | - Tanaya Panja
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, WB, India
| | - Indranil Dutta
- Department of Neuromedicine, Medical College and Hospital, Kolkata, WB, India
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An Y, Guo Y, Li L, Li Z, Fan M, Peng Y, Yi X, Lv H. Management and outcome of adult generalized tetanus in a Chinese tertiary hospital. Front Public Health 2024; 12:1301724. [PMID: 38425467 PMCID: PMC10902116 DOI: 10.3389/fpubh.2024.1301724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Tetanus is a rare surgical infectious disease with a high reported relevant mortality. It still remains a serious problem in public health, particularly in low-income and middle-income countries. The purpose of this study was to investigate the management and prognosis of adult generalized tetanus in our hospital. Methods A total of 20 adult generalized tetanus patients were recruited in this retrospective observational study. Patients were retrieved from the hospital data base via discharge diagnosis. Patients were divided into two groups (Severe or Non-severe tetanus group) based on the severity of tetanus by using the Ablett classification. The differences between the two groups were compared. Results The study included 11 males (55%) and 9 females (45%). All tetanus patients recovered. The median age was 53.5 years [IQR: 19-78]. There were 1 mild (Grade 1) case (5%),5 moderate (Grade 2) cases (25%), 2 severe (Grade 3) cases (10%), and 12 very severe (Grade 4) cases (60%). Nineteen patients (95%) did not have tetanus immunization before. The majority of patients were farmers (60%), and came from rural areas (60%). Thirteen (65%) patients had a history of puncture injury. The rate of wound debridement after admission was 60% overall. Thirteen (65%) patients required mechanical ventilation for a median of 21 [IQR:12-41] days. Autonomic instability occurred in 13 (65%) patients. Pulmonary infections occurred in 12 (60%) patients. Median duration of hospital stay was 29.5 [IQR:12-68] days. More patients in the Severe group needed ICU admission, wound debridement, mechanical ventilation and heavy sedation combined with muscle relaxants (p < 0.05). The hospital stay was significantly longer in patients in the Severe group (p < 0.05). Conclusion After effective treatment, all adult patients with generalized tetanus in this study were cured and discharged. Severe tetanus requires early ICU treatment, wound debridement and effective treatment of autonomic instability.
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Affiliation(s)
- Yuling An
- Department of Surgical Intensive Care Unit, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi Guo
- Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Lijuan Li
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ziyu Li
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingming Fan
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - You Peng
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaomeng Yi
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haijin Lv
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Ermolayev AV, Ershov AE, Sorokina TS, Podoprigora IV. [Gaston Ramon and concise history of anatoxins (to the centenary of discovery)]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2024; 32:111-116. [PMID: 38349695 DOI: 10.32687/0869-866x-2024-32-1-111-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
The article analyzes past history, main milestones of making, research and improvement of anatoxins from works of Gaston Ramon who first proposed 100 years ago method of obtaining reliable vaccine preparation (anatoxin) on the basis of formalin neutralized diphtheria (and then tetanus) toxin (1922-1923) to nowadays scientific achievements in prevention and treatment of these infectious diseases.
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Affiliation(s)
- A V Ermolayev
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University" of Russia of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia
| | - A E Ershov
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University" of Russia of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia
| | - T S Sorokina
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University" of Russia of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia,
| | - I V Podoprigora
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University" of Russia of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia
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Ma J, Sun Y, Cui Y, Dong J, Huang Y. Access to DTP-Based Combination Vaccines in Asia-Pacific Countries between 2019 and 2022. Vaccines (Basel) 2023; 12:33. [PMID: 38250846 PMCID: PMC10818609 DOI: 10.3390/vaccines12010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
The Asia-Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman's rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia-Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.
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Affiliation(s)
| | | | | | | | - Yangmu Huang
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China (Y.C.)
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Saputri DS, Ismanto HS, Nugraha DK, Xu Z, Horiguchi Y, Sakakibara S, Standley DM. Deciphering the antigen specificities of antibodies by clustering their complementarity determining region sequences. mSystems 2023; 8:e0072223. [PMID: 37975681 PMCID: PMC10734444 DOI: 10.1128/msystems.00722-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE Determining antigen and epitope specificity is an essential step in the discovery of therapeutic antibodies as well as in the analysis adaptive immune responses to disease or vaccination. Despite extensive efforts, deciphering antigen specificity solely from BCR amino acid sequence remains a challenging task, requiring a combination of experimental and computational approaches. Here, we describe and experimentally validate a simple and straightforward approach for grouping antibodies that share antigen and epitope specificities based on their CDR sequence similarity. This approach allows us to identify the specificities of a large number of antibodies whose antigen targets are unknown, using a small fraction of antibodies with well-annotated binding specificities.
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Affiliation(s)
- Dianita S. Saputri
- Department of Genome Informatics, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
- Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hendra S. Ismanto
- Department of Genome Informatics, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Dendi K. Nugraha
- Department of Molecular Bacteriology, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Zichang Xu
- Immunology Frontier Research Center, Osaka University, Suita, Japan
| | - Yasuhiko Horiguchi
- Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Molecular Bacteriology, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
- Center for Infectious Disease Education and Research, Osaka University, Suita, Japan
| | - Shuhei Sakakibara
- Immunology Frontier Research Center, Osaka University, Suita, Japan
- Graduate School of Medical Safety Management, Jikei University of Health Care Sciences, Osaka, Japan
| | - Daron M. Standley
- Department of Genome Informatics, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
- Graduate School of Medicine, Osaka University, Suita, Japan
- Immunology Frontier Research Center, Osaka University, Suita, Japan
- Center for Infectious Disease Education and Research, Osaka University, Suita, Japan
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Ahmadi A, Karimpour‐Razkenari E, Ansari R, Marashi M, Sharifnia H, Najafi A, Mojtahedzadeh M. Successful management of severe generalized tetanus in a 23-year man with phenobarbital adjuvant: A case report. Clin Case Rep 2023; 11:e8286. [PMID: 38107081 PMCID: PMC10724082 DOI: 10.1002/ccr3.8286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
Generalized tetanus is still a global concern with a mortality rate of up to 50%, especially in low and middle-income countries. We reported a 23-year-old man from Afghanistan admitted to emergency department, with the chief complaint of generalized severe spasms and lockjaw. The patient had skin lesions and had never been vaccinated against tetanus. He intubated and admitted to the intensive care unit (ICU) with diagnose of severe generalized tetanus. After receiving tetanus immunoglobulin and intravenous metronidazole, a combination therapy of midazolam, propofol, atracurium, and morphine was administered. Due to the refractory muscular spasms intravenous phenobarbital started and little by little recovery was achieved. The patient receiving the first two doses of the Td vaccine, and discharged on Day 42 of hospitalization with no symptom recurrence. This case management showed adding phenobarbital to severe tetanus treatment regimen could significantly reduce refractory spasm caused by tetanus, also decrease other medication requirement.
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Affiliation(s)
- Arezoo Ahmadi
- Department of Anesthesiology and Critical Care, School of Medicine, Sina HospitalTehran University of Medical SciencesTehranIran
| | | | - Ramin Ansari
- Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
| | - Mahforouzalsadat Marashi
- Department of Infectious Disease and Tropical Medicine, School of Medicine, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Hamidreza Sharifnia
- Department of Anesthesiology and Critical Care, School of Medicine, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care, School of Medicine, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
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Kalatzi P, Travlos AK, Geladas N, Iliadou M, Tzavara C, Chryssanthopoulos C, Mihopoulos A, Tziaferi S. Vaccination coverage of primary care providers against seasonal influenza, tetanus, pneumococcal pneumonia and herpes zoster: A cross-sectional study in Greece. AIMS Public Health 2023; 10:952-963. [PMID: 38187900 PMCID: PMC10764975 DOI: 10.3934/publichealth.2023061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs. Methods A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05. Results In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14-0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31-0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37-0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40-49 vs. 19-39; OR = 0.42; 95% CI = 0.28-0.63, over 50 years old vs. 19-39; OR = 0.54; 95% CI = 0.36-0.79). Conclusions The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.
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Affiliation(s)
- Panagiota Kalatzi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Antonios K. Travlos
- Department of Sports Organization and Management, University of Peloponnese, Sparti, Greece
| | - Nickos Geladas
- Department of Physical Education & Sport Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Chara Tzavara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Alexandros Mihopoulos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
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Ayouni I, Amponsah-Dacosta E, Noll S, Kagina BM, Muloiwa R. Interventions to Improve Knowledge, Attitudes, and Uptake of Recommended Vaccines during Pregnancy and Postpartum: A Scoping Review. Vaccines (Basel) 2023; 11:1733. [PMID: 38140138 PMCID: PMC10747157 DOI: 10.3390/vaccines11121733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
Tetanus, pertussis, influenza, and COVID-19 vaccines are recommended for the prevention of related morbidity and mortality during pregnancy and postpartum. Despite the established benefits of vaccination for prenatal and postnatal women, maternal vaccination is not universally included in routine antenatal programs, especially in low- and middle-income countries. Furthermore, the uptake of recommended vaccines among pregnant and postpartum women remains below optimum globally. This review aimed to map the evidence on interventions to improve knowledge, attitudes, and uptake of recommended vaccines among pregnant and postpartum women. We conducted a comprehensive and systematic search for relevant literature in PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar. Overall, 29 studies published between 2010 and 2023 were included in this review. The majority (n = 27) of these studies were from high-income countries. A total of 14 studies focused on the influenza vaccine, 6 on the Tdap vaccine, 8 on both influenza and Tdap vaccines, and only one study on the COVID-19 vaccine. Patient-centered interventions predominated the evidence base (66%), followed by provider-focused (7%), health system-focused (10%), and multilevel interventions (17%). Overall, the effect of these interventions on knowledge, attitudes, and uptake of maternal vaccines was variable.
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Affiliation(s)
- Imen Ayouni
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town 7700, South Africa;
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Susanne Noll
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Benjamin M. Kagina
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town 7700, South Africa;
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
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Murata M, Kovba A, Kaneko A, Morimoto M, Ishigami A, Natsume T, Washizaki A, Miyabe-Nishiwaki T, Suzuki J, Akari H. Annual two-dose tetanus toxoid vaccination induces protective humoral immunity to all age groups of rhesus macaques. Exp Anim 2023; 72:490-495. [PMID: 37286479 PMCID: PMC10658093 DOI: 10.1538/expanim.23-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
A tetanus outbreak occurred during 2014-2015 in the rhesus macaques reared in an open enclosure in our facility. As the soil of the facility was suspected to be contaminated with Clostridium tetani spores, there was a risk of further tetanus occurring among the macaques. To protect them from tetanus, a tetanus toxoid vaccination was recommended; however, the vaccinated elderly animals might not be effectively protected due to insufficient humoral immune responses. Hence, we evaluated the dynamics of antibody responses among rhesus macaques of all age groups vaccinated with two-dose tetanus toxoid at a 1-year interval during a 3-year follow-up study. The vaccination developed anti-tetanus toxin-specific antibodies in animals of all age groups, the antibody levels peaked 1 year after the second vaccination, and the peak levels decreased with age. However, the levels among elderly individuals (aged ≥13 years) were still higher than the threshold level, which was supposed to protect them from tetanus development. Although the rhesus macaques in our facility had a risk of occasional exposure to the spores due to the outbreak, no incidence of tetanus has ever occurred to date. These results indicate that the vaccination protocol is effective in protecting not only younger but also older animals from tetanus.
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Affiliation(s)
- Megumi Murata
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Anastasiia Kovba
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Akihisa Kaneko
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Mayumi Morimoto
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Akiyo Ishigami
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Takayoshi Natsume
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Ayaka Washizaki
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Takako Miyabe-Nishiwaki
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Juri Suzuki
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Hirofumi Akari
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
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Grant K, Long S. Case report: A case of tetanus in a dog: cranial nerve involvement and imaging findings. Front Vet Sci 2023; 10:1271334. [PMID: 38026619 PMCID: PMC10662016 DOI: 10.3389/fvets.2023.1271334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
An 11 years old male Labrador cross presented with unilateral vestibular signs, ipsilateral facial paresis, moderate obtundation, ptyalism, and paraparesis. MRI of the brain revealed diffuse, multifocal T2/FLAIR hyperintense changes throughout various regions of the brain including the medulla, midbrain, pons, thalamus and right cerebral hemisphere with mild multifocal contrast enhancement. The patient progressed to trismus with generalized increased extensor tone and risus sardonicus. A diagnosis of generalized tetanus was made and the patient was started on antibiotics, skeletal muscle relaxants and tetanus antitoxin and made a full recovery. To the best of the authors' knowledge, this is the first reported case of canine tetanus in which the presenting signs involved cranial nerve dysfunction as well as the first report describing MRI changes in canine tetanus within the central nervous system.
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Affiliation(s)
- Kylie Grant
- Veterinary Referral Hospital, Melbourne, VIC, Australia
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12
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Agbemavi W, Ayebeng C, Okyere J, Acheampong E, Bediako VB. Prevalence and factors associated with rural mothers' protection against tetanus: a cross-national analysis in 33 sub-Saharan African countries. Int Health 2023:ihad103. [PMID: 37923368 DOI: 10.1093/inthealth/ihad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/25/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) and South Asia account for most new cases of tetanus. Despite efforts by the World Health Organization to eradicate tetanus, it still causes many maternal mortalities. We examined the prevalence and risk factors associated with tetanus protection among rural mothers in 33 SSA countries. METHODS Data were extracted from the most recent Demographic and Health Surveys of 33 SSA countries. A sample of 162 601 women from rural areas was drawn. Both descriptive and binary logistic regression analyses were conducted. RESULTS Overall, approximately half (49.3%) of rural mothers were protected against tetanus. The association between maternal age, education, marital status, working status, distance to the health facility and number of antenatal visits were statistically significant with rural mothers' protection from tetanus. Also, relationship to the household head, household size and frequency of listening to radio, reading a newspaper and watching television were statistically significant in predicting rural mothers' protection from tetanus. CONCLUSIONS Policies and interventions by stakeholders must target high-risk populations, including adult women, those of poorer wealth status, those without media exposure and mothers with low educational attainment.
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Affiliation(s)
- Wonder Agbemavi
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Demography, Australian National University, Canberra, Acton, ACT, Australia
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Vincent Bio Bediako
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Ewim Polyclinic, Ghana Health Service, Cape Coast, Ghana
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13
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Morris ESG, Dey A, Vette K, Rashid H, Wood N, Beard F. Australian vaccine preventable disease epidemiological review series: tetanus 2003-2019. Commun Dis Intell (2018) 2023; 47. [PMID: 37857556 DOI: 10.33321/cdi.2023.47.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 10/21/2023]
Abstract
Background We examined trends in tetanus notification, hospitalisation and death data from 2003-2019 to assess the impact of adult tetanus booster recommendations in Australia. Methods Tetanus notifications and deaths from the National Notifiable Diseases Surveillance System; hospitalisations from the Australian Institute of Health and Welfare National Hospital Morbidity Database; and deaths from the Australian Coordinating Registry were analysed by age group, sex, Aboriginal and Torres Strait Islander status and state/territory. Annual rates were calculated using Australian Bureau of Statistics mid-year estimated resident populations from 2003-2019 as denominators. To assess the impact of a recommended booster dose of reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine for adults aged ≥ 65 years, notification, hospitalisation and death rates of tetanus per 100,000 population were compared pre (2003-2012) and post (2013-2019) the recommendation's introduction. Results There were 63 notifications of tetanus from 2003-2019 with an average annual incidence rate of 0.02/100,000. Similar to previous studies, the burden of tetanus in the Australian population continues to disproportionately affect the elderly, with those aged ≥ 65 years encompassing 63% (40/63) of notifications and 100% (11/11) of the deaths observed in this timeframe. Following the introduction of a recommendation for those aged ≥ 65 years to receive a dTpa booster, average annual notification and hospitalisation rates in those aged ≥ 65 years were significantly lower (notifications: 0.11/100,000 in 2003-2012 and 0.05/100,000 in 2013-2019, p = 0.01; hospitalisations: 0.24/100,000 in 2003-2012 and 0.10/100,000 in 2013-2019, p = 0.01]). The average annual death rate was similar in the two periods (0.002/100,000), although based on small numbers. Conclusions The findings of this analysis suggest a positive impact from the 2013 recommendation. However, the burden is still disproportionately higher in those aged ≥ 65 years and strategies to improve vaccination coverage in older Australians are recommended.
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Affiliation(s)
- Eliora SG Morris
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Aditi Dey
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Kaitlyn Vette
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Harunor Rashid
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Nicholas Wood
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Frank Beard
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
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Cheng D, Liang L, Miaomiao H, Guolei H, Wei S. Adult patients with tetanus in Anhui Province of China from 2013 to 2022: A retrospective study. Medicine (Baltimore) 2023; 102:e35274. [PMID: 37800818 PMCID: PMC10553034 DOI: 10.1097/md.0000000000035274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
Tetanus is a highly fatal infectious disease with an incubation period of 7 to 8 days. The aim of this study was to identify risk factors for death in tetanus patients, develop a nomogram model for predicting mortality risk. This retrospective study included tetanus patients who were admitted to the intensive care unit department between January 2013 and December 2022. The patients were divided into 2 groups based on their final outcome, namely death group and survival group. Risk factors associated with mortality were analyzed using univariate and multivariate logistic regression analysis. Finally, a nomogram model was developed using the rms package. A total of 91 patients were enrolled in this study, including 54 males and 37 females. The average age of the tetanus patients was 52.88 ± 16.56 years, with a mean incubation period of 8.51 ± 3.97 days. The foot was the most common injury site (42.86%), and metal product stabbing was the leading cause of injury (48.78%). Ventilator-associated pneumonia was the most frequent complication (21.98%). Univariate and multivariate logistic regression analyses revealed that Ablett classification (odds ratio [OR], 21.999; 95% confidence interval [CI], 4.124-117.352), white blood cell count (OR, 6.033; 95%CI, 1.275-28.552), and autonomic nervous dysfunction (OR, 22.663; 95%CI, 4.363-117.728) as independent risk factors for tetanus patients. The C-index of the nomogram model was 0.942, with an area under the curve of the receiver operating characteristic curve at 0.942 (95%CI, 0.871-0.905). Ablett classification, white blood cell count, autonomic nervous dysfunctions were associated with the prognosis of patients with tetanus. The nomogram model developed based on risk factors has high accuracy.
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Affiliation(s)
- Dai Cheng
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Li Liang
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Hu Miaomiao
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group CO., Ltd., Hangzhou, Zhejiang Province, China
| | - Han Guolei
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Sun Wei
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
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Ohno T, Kanazawa M, Nakano T, Takemoto M, Ito T. Tetanus Overlooked Due to the Involvement of Multiple Departments: A Case Report. Cureus 2023; 15:e48066. [PMID: 38046504 PMCID: PMC10689120 DOI: 10.7759/cureus.48066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Tetanus is a fatal disease caused by a neurotoxin produced by the biotrophic anaerobic bacterium Clostridium tetani, which causes muscle hypertonia and autonomic neuropathy. The diagnosis is based on clinical findings and not the result of specific blood and imaging tests; hence, it is very difficult to diagnose at first sight, despite typical initial findings such as lockjaw, muscle spasms, and neck pain and stiffness. This article discusses the case of a 79-year-old woman who first consulted her local doctor because of a lack of jaw opening. Seeing no improvement, she visited our hospital and was suspected of having tetanus after consulting with nine different departments over seven days from the initial visit. In developed countries, tetanus prevalence has declined due to immunization, leading to clinicians' lack of experience in diagnosing it. Furthermore, the increasing specialization in general hospitals poses a risk of missing a tetanus diagnosis when a patient consults multiple departments.
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Affiliation(s)
- Takanori Ohno
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Masashi Kanazawa
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Takaaki Nakano
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Masaaki Takemoto
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Toshitaka Ito
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
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Pham OKN, Tran BN, Duong MC, Do TCN, Pham TL, Lam MY, Thwaites L, Nguyen VH. Magnitude, Patterns, and Associated Predictors of Cardiovascular Events in Tetanus: A 2-Year, Single-Center, Ambidirectional Cohort Study Involving 572 Patients. Open Forum Infect Dis 2023; 10:ofad473. [PMID: 37795506 PMCID: PMC10546955 DOI: 10.1093/ofid/ofad473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
Background Cardiovascular events (CEs) remain the leading cause of death in patients with tetanus. We examined the incidence, patterns, and associated predictors of CEs among patients with tetanus in Vietnam. Methods An ambidirectional cohort study was conducted on hospitalized adult patients with tetanus at the Hospital for Tropical Diseases between 2019 and 2020. Information on demographics, tetanus disease, CEs and outcomes were collected. Results Among all 572 included patients, CEs accounted for 10.8% (95%CI 8.6-13.7%) and included Takotsubo cardiomyopathy (40.3%, 95%CI 29.0-52.8%), arrhythmia (19.4%, 95%CI 11.4-30.9%), sudden cardiac arrest (16.1%, 95%CI 9.0-27.2%), myocardial infarction (11.3%, 95%CI 5.6-21.5%), heart failure (6.5%, 95%CI 2.5-15.4%) and pulmonary embolism (6.5%, 95%CI 2.5-15.4%). CEs occurred from day 5 to 20 of illness. Among 62 CE patients, 21% (95%CI 12.7-32.6%) died and 61.3% (95%CI 48.9-72.4%) developed autonomic nervous system dysfunction (ANSD). Three-fourths (24/32) of patients with Takotsubo cardiomyopathy or myocardial infarction had ANSD. CEs were significantly associated with modified Ablett scores (AOR = 2.42, 95%CI 1.1-5.6, P = .04), underlying diseases (AOR = 2.7, 95%CI 1.1-6.8, P = .04) and overweight (AOR = 0.18, 95%CI .04-.8, P = .02). Conclusions CEs are not rare and associated with high mortality. The most common CE is Takotsubo cardiomyopathy. CEs can occur at any stage of illness, with or without ANSD. To prevent mortality, it is pivotal to screen CEs in patients with tetanus, especially those with underlying diseases, high modified Ablett scores, and a normal or low BMI. More studies are needed to fully elucidate the impact of ANSD on the cardiovascular function and the CE associated mortality in tetanus.
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Affiliation(s)
- Oanh Kieu Nguyet Pham
- Faculty of Infectious Diseases, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
- Viet Anh Department, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Bao Nhu Tran
- Faculty of Infectious Diseases, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
| | - Minh Cuong Duong
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Thi Cam Nhung Do
- Viet Anh Department, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Thi Lieu Pham
- Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Minh Yen Lam
- Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Louise Thwaites
- Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Van Hao Nguyen
- Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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17
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Gupta S, Pellett S. Recent Developments in Vaccine Design: From Live Vaccines to Recombinant Toxin Vaccines. Toxins (Basel) 2023; 15:563. [PMID: 37755989 PMCID: PMC10536331 DOI: 10.3390/toxins15090563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Vaccines are one of the most effective strategies to prevent pathogen-induced illness in humans. The earliest vaccines were based on live inoculations with low doses of live or related pathogens, which carried a relatively high risk of developing the disease they were meant to prevent. The introduction of attenuated and killed pathogens as vaccines dramatically reduced these risks; however, attenuated live vaccines still carry a risk of reversion to a pathogenic strain capable of causing disease. This risk is completely eliminated with recombinant protein or subunit vaccines, which are atoxic and non-infectious. However, these vaccines require adjuvants and often significant optimization to induce robust T-cell responses and long-lasting immune memory. Some pathogens produce protein toxins that cause or contribute to disease. To protect against the effects of such toxins, chemically inactivated toxoid vaccines have been found to be effective. Toxoid vaccines are successfully used today at a global scale to protect against tetanus and diphtheria. Recent developments for toxoid vaccines are investigating the possibilities of utilizing recombinant protein toxins mutated to eliminate biologic activity instead of chemically inactivated toxins. Finally, one of the most contemporary approaches toward vaccine design utilizes messenger RNA (mRNA) as a vaccine candidate. This approach was used globally to protect against coronavirus disease during the COVID-19 pandemic that began in 2019, due to its advantages of quick production and scale-up, and effectiveness in eliciting a neutralizing antibody response. Nonetheless, mRNA vaccines require specialized storage and transport conditions, posing challenges for low- and middle-income countries. Among multiple available technologies for vaccine design and formulation, which technology is most appropriate? This review focuses on the considerable developments that have been made in utilizing diverse vaccine technologies with a focus on vaccines targeting bacterial toxins. We describe how advancements in vaccine technology, combined with a deeper understanding of pathogen-host interactions, offer exciting and promising avenues for the development of new and improved vaccines.
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Affiliation(s)
| | - Sabine Pellett
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53706, USA;
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18
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Lu P, Creagh AP, Lu HY, Hai HB, Thwaites L, Clifton DA. 2D-WinSpatt-Net: A Dual Spatial Self-Attention Vision Transformer Boosts Classification of Tetanus Severity for Patients Wearing ECG Sensors in Low- and Middle-Income Countries. Sensors (Basel) 2023; 23:7705. [PMID: 37765761 PMCID: PMC10535235 DOI: 10.3390/s23187705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
Tetanus is a life-threatening bacterial infection that is often prevalent in low- and middle-income countries (LMIC), Vietnam included. Tetanus affects the nervous system, leading to muscle stiffness and spasms. Moreover, severe tetanus is associated with autonomic nervous system (ANS) dysfunction. To ensure early detection and effective management of ANS dysfunction, patients require continuous monitoring of vital signs using bedside monitors. Wearable electrocardiogram (ECG) sensors offer a more cost-effective and user-friendly alternative to bedside monitors. Machine learning-based ECG analysis can be a valuable resource for classifying tetanus severity; however, using existing ECG signal analysis is excessively time-consuming. Due to the fixed-sized kernel filters used in traditional convolutional neural networks (CNNs), they are limited in their ability to capture global context information. In this work, we propose a 2D-WinSpatt-Net, which is a novel Vision Transformer that contains both local spatial window self-attention and global spatial self-attention mechanisms. The 2D-WinSpatt-Net boosts the classification of tetanus severity in intensive-care settings for LMIC using wearable ECG sensors. The time series imaging-continuous wavelet transforms-is transformed from a one-dimensional ECG signal and input to the proposed 2D-WinSpatt-Net. In the classification of tetanus severity levels, 2D-WinSpatt-Net surpasses state-of-the-art methods in terms of performance and accuracy. It achieves remarkable results with an F1 score of 0.88 ± 0.00, precision of 0.92 ± 0.02, recall of 0.85 ± 0.01, specificity of 0.96 ± 0.01, accuracy of 0.93 ± 0.02 and AUC of 0.90 ± 0.00.
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Affiliation(s)
- Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Andrew P. Creagh
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Huiqi Y. Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
- Oxford Suzhou Centre for Advanced Research, Suzhou 215123, China
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Ershov AE, Sorokina TS, Ermolaev AV. Gaston Ramon (to Centenary of the discovery of anatoxins). Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1035-1040. [PMID: 37898896 DOI: 10.32687/0869-866x-2023-31-5-1035-1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 10/31/2023]
Abstract
In the history of science, there are great scientists who, without being physicians, wrote golden pages in the History of Medicine. Such was Louis Pasteur, founder of scientific microbiology and immunology. Such was his follower Gaston Ramon (1886-1963), French veterinarian and immunologist who created 100 years ago first anatoxin for active prevention of diphtheria and later tetanus and thus opened era of anatoxins (toxoids) - vaccines based on toxin molecule devoid of toxic properties, but preserving immunogenicity and antigenic specificity. For many centuries, diphtheria (originally known as 'croup') was incurable contagious disease, especially among children. In XIX century, it affected in France up to 30,000 people per year and killed every second infected child. In 1888, at the Pasteur Institute (Paris), Emile Roux (1853-1933) and Alexandre Yersin (1863-1943) demonstrated for first time that symptoms of diphtheria are caused not by bacteria themselves, but by deadly toxin released by them. The long-term search for method of treatment and prevention of diphtheria did not bring the desired result. It will take many years, before Gaston Ramon in 1923 will be able to neutralize diphtheria toxin by acting on it with formalin at certain temperature and thus will receive "anatoxin", mean of vaccination against diphtheria. The article analyzes stages of these studies, which proved high effectiveness of anatoxin and proceeded with widespread implementation of vaccination against diphtheria and later tetanus in short time in France and in Russia (with active participation of Pavel F. Zdrodovsky, 1890-1976). The separate section of the article is devoted to life story of Gaston Ramon and his activities in the Pasteur Institute. The scientist who opened the era of anatoxins did not become Nobel Prize winner, despite the fact that various organizations and scientists from many countries of the world have nominated him 155 times for the Nobel Prize in Physiology or Medicine in different years. He received recognition in France, his Motherland: Gaston Ramon is holder of the Grand Cross of the Order of the Legion of Honor and streets, colleges, lyceums, schools are named after him.
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Affiliation(s)
- A E Ershov
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University of Russia" of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia
| | - T S Sorokina
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University of Russia" of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia,
| | - A V Ermolaev
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University of Russia" of Minobrnauka of Russia (RUDN University), 117198, Moscow, Russia
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Söğüt Ö, Ergenc H, Yigit Y. Untangling Tetanus: A Comprehensive Case Report Describing Its Diagnosis and Treatment. Cureus 2023; 15:e44702. [PMID: 37809177 PMCID: PMC10552333 DOI: 10.7759/cureus.44702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Tetanus, caused by a grave and potentially lethal bacteria, is a medical condition that severely affects the central nervous system and demands vigilant attention and comprehensive preventive measures to safeguard public health. The onset of this condition is sudden and characterized by the emergence of intense tonic muscle spasms, underscoring its critical nature. In Türkiye, around 50 cases are officially reported each year; however, it is widely suspected that numerous cases remain unreported, contributing to an even more significant impact. This report aims to shed light on a remarkable case involving a 24-year-old male patient. Despite having a complete vaccination history, this individual contracted tetanus and required intensive care and mechanical ventilation due to the severity of his tetanus infection. This case serves as a poignant reminder of the importance of booster administration, highlighting the significance of continued and timely reinforcement of vaccinations.
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Affiliation(s)
- Özgür Söğüt
- Emergency Medicine, Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, TUR
| | - Hüseyin Ergenc
- Emergency Medicine, Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, TUR
| | - Yavuz Yigit
- Emergency Medicine, Department of Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Blizard Institute, Queen Mary University, London, GBR
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García-Hernández H, Zárate-Ramírez J, Kammar-García A, García-Peña C. Estimation of vaccination coverage and associated factors in older Mexican adults. Epidemiol Infect 2023; 151:e134. [PMID: 37577972 PMCID: PMC10468813 DOI: 10.1017/s0950268823001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
National vaccination programmes recommend the influenza vaccine for older adults, but this population group has the greatest morbidity and mortality from other preventable vaccine diseases. The aim of this article is to estimate the vaccine coverage in adults aged 65 years and older and to analyse the factors that could increase or decrease vaccination uptake probability for the three listed vaccines in the national vaccination programme (influenza, tetanus and diphtheria, and pneumococcus) and the full scheme in Mexico. We conducted an analytical cross-sectional study with 2012, 2018, and 2021 rounds from the National Health and Nutrition Survey, in which we calculated the vaccine coverage estimations and performed multivariable logistic regression models to analyse the factors related to vaccine uptake. Tetanus and diphtheria vaccines had the greatest coverage estimation in all years (59-71%), whereas the pneumococcus vaccine had the lowest (32-53%). Full scheme vaccine coverage decreased from 37.80% to 24.77% in 2012 and 2021, respectively. The National Health Card property, morbidity, being a beneficiary of any health system institution, and use of preventive services increased the probability of vaccine uptake. In conclusion, vaccine coverage in older Mexican adults decreased over time, and the Mexican health system plays a strategic role in immunisation.
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Affiliation(s)
| | - Judith Zárate-Ramírez
- Research Fellow, Health Reserch Division, National Institute of Geriatrics, Mexico City, Mexico
| | - Ashuin Kammar-García
- Researcher, Health Research Division, National Institute of Geriatrics, Mexico City, Mexico
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22
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Nejad HR, Mehrabadi JF, Saeedi P, Zanganeh S. Phage display technology for fabricating a recombinant monoclonal ScFv antibody against tetanus toxin. Toxicol Res (Camb) 2023; 12:591-598. [PMID: 37663798 PMCID: PMC10470330 DOI: 10.1093/toxres/tfad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 09/05/2023] Open
Abstract
Tetanus is a specific infectious disease, often associated with lower immunization in developing countries and catastrophic events (such as earthquakes). Millions of people, especially children, die every year from tetanus disease. Therefore, it is necessary to devise a rapid and sensitive detection method for tetanus toxin to ensure an early diagnosis and clinical treatment of tetanus. The current study looks at developing a novel, high specific, low-cost, and sensitive ScFv antibody. It is capable of tetanus detection immunoassays in clinical diagnosis, suspicious foods, and water monitoring. For this regard, a high-quality phage display antibody library (8.7 × 107 PFU/ml) was constructed. Tetanus-specific antibodies with high affinity retrieved from libraries. After phage rescue and four rounds of biopanning, clone screening was performed by phage ELISA. Recombinant antibodies expressed from the AC8 clone showed the highest affinity for tetanus. SDS-PAGE and western blotting confirmed the presence of a high-quality, pure ScFv band at 32 kDa. ELISA was used to determine the affinity value, estimated to be around 10-8 M. The results suggest that the proposed detection method by ScFv antibodies is an alternative diagnostic tool enabling rapid and specific detection of the tetanus toxin.
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Affiliation(s)
- Hamideh Rouhani Nejad
- Faculty of Science, Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Pardis Saeedi
- Faculty of Science, Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Saeed Zanganeh
- Department of Hematology and Medical Laboratory Sciences, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Ibrahim ZA, Sabahelzain MM, Elhadi YAM, Malande OO, Babiker S. Predictors of Tetanus Vaccine Uptake among Pregnant Women in Khartoum State, Sudan: A Hospital-Based Cross-Sectional Study. Vaccines (Basel) 2023; 11:1268. [PMID: 37515083 PMCID: PMC10386498 DOI: 10.3390/vaccines11071268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
Tetanus toxoid (TT) vaccination during pregnancy has been proven as an effective preventative measure to reduce the incidence of maternal and neonatal morbidity and mortality worldwide. This study aimed to assess the determinants of TT vaccine uptake among pregnant women at two public maternity specialized hospitals in Sudan. A hospital-based cross-sectional study was conducted at two public hospitals, Omdurman Maternity Hospital and Al Saudi Hospital in Omdurman, Khartoum State, in Sudan from February to April 2020. Logistic regression analysis was carried out to identify factors associated with receiving three or more doses of the TT vaccine among pregnant women, presented as odds ratios, with p-values < 0.05 considered significant (at a 95% confidence interval). The study recruited 350 pregnant women, with 313 participants included in the analysis. This study found that only 40% of the pregnant women had received three doses or more of the TT vaccine. Pregnant women who attended Al Saudi Hospital were less likely to be vaccinated with the recommended dose of the TT vaccine in districts at high risk (received ≥3 doses) compared to those who attended Omdurman Hospital [OR = 0.49 (95% C.I. 0.29-0.82), p-value < 0.05]. Furthermore, the number of children at home was a significant predictor of the mothers' immunization status as those with five children or more were ten times more likely to be vaccinated with three doses or more [OR = 10.54 (95% C.I. 4.30-25.86), p-value < 0.05]. We conclude that this low rate of TT vaccine uptake found in this study among pregnant women increases the number of newborn babies susceptible to contracting neonatal tetanus. The findings of this study should be considered in the development of communication strategies targeting and prioritizing at-risk groups to increase TT vaccine uptake among pregnant women in Sudan.
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Affiliation(s)
| | - Majdi M Sabahelzain
- Nutrition and Health Center for Training and Research, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
| | | | - Ombeva Oliver Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru P.O. Box 3366-20100, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Kampala P.O. Box 3040, Uganda
- Department of Paediatrics & Child Health, Makerere University, Kampala P.O. Box 3040, Uganda
| | - Suad Babiker
- School of Medicine, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
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Deniz M, Erat T. Generalized tetanus: a pediatric case report and literature review. Rev Inst Med Trop Sao Paulo 2023; 65:e40. [PMID: 37377323 PMCID: PMC10313328 DOI: 10.1590/s1678-9946202365040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023] Open
Abstract
Pediatric tetanus is a rare and forgotten disease in countries with high childhood tetanus toxoid vaccination rates. Therefore, the clinical manifestations, treatment and management of this potentially life-threatening disease are not well known. With a literature review and discussion of tetanus management in pediatric patients, we describe a clinical course of a rare and fatal but vaccine-preventable disease, the generalized tetanus, in an adolescent who was successfully treated.
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Affiliation(s)
- Melis Deniz
- Sanlıurfa Training and Research Hospital, Department of Pediatric Infectious Diseases, Sanlıurfa, Turkey
| | - Tugba Erat
- Ankara City Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
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Prygiel M, Mosiej E, Wdowiak K, Rabczenko D, Zasada AA. Adjuvant Effect of Whole-Cell Pertussis Component on Tetanus Toxoid Potency in Murine Model. Biomedicines 2023; 11:1795. [PMID: 37509435 PMCID: PMC10376220 DOI: 10.3390/biomedicines11071795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
There is currently an increasing interest in the development of new-generation purified antigen-based vaccines with a higher safety profile compared to conventional inactivated vaccines. The main problem of subunit vaccines is their lower immunogenicity compared to whole-cell vaccines and inducing weaker and shorter-lasting immune responses. In this paper, the results of the assay of the potency of the tetanus component combined with the diphtheria component and whole-cell pertussis vaccine (DTwP), diphtheria and tetanus vaccine (DT), and in monovalent tetanus vaccine (T) are presented. In the mice model, an adjuvant impact of the whole-cell pertussis component on the immune response against tetanus was observed. It was noticed that the potency of tetanus component in the DTwP vaccine was significantly higher than tetanus potency in DT and T vaccines, despite the same bounding ability unit of the tetanus toxoid in the vaccine formulations. The levels of induction of tetanus antibodies by the tested vaccines were also examined. There were no differences in the induction of humoral responses against tetanus by tested vaccines. This publication discusses the possible mechanisms of impact of the whole-cell pertussis component on the other vaccine antigens and the positive and negative aspects of using the whole-cell pertussis component as an adjuvant.
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Affiliation(s)
- Marta Prygiel
- Department of Sera and Vaccines Evaluation, National Institute of Public Health NIH-National Research Institute, Chocimska 24, 00-791 Warsaw, Poland
| | - Ewa Mosiej
- Department of Sera and Vaccines Evaluation, National Institute of Public Health NIH-National Research Institute, Chocimska 24, 00-791 Warsaw, Poland
| | - Karol Wdowiak
- Department of Sera and Vaccines Evaluation, National Institute of Public Health NIH-National Research Institute, Chocimska 24, 00-791 Warsaw, Poland
| | - Daniel Rabczenko
- Department-Center for Monitoring and Analyses of Population Health Status, National Institute of Public Health NIH-National Research Institute, Chocimska 24, 00-791 Warsaw, Poland
| | - Aleksandra Anna Zasada
- Department of Sera and Vaccines Evaluation, National Institute of Public Health NIH-National Research Institute, Chocimska 24, 00-791 Warsaw, Poland
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Rathod V, Kadam L, Gautam M, Gumma PD, Marke K, Asokanathan C, Douglas-Bardsley A, Hassell L, Bhandare S, Gupta S, Parekh S, Pujari P, Rao H, Sharma H, Shaligram U, Gairola S. Multiplexed bead-based assay for the simultaneous quantification of human serum IgG antibodies to tetanus, diphtheria, pertussis toxin, filamentous hemagglutinin, and pertactin. Front Immunol 2023; 14:1190404. [PMID: 37342321 PMCID: PMC10278353 DOI: 10.3389/fimmu.2023.1190404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
Background Luminex bead-based assays offer multiplexing to test antibodies against multiple antigens simultaneously; however, this requires validation using internationally certified reference standards. Therefore, there is an urgent need to characterize existing reference standards for the standardization of multiplex immunoassays (MIAs). Here, we report the development and validation of an MIA for the simultaneous estimation of levels of human serum immunoglobulin G (IgG) antibodies for pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (PRN), diphtheria toxoid (DT), and tetanus toxoid (TT). Methods The MIA was assessed using a panel of human serum samples and WHO reference standards. The WHO reference standards were also studied for suitability in the MIA. Purified antigens (PT, FHA, PRN, DT, and TT) were coupled to the spectrally unique magnetic carboxylated microspheres. The method was validated in accordance with the United States Food and Drug Administration (US FDA), European Medicines Agency (EMA), and the International Committee of Harmonization Multidisciplinary (ICH M10) guidelines, and parameters such as precision, accuracy, dilutional linearity, assay range, robustness, and stability were assessed. Method agreements with commercially available IgG enzyme-linked immunosorbent assay (ELISA) assays were also evaluated. In addition, the study assessed the level of correlation between the IgG levels estimated by the MIA and the cell-based neutralizing antibody assays for PT and DT. Results We identified that an equimix of WHO international standards (i.e., 06/142, 10/262, and TE-3) afforded the best dynamic range for all the antigens in the MIA. For all five antigens, we observed that the back-fitted recoveries using the four-parameter logistic (4-PL) regression fits ranged between 80% and 120% for all calibration levels, and the percentage coefficient of variation (% CV) was < 20%. In addition, the difference in mean fluorescence intensity (MFI) between the monoplex and multiplex format was < 10% for each antigen, indicating no crosstalk among the beads. The MIA also showed good agreement with conventional and commercially available assays, and a positive correlation (> 0.75) with toxin neutralization assays for PT and DT was observed. Conclusion The MIA that was calibrated in accordance with WHO reference standards demonstrated increased sensitivity, reproducibility, and high throughput capabilities, allowing for the design of robust studies that evaluate both natural and vaccine-induced immunity.
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Affiliation(s)
- Vishal Rathod
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Laxmikant Kadam
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Manish Gautam
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Prabhu Dasu Gumma
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Kevin Marke
- Science, Research and Innovation, Medicines, and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Cathy Asokanathan
- Science, Research and Innovation, Medicines, and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Alex Douglas-Bardsley
- Science, Research and Innovation, Medicines, and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Laura Hassell
- Science, Research and Innovation, Medicines, and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Sachin Bhandare
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Sumit Gupta
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Sameer Parekh
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Pramod Pujari
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Harish Rao
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Hitt Sharma
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Umesh Shaligram
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
| | - Sunil Gairola
- Clinical Bioanalytical Laboratory, Serum Institute of India Pvt. Ltd., Pune, Maharashtra, India
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Kinoshita Y, Yamanaka T, Kodaira K, Niwa H, Uchida-Fujii E, Ueno T. Assessment of tetanus revaccination regimens in horses not vaccinated in the previous year. J Vet Med Sci 2023:23-0158. [PMID: 37258221 PMCID: PMC10372253 DOI: 10.1292/jvms.23-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
A two-dose revaccination against tetanus is recommended for horses over 2 years old in Japan with no history of vaccination in the previous year. Here, the need for two-dose revaccination was evaluated in terms of antibody titers for each vaccine type, namely monovalent or multivalent. There was no difference in antibody titers between one- and two-dose regimens for up to 1 year, except at 8 weeks with the multivalent vaccine, and all horses had sufficient antibody titers for 1 year of tetanus prophylaxis. These results suggest that one-dose revaccination, regardless of the vaccine type, is as effective as two-dose in preventing tetanus for at least 1 year in horses not vaccinated in the previous year.
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Affiliation(s)
- Yuta Kinoshita
- Microbiology Division, Equine Research Institute, Japan Racing Association
| | - Takashi Yamanaka
- Research Planning and Coordination Division, Equine Research Institute, Japan Racing Association
| | | | - Hidekazu Niwa
- Microbiology Division, Equine Research Institute, Japan Racing Association
| | - Eri Uchida-Fujii
- Microbiology Division, Equine Research Institute, Japan Racing Association
| | - Takanori Ueno
- Microbiology Division, Equine Research Institute, Japan Racing Association
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28
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Oshima K, Sawada Y, Isshiki Y, Ichikawa Y, Fukushima K, Aramaki Y. Clinical Experience of Use of Kampo Medicine Shakuyakukanzoto for Muscle Spasms Caused by Tetanus. Cureus 2023; 15:e40612. [PMID: 37476111 PMCID: PMC10354374 DOI: 10.7759/cureus.40612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/22/2023] Open
Abstract
Background Tetanus is an infectious disease caused by Clostridium tetani, which produces tetanospasmin. Intensive care using sedatives and muscle relaxants is required for the management of severe tetanus, however, long-term use of those medicines is associated with the occurrence of post-intensive care syndrome (PICS). Shakuyakukanzoto (SKT), which is clinically used for the treatment of pain associated with sudden myospasm widely, is one of Kampo medicines, and some studies showed that they are effective in treating muscle spasms caused by tetanus. The purpose of this study is to evaluate the usefulness of SKT in the management of tetanus patients from the viewpoint of the reduction of sedatives. Methods Patients who were diagnosed with tetanus and were treated in our hospital between January 2006 and December 2022 were included. Patients were divided into two groups, patients treated with SKT and those without SKT, and the background information and clinical courses, especially the reduction of sedatives, were compared between the two groups. Results There were five tetanus patients who were treated with SKT (SKT(+) group) and two tetanus patients without SKT (SKT(-) group), respectively. Intubation and mechanical ventilation were required for the management of generalized seizures in all seven patients, who were admitted to the intensive care unit (ICU). The administration of propofol could be discontinued after an average of 8.6 days (range: 3-22 days) from the initiation of SKT administration. The dosage of propofol was lower in patients who received SKT versus those who did not; midazolam and fentanyl exhibited a similar tendency. The mean durations of ICU and hospital stays for patients treated with or without SKT were almost equal (the mean durations of ICU stay in SKT(+) and SKT(-) groups were 22.6 and 24.0 days, and those of hospital stay in SKT(+) and SKT(-) groups were 35.2 and 36.0 days, respectively). All seven patients were discharged and transferred to another hospital for rehabilitation. Conclusions SKT may be useful in the management of myospasms in patients with tetanus. It may also prevent the occurrence of PICU in patients with tetanus who require intensive care by reducing the use of sedatives and analgesics.
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Affiliation(s)
- Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
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29
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Vantava S, Hefele L, Virachith S, Vannachone S, Khounvisith V, Nouanthong P, Hübschen JM, Sayasone S, Black AP. Low seroprotection against diphtheria and tetanus in Lao adolescents. Trop Med Int Health 2023. [PMID: 37199458 DOI: 10.1111/tmi.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES There is currently no booster diphtheria or tetanus vaccine for Lao children before adolescence, despite international recommendations. We investigated seroprotection against diphtheria and tetanus among Lao adolescents. METHODS Seven hundred seventy-nine serum samples were tested for anti-diphtheria and anti-tetanus antibodies. RESULTS Overall, 25.8% of the adolescents had antibody titers corresponding to protection against diphtheria and 30.9% to sufficient immunity against tetanus. Female participants >16 years were more likely to be protected against diphtheria (p < 0.001) and tetanus (p < 0.029). CONCLUSION Low protection against diphtheria and tetanus, possibly due to low vaccination coverage or antibody waning, suggests booster doses are warranted before adolescence.
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Affiliation(s)
- Sonephet Vantava
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Lisa Hefele
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Siriphone Virachith
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao People's Democratic Republic
| | - Souphaphone Vannachone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Vilaysone Khounvisith
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao People's Democratic Republic
| | | | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Antony P Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao People's Democratic Republic
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Doğan A, Mohamed Alİ A, Abdullahi Alİ M, Orul H. Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia. Hum Vaccin Immunother 2023:2202128. [PMID: 37133877 DOI: 10.1080/21645515.2023.2202128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Tetanus is still a major problem in sub-Saharan African countries. This study aims to evaluate tetanus disease and vaccine awareness among healthcare workers in Mogadishu. This descriptive, cross-sectional study was scheduled for January 2-7, 2022. A questionnaire consisting of 28 questions was applied in a face-to-face manner to 418 healthcare workers. Only health workers aged≥18 living in Mogadishu were included. Questions about sociodemographic characteristics, tetanus disease, and vaccines were developed. 71.1% of the participants were female, 72% were ˂25 years old, 42.6% were nursing students, and 63.2% had a university education. It was observed that 46.9% of the volunteers had an income level of <$250, and 60.8% resided in the city center. 50.5% of the participants received a tetanus vaccine in their childhood. Questions to determine participants' level of knowledge about tetanus and the tetanus vaccine were responded to with an accuracy of between 44 and 77%. Although 38.5% of the participants reported that they were exposed to trauma at least once a day, the rate of those who had three or more doses of the vaccine was only 10.8%. On the other hand, 51.4% reported that they had received training about tetanus and vaccination. There was a significant difference (p < .001) in terms of knowledge level among sociodemographic characteristics. The fear of side effects was the most important reason for not being vaccinated. Healthcare workers in Mogadishu have little awareness of tetanus disease and vaccines. Efforts to improve education and other factors will be sufficient to eliminate the disadvantage brought about by the socio-demographic structure.
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Affiliation(s)
- Ahmet Doğan
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Mohamed Alİ
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mukhtar Abdullahi Alİ
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Havva Orul
- Infection Committee Control Nurse, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
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Sanchez-Grillo R, Zavaleta-Monestel E, Ruiz-Munguia E, Díaz-Madriz JP, Rojas-Chinchilla C. Uncommon Progressive Systemic Tetanus: A Case Report. Cureus 2023; 15:e38383. [PMID: 37265915 PMCID: PMC10231406 DOI: 10.7759/cureus.38383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Tetanus is a bacterial infection caused by the toxin of Clostridium tetani. While it primarily affects newborns, people with incomplete vaccination schedules, it can also impact people of any age, especially in developing countries. Even though in the last 20 years several initiatives have been implemented worldwide to reduce the impact of this disease, regions like South Asia and sub-Saharan Africa have registered mortality rates highest since 2015-2019. In Latin America, regional immunization coverage rates were reported at 89% in 2017 for diphtheria-tetanus toxoid and pertussis (DTP-3), although Costa Rica has reported decreased coverage rates of the national immunization schedule from 2019 to 2021. In this case study, we present a 53-year-old woman from Puntarenas, Costa Rica diagnosed with progressive systemic tetanus who developed status epilepticus. She previously was assessed in a central hospital of Costa Rica for paresthesia in her right upper limb of three months of duration, myoclonus and difficulty walking in the last weeks; the presumed diagnosis was Guillain-Barré syndrome. During her hospitalization she had three generalized tonic-clonic seizures treated with diazepam and phenytoin. Since there was no improvement, she was transferred to our medium-sized private hospital for the treatment of painful spasms and weakness in the lower limbs. On initial evaluation, no injury was found. She was initially treated with midazolam and magnesium sulfate for presenting seizures-like spasms in the lower limbs and then generalized without loss of consciousness for up to 15 minutes, mainly associated with desaturation, tachycardia and tachypnea. In the differential diagnosis, muscle contractions linked to hypocalcemia, neurosyphilis and epilepsy were ruled out. Despite this, magnetic resonance imaging showed fractures in T11, L1 and L2. Mainly due to the presence of spasms, opisthotonos and history of seizures and a wound on the hand four months ago, she was diagnosed with tetanus. Among the initial management, tetanus toxoid (Td), antimicrobial therapy, and human antitetanic immunoglobulin (HTIG) were administered, which partially improved the patient's condition, although she remained dependent on the infusions. On the sixth week of hospitalization, the patient developed status epilepticus which is explained by the magnetic resonance findings that show subacute bi-occipital infarcts caused by hypoxia from the previous crises. Lacosamide therapy reversed the condition and kept the patient free of seizures. It was necessary to carry out a lumbar osteosynthesis which was highly favorable to stabilize the patient's condition. The frequency and intensity of the spasms were gradually reduced, which allowed the gradual suspension of the infusions and the benzodiazepine overlap intravenous (IV) to oral (PO). The patient now has only self-limiting spasms and her maintenance therapy consists of lacosamide and oral clonazepam. This case highlights the importance of considering tetanus in the differential diagnosis even if the vaccination schedule is complete, especially if there are spasms, convulsions, or a history of wounds or bites. It is important to monitor this type of report to reconsider and update the key elements in the prevention, diagnosis, management, and treatment of tetanus; as well as improve access to essential medicines, including the HTIG, and the patient's prognosis in terms of symptom resolution and associated sequelae.
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Wu D, Jing R, Zheng H, He K, Li Y, Yu W, Yin Z, Fang H. Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis. Value Health 2023; 26:666-675. [PMID: 36328326 DOI: 10.1016/j.jval.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.
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Affiliation(s)
- Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rize Jing
- School of Public Administration and Policy, Renmin University of China, Beijing, China; Health Science, Hospital Reform and Medical Big Data Liberal Arts and Sciences Cross Platform, Renmin University of China, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kun He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China; Institute of Global Health and Development, Peking University, Beijing, China.
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Zhu P, Wu D, Wang Y, Liu X, Rodewald LE, Li Y, Zheng H, Cao L, Song Y, Song L, Zhao X, Yao J, Wang F, Li M, Zhang Q, Yan T, Yin Z. Effectiveness of DTaP Against Pertussis in ≤2-Year-Old Children - Linyi Prefecture, Shandong Province, China, 2017-2019. China CDC Wkly 2023; 5:374-378. [PMID: 37197447 PMCID: PMC10184384 DOI: 10.46234/ccdcw2023.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
What is already known about this topic? Vaccine effectiveness (VE) is positively correlated with the number of administered co-purified diphtheria, tetanus, and acellular pertussis vaccine (DTaP) doses. A matched case-control study conducted in Zhongshan City revealed that the co-purified DTaP VE against pertussis-related illnesses in children aged 4-11 months was 42% for one dose, 88% for two doses, and 95% for three doses, respectively. What is added by this report? The results of this study contribute to the current body of research. We found that the VE of co-purified DTaP against pertussis-related illness and hospitalization increased substantially, ranging from 24%-26% after one dose to 86%-87% after four doses. What are the implications for public health practice? The results of this study underscore the significance of prompt and comprehensive immunization using co-purified DTaP to decrease the incidence of pertussis. Additionally, these findings offer evidence supporting the modification of China's pertussis vaccination approach.
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Affiliation(s)
- Pinpin Zhu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Wang
- Linyi Center for Disease Control and Prevention, Linyi City, Shandong Province, China
| | - Xiaoxue Liu
- Jinan Center for Disease Control and Prevention, Jinan City, Shandong Province, China
| | - Lance E. Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Song
- Linyi Center for Disease Control and Prevention, Linyi City, Shandong Province, China
| | - Xiaodong Zhao
- Jinan Center for Disease Control and Prevention, Jinan City, Shandong Province, China
| | - Jianyi Yao
- Health Communication Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuzhen Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingshuang Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingting Yan
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- Zundong Yin,
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Mukadi P, Higgins SG, Budd R, Randall C, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Wells C, Rimoin AW. Reported History of Measles and Long-term Impact on Tetanus Antibody Detected in Children 9-59 Months of Age and Receiving 3 Doses of Tetanus Vaccine in the Democratic Republic of the Congo. Pediatr Infect Dis J 2023; 42:338-345. [PMID: 36795582 PMCID: PMC9990594 DOI: 10.1097/inf.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Recent studies suggest measles-induced immune amnesia could have long-term immunosuppressive effects via preferential depletion of memory CD150+ lymphocytes, and associations with a 2-3 year period of increased mortality and morbidity from infectious diseases other than measles has been shown in children from wealthy and low-income countries. To further examine the associations previous measles virus infection may have on immunologic memory among children in the Democratic Republic of the Congo (DRC), we assessed tetanus antibody levels among fully vaccinated children, with and without a history of measles. METHODS We assessed 711 children 9-59 months of age whose mothers were selected for interview in the 2013-2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report and classification of children who had measles in the past was completed using maternal recall and measles IgG serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. Tetanus IgG antibody serostatus was similarly obtained. A logistic regression model was used to identify association of measles and other predictors with subprotective tetanus IgG antibody. RESULTS Subprotective geometric mean concentration tetanus IgG antibody values were seen among fully vaccinated children 9-59 months of age, who had a history of measles. Controlling for potential confounding variables, children classified as measles cases were less likely to have seroprotective tetanus toxoid antibody (odds ratio: 0.21; 95% confidence interval: 0.08-0.55) compared with children who had not had measles. CONCLUSIONS History of measles was associated with subprotective tetanus antibody among this sample of children in the DRC who were 9-59 months of age and fully vaccinated against tetanus.
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Affiliation(s)
- Hayley R. Ashbaugh
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - James D. Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nicole A. Hoff
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Reena H. Doshi
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, Democratic Republic of the Congo
| | | | - Roger Budd
- DYNEX Technologies Incorporated, Chantilly, Virginia
| | | | | | | | - Sue K. Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Christine Wells
- UCLA IDRE Statistical Consulting Group, University of California, Los Angeles, Los Angeles, California
| | - Anne W. Rimoin
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Košenina S, Stenmark P. Crystal structure of the OrfX1-OrfX3 complex from the PMP1 neurotoxin gene cluster. FEBS Lett 2023; 597:515-523. [PMID: 36403098 DOI: 10.1002/1873-3468.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
Paraclostridial mosquitocidal protein 1 (PMP1) is a member of the clostridial neurotoxin (CNT) family, which includes botulinum and tetanus neurotoxins. PMP1 has unique selectivity for anopheline mosquitos and is the only known member of the family that targets insects. PMP1 is encoded in an orfX gene cluster, which in addition to the toxin, consists of OrfX1, OrfX2, OrfX3, P47 and NTNH, which have been shown to aid in PMP1 toxicity. We here show that OrfX1 and OrfX3 form a complex and present its structure at 2.7 Å. The OrfX1-OrfX3 complex mimics the structure of full-length OrfX2 and belongs to the lipid-binding TULIP protein superfamily. With this report, the structures of all proteins encoded in the orfX gene cluster of CNTs are now determined.
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Affiliation(s)
- Sara Košenina
- Department of Biochemistry and Biophysics, Stockholm University, Sweden
| | - Pål Stenmark
- Department of Biochemistry and Biophysics, Stockholm University, Sweden
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Harris K, Ling Y, Bukhbinder AS, Chen L, Phelps KN, Cruz G, Thomas J, Kim Y, Jiang X, Schulz PE. The Impact of Routine Vaccinations on Alzheimer's Disease Risk in Persons 65 Years and Older: A Claims-Based Cohort Study using Propensity Score Matching. J Alzheimers Dis 2023; 95:703-718. [PMID: 37574727 PMCID: PMC10578243 DOI: 10.3233/jad-221231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Accumulating evidence suggests that adult vaccinations can reduce the risk of developing Alzheimer's disease (AD) and Alzheimer's disease related dementias. OBJECTIVE To compare the risk for developing AD between adults with and without prior vaccination against tetanus and diphtheria, with or without pertussis (Tdap/Td); herpes zoster (HZ); or pneumococcus. METHODS A retrospective cohort study was performed using Optum's de-identified Clinformatics® Data Mart Database. Included patients were free of dementia during a 2-year look-back period and were≥65 years old by the start of the 8-year follow-up period. We compared two similar cohorts identified using propensity score matching (PSM), one vaccinated and another unvaccinated, with Tdap/Td, HZ, or pneumococcal vaccines. We calculated the relative risk (RR) and absolute risk reduction (ARR) for developing AD. RESULTS For the Tdap/Td vaccine, 7.2% (n = 8,370) of vaccinated patients and 10.2% (n = 11,857) of unvaccinated patients developed AD during follow-up; the RR was 0.70 (95% CI, 0.68-0.72) and ARR was 0.03 (95% CI, 0.02-0.03). For the HZ vaccine, 8.1% (n = 16,106) of vaccinated patients and 10.7% (n = 21,417) of unvaccinated patients developed AD during follow-up; the RR was 0.75 (95% CI, 0.73-0.76) and ARR was 0.02 (95% CI, 0.02-0.02). For the pneumococcal vaccine, 7.92% (n = 20,583) of vaccinated patients and 10.9% (n = 28,558) of unvaccinated patients developed AD during follow-up; the RR was 0.73 (95% CI, 0.71-0.74) and ARR was 0.02 (95% CI, 0.02-0.03). CONCLUSION Several vaccinations, including Tdap/Td, HZ, and pneumococcal, are associated with a reduced risk for developing AD.
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Affiliation(s)
- Kristofer Harris
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yaobin Ling
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Avram S. Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Division of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Luyao Chen
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamal N. Phelps
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gabriela Cruz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jenna Thomas
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul E. Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Yamaguchi J, Kinoshita K. The threat of a new tetanus outbreak due to urban flooding disaster requires vigilance: a narrative review. Acute Med Surg 2023; 10:e839. [PMID: 37077453 PMCID: PMC10106935 DOI: 10.1002/ams2.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023] Open
Abstract
Vaccines for tetanus prevention have rapidly progressed, and the number of outbreaks, especially the incidence of tetanus in developed countries, has decreased dramatically. However, the mortality rate associated with severe tetanus remains high. Tetanus eradication is difficult owing to the widespread presence of the spores of tetanus bacteria in the environment, but tetanus can be prevented by acquired immunity from vaccines. Older people, intravenous drug users, and migrants are at a high risk of tetanus in developed countries owing to the lack of booster vaccination programs. Natural disasters, especially floods, often cause an increase in the prevalence of tetanus because of the associated injuries. Precautions should be taken to combat the threat of a new tetanus outbreak due to floods in urban areas owing to global warming. In particular, Japan is facing a high risk of urban flooding-induced tetanus, despite its status as a developed country. This review aims to highlight the data on the epidemiology, causes, treatment, and prevention of tetanus and problems associated with tetanus countermeasures during future floods.
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Affiliation(s)
- Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute MedicineNihon University School of MedicineTokyoJapan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute MedicineNihon University School of MedicineTokyoJapan
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Guerra GL, Pedro FL, Severo MD, Guerra GL, Ribeiro TA. Strategy to increase vaccination coverage in diabetic patients at a public tertiary university hospital: A randomized controlled trial. SAGE Open Med 2023; 11:20503121231161193. [PMID: 36993779 PMCID: PMC10041585 DOI: 10.1177/20503121231161193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective To evaluate whether there is an increase in vaccination rates of patients with diabetes mellitus who received guidance to update their vaccination schedules for influenza, hepatitis B, pneumonia, and tetanus. Methodology A randomized controlled trial was conducted between December 2018 and November 2020. The sample consisted of 139 patients from the endocrinology service outpatient clinic of Santa Maria University Hospital was randomized into an intervention group (n = 68) and a control group (n = 71). The intervention consisted of a phone call to update the vaccination schedule for the diseases evaluated. Results The mean age of the subjects was 59.17 ± 12.91 years and 62.6% were female. No age differences were observed between genders and randomization groups (p = 0.548, p = 0.791) and groups were homogeneous (p = 0.173, p = 0.443). The intervention group showed a significant increase in vaccination rates after the intervention. For influenza, 79.4-89.7% (p = 0.016); hepatitis B, 29.4-48.5% (p = 0.002); tetanus, 51.5-72.1% (p = 0.007); and pneumonia, 22.1-29.4% (p = 0.049). No significant increase was observed in control group. Conclusion The orientation to update the vaccination schedule through telephone contact was effective in increasing vaccination rates for influenza, hepatitis B, pneumonia, and tetanus. Trial registry RBR-92z99d2 https://ensaiosclinicos.gov.br/rg/RBR-92z99d2.
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Affiliation(s)
- Giulia Limana Guerra
- Postgraduate Program of Health Science, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Endocrinology Department, University Hospital of Santa Maria (HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Fabio Lopes Pedro
- Department of Clinic Medicine, Medicine School of Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Mateus Dornelles Severo
- Endocrinology Department, University Hospital of Santa Maria (HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Giorgia Limana Guerra
- Medicine School of Universidade Franciscana (UFN), Santa Maria, Rio Grande do Sul, Brazil
| | - Tiango Aguiar Ribeiro
- Postgraduate Program of Health Science, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Medicine School of Universidade Franciscana (UFN), Santa Maria, Rio Grande do Sul, Brazil
- Department of Surgery, Medicine School of Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Tiango Aguiar Ribeiro, Postgraduate Program of Health Science, Federal University of Santa Maria, Roraima Avenue n 1000 – in University Campus, Santa Maria, Rio Grande do Sul 97105-900, Brazil.
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Sharma HJ, Parekh S, Pujari P, Shewale S, Desai S, Kawade A, Ravi M, Oswal J, James S, Mahantashetti N, Munshi R, Ghosh A, Rao V, Balsubramaniam S, Varughese P, Somshekhar A, Ginsburg AS, Rao H, Gautam M, Gairola S, Shaligram U. Safety and immunogenicity of an indigenously developed tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine (Tdap) in adults, adolescents, and children in India. Expert Rev Vaccines 2023; 22:278-287. [PMID: 36883291 DOI: 10.1080/14760584.2023.2188942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND This study assessed safety and immunogenicity of Serum Institute of India Pvt Ltd (SIIPL)'s tetanus toxoid (TT), diphtheria toxoid (DT), and acellular pertussis booster vaccine (Tdap). RESEARCH DESIGN AND METHODS In this Phase II/III, multicenter, randomized, active-controlled, open-label study, 1500 healthy individuals, aged 4-65 years, were randomized to receive a single dose of SIIPL Tdap or comparator Tdap vaccine (Boostrix®; GlaxoSmithKlines, India). Adverse events (AEs) during initial 30 minutes, 7-day, 30-day post-vaccination were assessed. Blood samples were taken before and 30 days post-vaccination for immunogenicity assessment. RESULTS No significant differences in incidence of local and systemic solicited AEs were observed between the two groups; no vaccine-related serious AEs were reported. SIIPL Tdap was non-inferior to comparator Tdap in achieving booster responses to TT and DT in 75.2% and 70.8% of the participants, respectively, and to pertussis toxoid (PT), pertactin (PRN), and filamentous hemagglutinin (FHA) in 94.3%, 92.6%, and 95.0% of the participants, respectively. Anti-PT, anti-PRN, and anti-FHA antibody geometric mean titers in both the groups, were significantly higher post-vaccination compared to pre-vaccination. CONCLUSIONS Booster vaccination with SIIPL Tdap was non-inferior to comparator Tdap with respect to immunogenicity against tetanus, diphtheria, and pertussis and was well tolerated.
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Affiliation(s)
- Hitt J Sharma
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sameer Parekh
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Pramod Pujari
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sunil Shewale
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Shivani Desai
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Anand Kawade
- Department of Pediatrics, KEM Hospital Research Centre, Vadu Rural Health Program, Pune, India
| | - Mandyam Ravi
- Department of Pediatrics, JSS Hospital, Mysore, India
| | - Jitendra Oswal
- Department of Pediatrics, Bharti Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - Saji James
- Department of Pediatrics, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | - N Mahantashetti
- Department of Pediatrics, KLE's Dr. Prabhakar Kore Hospital, Belgavi, India
| | - Renuka Munshi
- Department of Clinical Pharmacology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, India
| | - Apurba Ghosh
- Department of Pediatrics, Institute of Child Health, Kolkata, India
| | - Venkateshwar Rao
- Department of Medicine, Global Gleneagles Hospitals, Hyderabad, India
| | | | - P Varughese
- Department of Pediatrics, Christian Medical College, Ludhiana, India
| | - A Somshekhar
- Department of Pediatrics, M. S. Ramaiah Medical College & Hos, Bengaluru, India
| | | | - Harish Rao
- Production Department, Serum Institute of India Pvt Ltd, Pune, India
| | - Manish Gautam
- Department of Quality Control, Serum Institute of India Pvt Ltd, Pune, India
| | - Sunil Gairola
- Department of Quality Control, Serum Institute of India Pvt Ltd, Pune, India
| | - Umesh Shaligram
- Production Department, Serum Institute of India Pvt Ltd, Pune, India
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Muacevic A, Adler JR, Fujisaki N, Urushidani S. Understanding the Trajectory to a Diagnosis of Tetanus: A Descriptive Study. Cureus 2023; 15:e33287. [PMID: 36741638 PMCID: PMC9892862 DOI: 10.7759/cureus.33287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/05/2023] Open
Abstract
Background and objective Tetanus is a rare but potentially fatal disease in developed countries, including Japan. It is very difficult to diagnose this condition early because of its broad symptomatology and the lack of familiarity with tetanus among both physicians and patients. In this study, we aimed to describe the clinical manifestations of tetanus and to examine as to which departments/branches of medicine patients consult in order to provide helpful information for diagnosing this challenging condition. Materials and methods This was a descriptive, retrospective study conducted at a single tertiary hospital from January 2011 to December 2021. Patients with generalized tetanus, cephalic tetanus, and local tetanus presenting to our emergency department were included in the study. We examined the clinical manifestations and departments that patients with tetanus visited first. Additionally, the initial diagnosis and diagnostic evaluation before the diagnosis were examined. Results Of the total 10 patients included in the study, nine had generalized tetanus and one had cephalic tetanus; the common initial manifestations were neck stiffness (30%), dysarthria (20%), and trismus (20%). Of note, 80% of patients also complained of dysphagia before the diagnosis. Patients first visited various departments, including a dental clinic (30%) and the department of otorhinolaryngology (20%). Only two patients were accurately diagnosed with tetanus at the first department they visited. Physicians performed head imaging for all the patients. Conclusions Based on our findings, in Japan, patients with tetanus present with symptoms that physicians interpret or suspect to be associated with disorders of the central nervous system. Meanwhile, patients themselves tend to consider the symptoms as indicative of oral or dental issues. Further prospective studies involving a larger number of participants are needed to investigate the clinical course of tetanus until the establishment of a diagnosis.
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Dakin A, Borrow R, Arkwright PD. A review of the DTaP-IPV-HB-PRP-T Hexavalent vaccine in pediatric patients. Expert Rev Vaccines 2023; 22:104-117. [PMID: 36545777 DOI: 10.1080/14760584.2023.2161519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hexaxim is a hexavalent vaccine approved as primary and booster vaccination in infants 6 weeks and older, protecting against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae type b. AREAS COVERED To evaluate the immunogenicity and reactogenicity (safety) of Hexaxim (Hexyon, Hexacima) in primary and booster vaccine schedules; long-term antibody persistence; concomitant use with other childhood vaccines and use in immunocompromised infants. Hexaxim was found to be noninferior to other licensed hexavalent vaccines, being highly immunogenic for all toxoids/antigens and with an acceptable safety profile. It can be administered concomitantly with other childhood vaccines. Hexaxim can be given as a booster for infants primed with Infanrix Hexa and given in a pentavalent-hexavalent-pentavalent series. Hexaxim elicits a similar immune response and safety profile in human immunodeficiency virus (HIV) positive infants. It has the benefit of being a ready-to-use liquid formulation, minimizing dosage errors and preparation time. EXPERT OPINION Hexaxim has an acceptable safety profile and provides immunity against all six targeted diseases. It is an acceptable alternative to other hexavalent vaccines on the market. Further studies are required on the use of immunocompromised patients as well as the antibody persistence of each of the vaccine components.
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Affiliation(s)
- Andrew Dakin
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.,Department of Paediatric Allergy & Immunology, Royal Manchester Children's Hospital, Manchester, UK
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Basov AA, Zhernov YV, Kashutina MI, Kashkovskaya NN, Kombarova SY, Enilenis II, Severova LP, Fadeeva IA, Vysochanskaya SO, Belova EV, Shashina EA, Makarova VV, Shcherbakov DV, Skopin AY, Mitrokhin OV. Diphtheria, tetanus, and pertussis immunity among healthcare professionals and pregnant women in the Moscow region, Russian federation: A preliminary cross-sectional study. Front Pediatr 2023; 11:1043707. [PMID: 36896403 PMCID: PMC9989173 DOI: 10.3389/fped.2023.1043707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Despite more than 50 years of primary immunization against diphtheria, pertussis, and tetanus in Russia, complicated illnesses, including fatal ones, still occur. The goal of this preliminary cross-sectional study is to see how well pregnant women and healthcare workers are protected against diphtheria, pertussis, and tetanus. The required sample size (pregnant women and healthcare professionals, as well as pregnant women of two age categories) for this preliminary cross-sectional study was calculated using a confidence value of 0.95 and a probability of 0.05. The required number of participants in each group calculated sample size must be at least 59 people. In the Moscow region (Solnechnogorsk city, Russia), a cross-sectional study of pregnant patients and healthcare professionals interacting with children regularly as part of their job from numerous medical organizations was conducted in the year 2021 (n = 655). Antibodies to diphtheria, tetanus, and pertussis toxoids and microorganisms were measured using an enzyme-linked immunosorbent assay (ELISA). The STATISTICA and IBM SPSS Statistics 26.0 were used to process the study results statistically. Descriptive statistics methods, the Mann-Whitney U-test, discriminant analysis with the stepwise selection and analysis of ROC-curves were applied. IgG against diphtheria was found in 99.5% of pregnant women, tetanus in 91.5%, and pertussis in only 36.5%. According to the results of the discriminant analysis, the value of IgG to pertussis is linked to the value of IgA to pertussis and the gestational periods. Immunity to diphtheria was discovered in 99.1% of medical personnel, tetanus in 96.9%, and pertussis in 43.9%, no significant variations with age. When comparing the levels of immunity of pregnant women and healthcare professionals, it was shown that healthcare workers have greater levels of immunity against diphtheria and tetanus. The novel contribution of this study is that it will reveal the proportion of those vulnerable to pertussis, diphtheria, and tetanus among health workers and pregnant women in all age groups under the current national immunization program in Russia. Considering the data obtained from the preliminary cross-sectional study, we believe that it is necessary to conduct a full-scale study on a larger sample and, based on that, make certain changes to the national immunization program in Russia.
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Affiliation(s)
- Artem A Basov
- Diphtheria and Pertussis Surveillance Laboratory, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia.,Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yury V Zhernov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia.,Center of Life Sciences, Skolkovo Institute of Science and Technology, Moscow, Russia.,Center for Medical Anthropology, N.N. Miklukho-Maclay Institute of Ethnology and Anthropology of the Russian Academy of Sciences, Moscow, Russia
| | - Maria I Kashutina
- Department of Diagnostics and Treatment of Diseases of the Breast and Reproductive System No 2, Women's Health Clinic - Mammological Center, Loginov Moscow Clinical Scientific and Practical Center, Moscow, Russia.,Department of Healthcare Promotion, National Research Center for Therapy and Preventive Medicine, Moscow, Russia.,Department of Therapy, Clinical Pharmacology and Emergency Medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Natalia N Kashkovskaya
- Diphtheria and Pertussis Surveillance Laboratory, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Svetlana Yu Kombarova
- Diphtheria and Pertussis Surveillance Laboratory, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Inga I Enilenis
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Lyudmila P Severova
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Inna A Fadeeva
- Department of English Language, Institute of World Economy, Diplomatic Academy of the Russian Foreign Ministry, Moscow, Russia
| | - Sonya O Vysochanskaya
- Diphtheria and Pertussis Surveillance Laboratory, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia.,Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena V Belova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina A Shashina
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Valentina V Makarova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Denis V Shcherbakov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anton Yu Skopin
- Department of Scientific Support for Laboratory Research of Products and Environment Objects, F.F. Erisman Federal Scientific Center of Hygiene of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow Region, Mytishchi, Russia
| | - Oleg V Mitrokhin
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Amoak D, Kye NO, Anfaara FW, Sano Y, Antabe R. Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey. Vaccines (Basel) 2022; 11. [PMID: 36679921 DOI: 10.3390/vaccines11010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Tetanus toxoid vaccination is critical for improving maternal and child health. Yet, the prevalence and correlates of maternal tetanus toxoid vaccination coverage remain largely underexplored in Benin where infant and child mortality rates are high. Using the 2017−18 Benin Demographic and Health Survey, we apply logistic regression analysis to address this void in the literature. We find that overall maternal vaccination coverage is 69%. A range of demographic, health care, and socioeconomic factors are associated with maternal tetanus toxoid vaccination coverage. Women aged 20−34 (OR = 0.84, p < 0.05) and 35−49 (OR = 0.63, p < 0.01) are less likely to receive tetanus toxoid vaccination in comparison to those aged 15−19. Health care factors are also significantly associated with maternal tetanus toxoid vaccination, indicating that women who deliver at home (OR = 0.20, p < 0.001) and visit antenatal care fewer than eight times (OR = 0.62, p < 0.001) are less likely to receive tetanus toxoid vaccination than their counterparts who deliver in a health facility and visit antenatal care eight times or more. We also find that women with secondary (OR = 0.54, p < 0.05), primary (OR = 0.47, p < 0.01), and no education (OR = 0.47, p < 0.01) are less likely to receive tetanus toxoid vaccination compared to their counterparts with higher education. Based on these findings, we discuss several implications for policymakers.
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Zitzl J, Dyckers J, Güssow A, Lehmann H, Hazuchova K. Survival in canine tetanus - retrospective analysis of 42 cases (2006-2020). Front Vet Sci 2022; 9:1015569. [PMID: 36590798 PMCID: PMC9797805 DOI: 10.3389/fvets.2022.1015569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
Objective To define factors associated with survival in dogs with tetanus and to evaluate the prognostic significance of an established severity classification scheme. Methods Medical records of dogs with the clinical diagnosis of tetanus were retrospectively reviewed with regard to signalment, clinical signs, clinicopathological findings on admission, wound characteristics, complications, therapeutic measures, and survival to discharge. Based on the extracted data, dogs were graded according to a previously published 4-class severity scheme. Non-parametric tests were applied for comparisons between survival categories. Results Forty-two dogs fulfilled inclusion criteria, of which 32 survived. Of 10 non-survivors, 4 died and 6 were euthanised. Non-survivors were more often younger than 2 years of age (6/10 vs. 7/32 dogs, p = 0.023), had shorter duration of specific signs of tetanus (time from onset of typical signs to presentation) (2 vs. 4 days, p = 0.016), were prescribed less often antibiotics prior to presentation (p = 0.006), had higher tetanus severity grade (10/12 dogs in Class III or IV died, p < 0.001), more often received acepromazine (p = 0.009) and atropine (p = 0.012), and more often had hyperthermia (p = 0.005) and respiratory complications (pneumonia, laryngeal spasm; p = 0.008). Wound characteristics, the use of tube feeding, metronidazole, methocarbamol, magnesium and antitoxin were not significantly different between non-survivors and survivors. Clinical significance and conclusion Young dogs with a rapid course of severe generalized tetanus have a guarded prognosis. The previously described severity classification scheme proved valuable in predicting survival. Prospective multi-center studies are needed to clarify the prognostic significance of age, sedative usage and modified versions of an established classification scheme, including the presence of respiratory complications.
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Gong HM, Ma W, Regnier M, Irving TC. Thick filament activation is different in fast- and slow-twitch skeletal muscle. J Physiol 2022; 600:5247-5266. [PMID: 36342015 PMCID: PMC9772099 DOI: 10.1113/jp283574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
The contractile properties of fast-twitch and slow-twitch skeletal muscles are primarily determined by the myosin isoform content and modulated by a variety of sarcomere proteins. X-ray diffraction studies of regulatory mechanisms in muscle contraction have focused predominately on fast- or mixed-fibre muscle with slow muscle being much less studied. Here, we used time-resolved X-ray diffraction to investigate the dynamic behaviour of the myofilament proteins in relatively pure slow-twitch-fibre rat soleus (SOL) and pure fast-twitch-fibre rat extensor digitorum longus (EDL) muscle during twitch and tetanic contractions at optimal length. During twitch contractions the diffraction signatures indicating a transition in the myosin heads from ordered OFF states, where heads are held close to the thick filament backbone, to disordered ON states, where heads are free to bind to thin filaments, were found in EDL and not in SOL muscle. During tetanic contraction, changes in the disposition of myosin heads as active tension develops is a quasi-stepwise process in EDL muscle whereas in SOL muscle this relationship appears to be linear. The observed reduced extensibility of the thick filaments in SOL muscle as compared to EDL muscles indicates a molecular basis for this behaviour. These data indicate that for the EDL, thick filament activation is a cooperative strain-induced mechano-sensing mechanism, whereas for the SOL, thick filament activation has a more graded response. These different approaches to thick filament regulation in fast- and slow-twitch muscles may be adaptations for short-duration, strong contractions versus sustained, finely controlled contractions, respectively. KEY POINTS: Fast-twitch muscle and slow-twitch muscle are optimized for strong, short-duration contractions and for tonic postural activity, respectively. Structural events (OFF to ON transitions) in the myosin-containing thick filaments in fast muscle help determine the timing and strength of contractions, but these have not been studied in slow-twitch muscle. The X-ray diffraction signatures of structural OFF to ON transitions are different in fast extensor digitorum longus (EDL) and slow soleus (SOL) muscle, being completely absent during twitches in soleus muscle and blunted during tetanic contractions SOL as compared to EDL Quasi-stepwise thick filament structural OFF to ON transitions in fast twitch muscle may be an adaptation for rapid, ballistic movements, whereas more graded OFF to ON structural transitions in slow-twitch muscle may be an adaptation for slower, finer motions.
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Affiliation(s)
- Henry M. Gong
- BioCAT, Department of Biology, Illinois Institute of Technology, Chicago, IL
| | - Weikang Ma
- BioCAT, Department of Biology, Illinois Institute of Technology, Chicago, IL
| | - Michael Regnier
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Thomas C. Irving
- BioCAT, Department of Biology, Illinois Institute of Technology, Chicago, IL
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Zhang C, Hu W, Ma Y, Li L, Si Y, Zhang S. Seroepidemiology of Tetanus among Healthy People Aged 1-59 Years Old in Shaanxi Province, China. Vaccines (Basel) 2022; 10:vaccines10111806. [PMID: 36366315 PMCID: PMC9698734 DOI: 10.3390/vaccines10111806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The study aims to determine the seroprevalence of antibodies against tetanus among healthy people aged 1−59 years old in Shaanxi province. IgG against tetanus in serum samples were detected by ELISA. 6,439 subjects were enrolled. The positive rate (≥0.01 IU/mL) was 84.39% and GMC was 0.03 IU/mL. There were significant differences in positive rates (χ2 = 308.944, p < 0.01) and GMC (Z = 5,200,000, p < 0.01) among different age groups. The positive rates (χ2 = 304.3, p < 0.01) and GMCs (χ2 = 146.417, p < 0.01) showed regional differences. Both full protection rate (≥0.1 IU/mL) (χ2 = 36.834, p < 0.01) and GMC (Z = 688,000, p < 0.01) increased with the doses of tetanus-toxoid-containing vaccines (TTCVs) administered. The positive rate (χ2 = 54.136, p < 0.01) and GMC (Z = 140,200, p < 0.01) decreased gradually with the time interval after full immunization with TTCVs. The full protection rate (≥0.1 IU/mL) (χ2 = 176.201, p < 0.01) and GMC (Z = 629,900, p < 0.01) decreased with the interval (years) since the last dose of TTCVs. There were significant differences in the positive rates and GMCs for different ages, regions, immunization histories of TTCVs, and doses of TTCVs administered. The full protection rate and GMC decreased with the interval following full immunization with TTCVs and the interval since the last dose of TTCVs. The importance of using tetanus booster doses should be emphasized in adolescents and adults.
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47
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Homer CSE, Javid N, Wilton K, Bradfield Z. Vaccination in pregnancy: The role of the midwife. Front Glob Womens Health 2022; 3:929173. [PMID: 36353468 PMCID: PMC9637860 DOI: 10.3389/fgwh.2022.929173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
Midwives are the front-line workers providing maternity care for women in many countries. The role of the midwife includes providing information about, and recommendations for, maternal vaccination in pregnancy and for the baby in the postnatal period. Vaccinations recommended in pregnancy include those to prevent influenza, pertussis, tetanus and now COVID-19. Vaccinations for the newborn baby include hepatitis B. Healthcare professionals play an important role in influencing decision-making around vaccination and midwives are key in supporting vaccination uptake. Midwives are strong influencer in women's decisions around vaccination for themselves and their babies. The COVID-19 vaccination programs have shone a light on vaccination in pregnancy especially as SARS-COV-2 infection has significant adverse effects in pregnancy. COVID-19 vaccination has been shown to be safe and effective in pregnancy. Despite this, there is vaccine hesitancy from pregnant women in many countries. Midwives play a unique role in the provision of care to women and families but they need specific support and information regarding vaccination in pregnancy. Targeted education, supportive mentoring and supervision and opportunities to lead innovative ways of ensuring vaccine access is logistically easy and possible are all needed. This Commentary outlines the key vaccinations recommended in pregnancy including COVID-19 vaccination and highlights some strategies to scale-up vaccination programs in pregnancy with a particular focus on the role of midwives.
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Affiliation(s)
- Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia,Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Correspondence: Caroline S. E. Homer
| | - Nasrin Javid
- Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Nursing and Midwifery Research Alliance, South West Sydney Local Health District, Liverpool, NSW, Australia
| | - Kellie Wilton
- Australian College of Midwives, Canberra, ACT, Australia
| | - Zoe Bradfield
- Faculty of Health Sciences, King Edward Memorial Hospital and Curtin University, Perth, WA, Australia
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Nguyen TH, Le XTT, Nguyen LH, Le HT, Do TTT, Nguyen HLT, Nguyen HT, Latkin CA, Ho CSH, Ho RCM. Resource mobilization for tetanus vaccination in Vietnam: Uptake, demand and willingness to pay among women of reproductive age. Front Public Health 2022; 10:980850. [PMID: 36330125 PMCID: PMC9623147 DOI: 10.3389/fpubh.2022.980850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Tetanus vaccine coverage in Vietnam has been declining in recent years due to a rapid population growth rate, shrinking budget, and inefficient resource mobilization strategy. This study examined the uptake, demand, and willingness to pay (WTP) for tetanus vaccines in Vietnamese women of reproductive age as well as determined associated factors and assessed the feasibility of the long-term tetanus vaccine resource mobilization scheme. Methods Cross-sectional data were obtained on 807 women of childbearing age in Hanoi, Vietnam in 2016. Tetanus vaccine uptake, demand, and willingness to pay were collected by using a structured questionnaire. Multivariable logistic and interval regression models were used to examine associated factors with vaccine uptake, demand, and WTP. Results Of 807 participants, 42.4 and 64.8% had sufficient tetanus vaccination (i.e., received at least three doses of vaccine) and were willing to pay for tetanus vaccination. The mean amount of WTP for one dose of tetanus was US$ 7.3 (95% CI = 6.7-7.9). Having children or being aware that the tetanus vaccine was free-of-charge were negatively associated with WTP for tetanus vaccine. Having a high school education, living in a rural area, and not being aware of vaccine prices or being aware that vaccines were provided freely reduced the amount of WTP. WTP increased among women receiving information from friends and relatives. Conclusion Despite of exemption from the tetanus vaccination programs, this study indicated a low tetanus vaccination coverage and a moderate degree of WTP for tetanus vaccine among Vietnamese women of childbearing age. Target-specific educational and financial support interventions, along with efforts to reduce vaccination costs are critical to improving the vaccine uptake, demand, and WTP for tetanus immunization among women.
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Affiliation(s)
- Thang Huu Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Thi Thanh Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Long Hoang Nguyen
- VNU School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Toan Thanh Thi Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam,*Correspondence: Huong Lan Thi Nguyen
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Huda F, Ong PA, Wibisono Y, Dian S, Ganiem AR. A Rarely Occurring Spinal Fracture Precipitated by Generalized Spasms of Tetanus Patient with Spondylitis Tuberculosis. Int Med Case Rep J 2022; 15:599-603. [PMID: 36281446 PMCID: PMC9587697 DOI: 10.2147/imcrj.s367615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background The occurrence of spinal fracture due to tetanus nowadays is extremely rare, as compared to the 1950s, since the widely available anti-tetanus and antispasmodic therapy. The spinal fracture in tetanus patients is usually reported in higher thoracic vertebrae, previously with a rate as high as 57.5%. Spondylitis is the most common form of skeletal tuberculosis (TB) and can cause a spinal fracture. In Indonesia, tetanus is still reported, while tuberculosis is still endemic; however, co-infection of both diseases is rarely reported. Case Presentation A 36-year-old male was brought to our hospital with jaw stiffness, accompanied by fever. A history of dental cavities was present, and 5 days prior, he experienced a fishing hook wound on his right index finger. There was no history of TB. Physical examination showed meningismus, 2 cm trismus, abdominal spasm, opisthotonus, and spontaneous muscle spasms, without dysautonomia. In the third week of hospitalization, while his tetanus condition improved, he complained of weakness in both legs. A thorough history taking revealed a history of backache for 3 years. A wedge-shaped fracture on his 11th and 12th thoracic vertebrae was observed on radiographic examination. A spinal TB diagnosis was made, and treatment was started. He refused to get spinal surgery, then went home with 4 out of 5 motor strength scale. After three months, he returned to his routine activity as a food hawker with no motor deficits. Conclusion Tetanus spinal fracture is extremely rare nowadays; a thorough history of spinal problems/medication is compulsory for anticipation. This patient’s spinal fracture was deemed due to a preexisting TB spinal infection that was precipitated by prolonged continuous tetanic spasm due to general tetanus.
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Affiliation(s)
- Fathul Huda
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia,Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia,Correspondence: Fathul Huda, Email
| | - Paulus Anam Ong
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
| | - Yusuf Wibisono
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
| | - Sofiati Dian
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
| | - Ahmad Rizal Ganiem
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
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50
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Adult immunization. Med Lett Drugs Ther 2022; 64:161-8. [PMID: 36206162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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