Tetanus and diphtheria immunity among term and preterm infant-mother pairs in Turkey, a country where maternal and neonatal tetanus have recently been eliminated

The aim of our study was to investigate the anti-tetanus and anti-diphtheria antibody titres and the placental transfer of these antibodies in a group of vaccinated and unvaccinated mothers and their term or preterm offsprings. Anti-tetanus and anti-diphtheria toxoid IgG antibodies were measured quantitatively by ELISA in 91 infant-mother pairs. Protective concentrations of anti-tetanus and anti-diphtheria were found in 58.3 and 50% of mothers in the unvaccinated group and 94.5 and 85.5% of the mothers in the vaccinated group. Protective concentrations were found in 63.9 and 50% of cord samples, respectively, in the unvaccinated group and in 96.4 and 85.5% of cord samples, respectively, in the vaccinated group (p = 0.0001). There were no differences in the maternal and cord geometric mean concentrations (GMCs) of anti-toxoid antibodies between those who received two doses or one dose of Td. The GMCs of maternal and cord anti-tetanus and anti-diphtheria were statistically similar between preterm and term groups. Placental transfer ratios (TR) for anti-tetanus and anti-diphtheria were 175 and 150%, respectively, in the preterm group and 213 and 178%, respectively, in the term group. There was a strong correlation between maternal and cord anti-toxoid antibody levels. Maternal vaccination was the only predictor of having protective concentrations of anti-toxoid antibodies in cord blood.

CONCLUSIONS

Vaccinating pregnant women with at least one dose of Td would confer protection for both the term and preterm infant-mother pairs. Therefore, health personnel caring for pregnant women have the responsibility to emphasize the importance of Td vaccination to avoid missed immunization opportunities.

Neonatal tetanus in the babies of Nigerian mothers immunised against Tetanus

The objective of this study was to describe the clinical characteristics of babies with neonatal tetanus (NNT) whose mothers were immunised against tetanus and determine the outcome of their hospitalisation. The hospital records of babies affected by NNT whose mothers received at least two doses of anti-tetanus vaccine during pregnancy were identified and compared with similarly affected babies whose mothers were not immunised against tetanus during pregnancy in a Nigerian hospital. Out of 175 cases of NNT, the mothers of 24 (13.7%) babies were immunised against tetanus during pregnancy while the mothers of 151 (86.3%) were not. The proportions of babies of immunised mothers and unimmunised mothers who presented within the first three days of life, within a day of the onset of symptoms and with spasms were similar. Nevertheless, the survival rate was higher (62.5% vs. 26.5%; P = 0.0004) among babies of immunised mothers. Despite similarities in clinical presentation of babies of mothers with and without anti-tetanus vaccination, the survival rate was higher for the former.