Tetanus antibodies measured by the toxin binding inhibition test (ToBI) in mothers and children in the Neonatal Tetanus Program in Vietnam

The immunoresponse to vaccination in the Neonatal Tetanus Program (NNT) for pregnant women was studied in Vietnam using the Toxin Binding Inhibition Test (ToBI). The vaccination schedule consisted of two primary doses of adsorbed tetanus toxoid (TT) vaccine given with a one month interval. The seroconversion rate in the women was 98%. Two and a half months after birth, 63% of the children born from these women had tetanus antibody values higher than 0.01 IU/ml. Four women who had anti-tetanus titres < 0.01 IU/ml at delivery, despite two doses of primary vaccination, received a third booster with vaccine one year after the first injection. Their antibody levels were well above 0.01 IU/ml one month after this additional booster, suggesting that (when economically feasible) a third TT injection could be considered into the NNT to confer optimal anti-tetanus antibody levels in women for subsequent pregnancies. This study confirmed the effectiveness of the TT vaccines investigated and indicates their potential to replace, in immunosurveillance studies under field conditions, the in vivo mouse neutralisation test by in vitro alternative methods such as the ToBI test.

Validation of the combined toxin-binding inhibition test for determination of neutralizing antibodies against tetanus and diphtheria toxins in a vaccine field study in Viet Nam

Determination of seroconversion and measurement of protective antibody levels in children against vaccine components are essential for gauging and monitoring the efficacy of paediatric vaccination programmes. For this purpose, we assessed the combined toxin-binding inhibition (ToBI) test for determining neutralizing antibodies to tetanus and diphtheria in a diphtheria-pertussis-tetanus (DPT) vaccine field trial in Viet Nam. A simple procedure involving collection of blood samples on filter-paper was found to be a suitable alternative to collection by venepuncture, despite a reduction in the sensitivity of the ToBI test as a result of the step necessary to elute the antibodies from the filter-paper. The results obtained demonstrate that the ToBI test can feasibly be carried out under field conditions. Preliminary results obtained with the ToBI test in DPT field trials indicate that a fourth dose of DPT vaccine one year after the third dose should be considered by developing countries.