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Kanu FA, Yusuf N, Kassogue M, Ahmed B, Tohme RA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2020. MMWR Morb Mortal Wkly Rep 2022; 71:406-411. [PMID: 35298457 PMCID: PMC8942310 DOI: 10.15585/mmwr.mm7111a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yusuf N, Raza AA, Chang-Blanc D, Ahmed B, Hailegebriel T, Luce RR, Tanifum P, Masresha B, Faton M, Omer MD, Farrukh S, Aung KD, Scobie HM, Tohme RA. Progress and barriers towards maternal and neonatal tetanus elimination in the remaining 12 countries: a systematic review. Lancet Glob Health 2021; 9:e1610-e1617. [PMID: 34678200 PMCID: PMC8551683 DOI: 10.1016/s2214-109x(21)00338-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023]
Abstract
This systematic review assessed the progress and barriers towards maternal and neonatal tetanus elimination in the 12 countries that are yet to achieve elimination, globally. Coverage of at least 80% (the coverage level required for elimination) was assessed among women of reproductive age for five factors: (1) at least two doses of tetanus toxoid-containing vaccine, (2) protection at birth, (3) skilled birth attendance, (4) antenatal care visits, and (5) health facility delivery. A scoping review of the literature and data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys provided insights into the barriers to attaining maternal and neonatal tetanus elimination. Findings showed that none of the 12 countries attained at least 80% coverage for women of reproductive age receiving at least two doses of tetanus toxoid-containing vaccine or protection at birth according to the data from Demographic and Health Surveys or Multiple Indicator Cluster Surveys. Barriers to maternal and neonatal tetanus elimination were mostly related to health systems and socioeconomic factors. Modification to existing maternal and neonatal tetanus elimination strategies, including innovations, will be required to accelerate maternal and neonatal tetanus elimination in these countries.
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Affiliation(s)
- Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Azhar A Raza
- Programme Division, United Nations Children Fund (UNICEF), New York, NY, USA
| | - Diana Chang-Blanc
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Bilal Ahmed
- Programme Division, United Nations Children Fund (UNICEF), New York, NY, USA
| | | | - Richard R Luce
- Department of Immunization and Vaccine Development, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Patricia Tanifum
- Department of Immunization and Vaccine Development, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Balcha Masresha
- Department of Immunization and Vaccine Development, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Mehoundo Faton
- Health Section, UNICEF Regional Office for West and Central Africa, Dakar, Senegal
| | - Mohamed D Omer
- Health Section, UNICEF Regional Office for Eastern and Southern Africa, Nairobi, Kenya
| | - Saadia Farrukh
- Health Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Khin D Aung
- Health Section, UNICEF Regional Office for East Asia and the Pacific, Bangkok, Thailand
| | - Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mustafa SS, Jamshed S, Vadamalai K, Ramsey A. Subcutaneous immunoglobulin replacement for treatment of humoral immune dysfunction in patients with chronic lymphocytic leukemia. PLoS One 2021; 16:e0258529. [PMID: 34653210 PMCID: PMC8519417 DOI: 10.1371/journal.pone.0258529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) experience hypogammaglobinemia and non-neutropenic infections. In this exploratory proof of concept study, our objective was to determine the prevalence of humoral immunodeficiency in patients with CLL and serum IgG ≥ 400 mg/dL, and to evaluate the efficacy of subcutaneous immunoglobulin (SCIG) in this population. Patients and methods Patients with CLL with serum IgG ≥ 400 mg/dL were evaluated for serum IgG, IgM, IgA, along with pre/post vaccine IgG titers to diphtheria, tetanus, and Streptococcus pneumoniae. Patients with evidence of humoral dysfunction were treated with SCIG with Hizentra every 7±2 days for 24 weeks. Results Fifteen patients enrolled with median IgG = 782 mg/dL [IQR: 570 to 827], and 6/15 (40%) responded to vaccination with Td, while 5/15 (33%) responded to vaccination with PPV23. 14/15 (93.3%) demonstrated humoral immunodeficiency as evidenced by suboptimal vaccine responses, and were treated with SCIG. In patients treated with SCIG, serum IgG increased from 670 mg/dL [IQR: 565 to 819] to 1054 mg/dL [IQR: 1040 to 1166] after 24 weeks (95% CI: 271–540). For streptococcus pneumoniae, the median protective serotypes at baseline was 8 [IQR: 4 to 9] and increased to 17 [IQR: 17 to 19] after 24 weeks (95% CI: 6.93–13.72). Non-neutropenic infections (NNI) decreased from 14 to 5 during treatment with SCIG. Conclusions Patients with CLL demonstrate humoral immunodeficiency despite IgG > 400 mg/dL. For these patients, SCIG is well tolerated and efficacious in improving serum IgG, specific IgG to streptococcus pneumoniae, and may decrease reliance on antibiotics for the treatment of NNIs. Clinical trials registration NCT 03730129.
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Affiliation(s)
- S. Shahzad Mustafa
- Division of Allergy, Immunology, Rheumatology, Rochester Regional Health, Rochester, New York, United States of America
- Division of Allergy, Immunology, Rheumatology, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States of America
- * E-mail:
| | - Saad Jamshed
- Division of Hematology and Oncology, Rochester Regional Health, Rochester, New York, United States of America
| | - Karthik Vadamalai
- Division of Critical Care, Mercy Hospital, Springfield, Missouri, United States of America
| | - Allison Ramsey
- Division of Allergy, Immunology, Rheumatology, Rochester Regional Health, Rochester, New York, United States of America
- Division of Allergy, Immunology, Rheumatology, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States of America
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Wolf KJ, Adeyemo AA, Williamson KC. Plasma cell immunoglobulin heavy chain repertoire dynamics before and after tetanus booster vaccination. Immunogenetics 2021; 73:321-332. [PMID: 33768273 DOI: 10.1007/s00251-021-01215-8] [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: 01/18/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Antibody sequence repertoire analysis of plasma cells (PC) isolated before and 1 week after a vaccine provides time-specific snapshots of the antibody response. Comparison of the immunoglobulin (Ig) sequences pre- and post-vaccination allows analysis of maturation over time and identification of antigen specific Ig. Here we compare the Ig heavy chain (Ig-H) repertoire of circulating PCs isolated from 109 peripheral blood mononuclear cells (PBMC) collected by apheresis 1 week after a tetanus toxoid vaccine booster with the Ig-H repertoire of PCs collected 2 and 11 weeks prior to the booster. A total of 21,060 unique Ig nucleotide sequences encoding 14,307 unique heavy chain complementarity determining region 3 (CDR-H3) amino acid sequences, also called clonotypes, were identified. Only 466 clonotypes (3.3%) were present at all 3 time points. In contrast, 90% of the 30 highest frequency CDR-H3 regions at +1w were also identified at another time point and 50% were present at all time points, suggesting the rapid expansion of a memory B cell population. The tetanus toxoid specificity of the CDR-H3 region with the 7th highest frequency at +1w was confirmed using immunoprecipitation and mass spectroscopy, and two public tetanus toxoid-specific CDR-H3 regions were also overrepresented at +1w. In summary, we have used the tetanus vaccine model system to demonstrate that bulk PC Ig repertoire analysis can identify PC populations that expand and mature following antigen exposure. The application of this approach before and after clinical infections should advance our understanding of clinical protection and facilitate vaccine design.
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Affiliation(s)
- Kyle J Wolf
- Department of Molecular Microbiology and Immunology, Saint Louis University, Saint Louis, MO, 63104, USA
- ArcherDX, Inc., Boulder, CO, 80301, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Kim C Williamson
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
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Trovato M, Ibrahim HM, Isnard S, Le Grand R, Bosquet N, Borhis G, Richard Y. Distinct Features of Germinal Center Reactions in Macaques Infected by SIV or Vaccinated with a T-Dependent Model Antigen. Viruses 2021; 13:v13020263. [PMID: 33572146 PMCID: PMC7916050 DOI: 10.3390/v13020263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
B-cell follicles constitute large reservoirs of infectious HIV/SIV associated to follicular dendritic cells and infecting follicular helper (TFH) and regulatory (TFR) T-cells in germinal centers (GCs). Thus, follicular and GC B-cells are persistently exposed to viral antigens. Despite recent development of potent HIV immunogens, numerous questions are still open regarding GC reaction during early HIV/SIV infection. Here, we dissect the dynamics of B- and T-cells in GCs of macaques acutely infected by SIV (Group SIV+) or vaccinated with Tetanus Toxoid (Group TT), a T-dependent model antigen. Systemic inflammation and mobilization of antigen-presenting cells in inguinal lymph nodes and spleen are lower in Group TT than in Group SIV+. Despite spleen GC reaction of higher magnitude in Group SIV+, the development of protective immunity could be limited by abnormal helper functions of TFH massively polarized into TFH1-like cells, by inflammation-induced recruitment of fCD8 (either regulatory or cytotoxic) and by low numbers of TFR limiting TFH/TFR competition for high affinity B-cells. Increased GC B-cells apoptosis and accumulation of CD21lo memory B-cells, unable to further participate to GC reaction, likely contribute to eliminate SIV-specific B-cells and decrease antibody affinity maturation. Surprisingly, functional GCs and potent TT-specific antibodies develop despite low levels of CXCL13.
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Affiliation(s)
- Maria Trovato
- Institut Cochin, Université de Paris, INSERM, CNRS, 75014 Paris, France; (M.T.); (H.M.I.); (S.I.)
| | - Hany M. Ibrahim
- Institut Cochin, Université de Paris, INSERM, CNRS, 75014 Paris, France; (M.T.); (H.M.I.); (S.I.)
| | - Stephane Isnard
- Institut Cochin, Université de Paris, INSERM, CNRS, 75014 Paris, France; (M.T.); (H.M.I.); (S.I.)
- Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), 92260 Fontenay-aux-Roses, France; (R.L.G.); (N.B.)
| | - Roger Le Grand
- Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), 92260 Fontenay-aux-Roses, France; (R.L.G.); (N.B.)
| | - Nathalie Bosquet
- Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), 92260 Fontenay-aux-Roses, France; (R.L.G.); (N.B.)
| | - Gwenoline Borhis
- Institut Cochin, Université de Paris, INSERM, CNRS, 75014 Paris, France; (M.T.); (H.M.I.); (S.I.)
- Correspondence: (G.B.); (Y.R.); Tel.: +44-12-2391-8127 (G.B.); +33-1-4051-6585 (Y.R.)
| | - Yolande Richard
- Institut Cochin, Université de Paris, INSERM, CNRS, 75014 Paris, France; (M.T.); (H.M.I.); (S.I.)
- Correspondence: (G.B.); (Y.R.); Tel.: +44-12-2391-8127 (G.B.); +33-1-4051-6585 (Y.R.)
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Zhang G, Yu R, Chi X, Chen Z, Hao M, Du P, Fan P, Liu Y, Dong Y, Fang T, Chen Y, Song X, Liu S, Li J, Yu C, Chen W. Tetanus vaccine-induced human neutralizing antibodies provide full protection against neurotoxin challenge in mice. Int Immunopharmacol 2021; 91:107297. [PMID: 33360088 DOI: 10.1016/j.intimp.2020.107297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/03/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Clostridium tetani causes life-threatening disease by producing tetanus neurotoxin (TeNT), one of the most toxic protein substances. Toxicosis can be prevented and cured by administration of anti-TeNT neutralizing antibodies. Here, we identified a series of monoclonal antibodies (mAbs) derived from memory B cells of a healthy adult immunized with the C-terminal domain of TeNT (TeNT-Hc). Thirteen mAbs bound to both tetanus toxoid (TT) and TeNT-Hc, while two mAbs recognized only TT. VH3-23 was the most frequently used germline gene in these TT-binding mAbs, and the pairwise identity values of the VH gene sequences ranged from 27% to 69%. Three of these mAbs-T3, T7, and T9-6-completely protected mice from challenge with 2× LD50 of TeNT, and two (T2 and T18) significantly prolonged the survival time. The five neutralizing mAbs recognized distinct epitopes on TT, with binding affinities ranging from 0.123 to 11.9 nM. Our study provides promising therapeutic candidates for tetanus.
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Affiliation(s)
- Guanying Zhang
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Rui Yu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Xiangyang Chi
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Zhengshan Chen
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Meng Hao
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Peng Du
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Pengfei Fan
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yujiao Liu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yunzhu Dong
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Ting Fang
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yi Chen
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Xiaohong Song
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Shuling Liu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Jianmin Li
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Changming Yu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Wei Chen
- Beijing Institute of Biotechnology, Beijing 100071, China.
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Meli H, Kaboré M, Cissé MA, Zaré A, Soumaré M, Cissoko Y, Dembélé JP, Konaté I, Fofana A, Dao S. [Localised tetanus with no obvious entry site: about a case in Bamako (Mali)]. Pan Afr Med J 2020; 36:377. [PMID: 33235654 PMCID: PMC7666701 DOI: 10.11604/pamj.2020.36.377.22721] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/11/2022] Open
Abstract
Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.
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Affiliation(s)
- Hermine Meli
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mikaila Kaboré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mohamed Aly Cissé
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Abdoulaye Zaré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mariam Soumaré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Yacouba Cissoko
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Jean Paul Dembélé
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Issa Konaté
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Assetou Fofana
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Sounkalo Dao
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
- Centre de Recherche et de Formation sur la Tuberculose et le VIH (SEREFO), Bamako, Mali
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Abraham K, Mielke H, Fromme H, Völkel W, Menzel J, Peiser M, Zepp F, Willich SN, Weikert C. Internal exposure to perfluoroalkyl substances (PFASs) and biological markers in 101 healthy 1-year-old children: associations between levels of perfluorooctanoic acid (PFOA) and vaccine response. Arch Toxicol 2020; 94:2131-2147. [PMID: 32227269 PMCID: PMC7303054 DOI: 10.1007/s00204-020-02715-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 01/19/2023]
Abstract
Perfluoroalkyl substances (PFASs) are a complex group of man-made chemicals with high stability and mobility leading to ubiquitous environmental contamination and accumulation in the food chain. In human serum/plasma samples, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are the lead compounds. They are immunotoxic in experimental animals, and epidemiological studies provided evidence of a diminished production of vaccine antibodies in young children. However, information on children of the first year of age is missing but relevant, as they have a relatively high exposure if breastfed, and may have a higher susceptibility as their immune system is developing. In a cross-sectional study with 101 healthy 1-year-old children, internal levels of persistent organic pollutants and a broad panel of biological parameters were investigated at the end of the 1990s. Additional analysis of PFASs resulted in plasma levels (mean ± SD) of PFOA and PFOS of 3.8 ± 1.1 and 6.8 ± 3.4 µg/L, respectively, in the 21 formula-fed children, and of 16.8 ± 6.6 and 15.2 ± 6.9 µg/L in the 80 children exclusively breastfed for at least 4 months. The study revealed significant associations between levels of PFOA, but not of PFOS, and adjusted levels of vaccine antibodies against Haemophilus influenza type b (Hib, r = 0.32), tetanus (r = 0.25) and diphtheria (r = 0.23), with no observed adverse effect concentrations (NOAECs) determined by fitting a 'knee' function of 12.2, 16.9 and 16.2 µg/L, respectively. The effect size (means for PFOA quintiles Q1 vs. Q5) was quantified to be - 86, - 54 and - 53%, respectively. Furthermore, levels of PFOA were inversely associated with the interferon gamma (IFNɣ) production of ex-vivo lymphocytes after stimulation with tetanus and diphtheria toxoid, with an effect size of - 64 and - 59% (means Q1 vs. Q5), respectively. The study revealed no influence of PFOA and PFOS on infections during the first year of life and on levels of cholesterol. Our results confirmed the negative associations of PFAS levels and parameters of immune response observed in other epidemiological studies, with high consistency as well as comparable NOAECs and effects sizes for the three vaccine antibodies investigated, but for PFOA only. Due to reduction of background levels of PFASs during the last 20 years, children in Germany nowadays breastfed for a long duration are for the most part not expected to reach PFOA levels at the end of the breastfeeding period above the NOAECs determined.
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Affiliation(s)
- Klaus Abraham
- Department Food Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Str. 8-10, 10589, Berlin, Germany.
| | - Hans Mielke
- Department Exposure, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Hermann Fromme
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Völkel
- Department of Chemical Safety and Toxicology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Juliane Menzel
- Department Food Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | - Matthias Peiser
- Department Pesticide Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Fred Zepp
- Children's Hospital, University Medical Center, Mainz, Germany
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelia Weikert
- Department Food Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Njuguna HN, Yusuf N, Raza AA, Ahmed B, Tohme RA. Progress Toward Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep 2020; 69:515-520. [PMID: 32352953 PMCID: PMC7206986 DOI: 10.15585/mmwr.mm6917a2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Wang CL. [Improving immunization strategy and promoting the development of tetanus prevention and control in China]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 53:1203-1205. [PMID: 31795575 DOI: 10.3760/cma.j.issn.0253-9624.2019.12.003] [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] [Indexed: 06/10/2023]
Abstract
Neonatal tetanus has been basically eliminated in China, but the incidence of non-neonatal tetanus is still high. Tetanus after trauma is the main type of non-neonatal tetanus. The correct application of tetanus toxoid containing vaccine (TTCV) has been neglected in the prevention of tetanus after trauma in China. On May 9, 2019, National Advisory Committee of Experts on Immunization Planning (NIAC) reviewed and approved the first guidelines for the use of TTCV and passive immune preparation after trauma, which clarified the basic process of treatment of tetanus after trauma, as well as the pointer to the use of TTCV and passive immune preparation after trauma. The main measure to prevent tetanus after trauma is to use TTCV for active immunization, and to use passive immune preparation for those without TTCV immune history. Through the construction of the top-down control and prevention system of tetanus, the change of the concept of tetanus immunoprophylaxis of medical staff is promoted. Active immunization is the main measure, but passive immunization is an added measure for the prevention of tetanus after trauma, which is of great significance to reverse the mistake of prevention of tetanus in China.
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Affiliation(s)
- C L Wang
- Emergency Depratment/Trauma Center, Peking University People's Hospital, Beijing 100044, China
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Fougère Y, El Houss S, Suris JC, Rouvenaz-Defago S, Miletto D, Von der Weid L, Willen F, Williams-Smith JA, Gehri M, Crisinel PA. Single doses of diphtheria-tetanus-pertussis and poliomyelitis vaccines are sufficient to generate a booster-type response to tetanus in most migrant children. Vaccine 2019; 37:6441-6446. [PMID: 31522805 DOI: 10.1016/j.vaccine.2019.08.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/16/2019] [Revised: 08/27/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Immunization coverage for three doses of the diphtheria-tetanus-pertussis and poliomyelitis vaccines in infants is high worldwide, therefore despite the lack of documentation of past vaccinations, most migrant children do not require complete revaccination. Our strategy was to administer a single dose of a tetanus toxoid containing vaccine (TTCV) to migrant children followed by anti-tetanus toxoid (TT) serology to determine whether additional vaccine doses were required. Our goal was to estimate the basic TTCV coverage and to identify potential determinants of the vaccination response. METHODS Newly arrived migrant children were prospectively enrolled between October 2014 and August 2017. We included patients aged 1-18 years with no proof of past vaccinations who accepted a single dose of TTCV. Anti-TT serology was performed after 4-6 weeks, and an anti-TT level ≥ 1 IU/mL was considered a booster-type antibody response with no need for additional doses of TTCV. Potential determinants of the vaccination response were identified using univariate and multivariate linear regression analyses. RESULTS Two hundred and eight children were eligible for analysis. The mean age of the children was 9 (±4.5) years and 100 (48%) were female. The majority (n = 129, 62%) of the children came from the WHO Eastern Mediterranean region. Only three patients (1.4%) required additional vaccine doses. A Syrian origin (p < 0.001) and direct arrival primarily by airplane into Switzerland without transiting through other European countries (p = 0.029) associated with higher anti-TT levels in a multivariate regression model (multiple r2 = 0.210, p < 0.001). CONCLUSION A single dose of TTCV is enough to generate long-term protection in most migrant children. In the context of high basic vaccination coverage, the strategy, which consists of administration of a single dose of TTCV followed by anti-TT serology, can be considered where serotesting is available and economical.
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Affiliation(s)
- Yves Fougère
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland.
| | - Samir El Houss
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Joan-Carles Suris
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Sylvie Rouvenaz-Defago
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Damien Miletto
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Lucie Von der Weid
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Fanny Willen
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | | | - Mario Gehri
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
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Rettig TA, Nishiyama NC, Pecaut MJ, Chapes SK. Effects of skeletal unloading on the bone marrow antibody repertoire of tetanus toxoid and/or CpG treated C57BL/6J mice. Life Sci Space Res (Amst) 2019; 22:16-28. [PMID: 31421845 PMCID: PMC6703179 DOI: 10.1016/j.lssr.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/11/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 06/10/2023]
Abstract
Spaceflight is known to impact the immune system in multiple ways. However, its effect on the antibody repertoire, especially in response to challenge, has not been well characterized. The development of the repertoire has multiple steps that could be affected by spaceflight, including V-(D-)J-gene segment rearrangement and the selection of complementarity determining regions (CDRs); specifically, CDR3, responsible for much of the diversity in the repertoire. We used skeletal unloading with the antiorthostatic suspension (AOS) model to simulate some of the physiological effects associated with spaceflight. Animals ± AOS were challenged with tetanus toxoid (TT) and/or CpG, an adjuvant. Two weeks after challenge, bone marrow was collected and sequenced using the Illumina MiSeq 2 × 300 platform. The resulting antibody repertoire was characterized, including V-, D- (heavy only), and J-gene segment usage, constant region usage, CDR3 length, and V(D)J combinations. We detected changes in gene-segment usage in response to AOS, TT, and CpG treatment in both the heavy and light chains. Additionally, changes were seen in the class-switched VH-gene repertoire. Alterations were also detected in V/J pairing for both the heavy and light chains, and changes in CDR3 length. We also detected lower levels of CDR3 AA overlap than detected in the splenic repertoire. These results demonstrate that AOS, TT, and CpG alter the bone marrow antibody repertoire however, it is still unclear from the data whether there is a loss of host antigen-specific responsiveness because of the change in gene use.
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Affiliation(s)
- Trisha A Rettig
- Division of Biology, Kansas State University, 1711 Claflin Rd, Manhattan, KS, USA; Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, 11175 Campus St, Chan Shun Pavilion, Loma Linda, CA, USA
| | - Nina C Nishiyama
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, 11175 Campus St, Chan Shun Pavilion, Loma Linda, CA, USA
| | - Michael J Pecaut
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, 11175 Campus St, Chan Shun Pavilion, Loma Linda, CA, USA
| | - Stephen K Chapes
- Division of Biology, Kansas State University, 1711 Claflin Rd, Manhattan, KS, USA.
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Medise BE, Soedjatmiko S, Rengganis I, Gunardi H, Sekartini R, Koesno S, Satari HI, Hadinegoro SR, Yang JS, Excler JL, Sahastrabuddhe S, Puspita M, Sari RM, Bachtiar NS. Six-month follow up of a randomized clinical trial-phase I study in Indonesian adults and children: Safety and immunogenicity of Salmonella typhi polysaccharide-diphtheria toxoid (Vi-DT) conjugate vaccine. PLoS One 2019; 14:e0211784. [PMID: 30759132 PMCID: PMC6373931 DOI: 10.1371/journal.pone.0211784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction There is a high global incidence of typhoid fever, with an annual mortality rate of 200,000 deaths. Typhoid fever also affects younger children, particularly in resource-limited settings in endemic countries. Typhoid vaccination is an important prevention tool against typhoid fever. However, the available polysaccharide typhoid vaccines are not recommended for children under 2 years of age. A new typhoid conjugate Vi-diphtheria toxoid (Vi-DT) vaccine has been developed for infant immunization. We aimed to define the safety and immunogenicity of the Vi-DT vaccine among adults and children in Indonesia. Methods An observational, blinded, comparative, randomized, phase I safety study in two age de-escalating cohorts was conducted in East Jakarta, Indonesia, from April 2017 to February 2018. We enrolled 100 healthy subjects in 2 age groups: adults and children (18–40 and 2–5 years old). These groups were randomized into study groups (Vi-DT vaccine), and comparator groups (Vi-polysaccharide (Vi-PS) vaccine and another additional vaccine) which was administered in 4 weeks apart. Subjects were followed up to six months. Result One hundred healthy adults and children subjects completed the study. The Vi-DT and Vi-PS vaccines showed no difference in terms of intensity of any immediate local and systemic events within 30 minutes post-vaccination. Overall, pain was the most common local reaction, and muscle pain was the most common systemic reaction in the first 72 hours. No serious adverse events were deemed related to vaccine administration. The first and second doses of the Vi-DT vaccine induced seroconversion and higher geometric mean titers (GMT) in all subjects compared to that of baseline. However, in terms of GMT, the second dose of Vi-DT did not induce a booster response. Conclusion The Vi-DT vaccine is safe and immunogenic in adults and children older than two years. A single dose of the vaccine is able to produce seroconversion and high GMT in all individuals.
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Affiliation(s)
- Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
- * E-mail:
| | - Soedjatmiko Soedjatmiko
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Hartono Gunardi
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Rini Sekartini
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Sukamto Koesno
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Hindra Irawan Satari
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
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Duggal MN, Bari A, Zeeshan F, Jabeen U. Frequency of risk factors, vaccination status and outcome of tetanus in children at the Children's Hospital Lahore. J PAK MED ASSOC 2019; 69:174-177. [PMID: 30804579] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the frequency of risk factors, vaccination status and outcome of tetanus in children beyond neonatal age at a tertiary care centre. METHODS The prospective observational study was conducted at The Children's Hospital, Lahore, Pakistan, from January 2012 to December 2014, and comprised children aged between 1 month and 15 years of either gender admitted with diagnosis of tetanus. Variables recorded included age, gender, vaccination status in terms of number of diphtheria, tetanus and pertussis vaccine doses received per routine infant immunisation and booster doses of tetanus toxoid, risk factors as trauma, ear discharge, ear prick and duration of hospitalisation and outcome. Data was analysed using SPSS 16. RESULTS Of the 74 patients, there were 47(63.5%) males and 27(36.5%) females. Overall, the mean age was 6.56+3.15 years 50(67%) were unvaccinated, none (0%) had received booster dose and posttrauma immune prophylaxis. Besides, trauma was the most common risk factor in 33(44.6%) cases followed by ear discharge 15 (20.3%) and ear/nose prick 2(2.7%), while the risk factor was unknown in 24(32.4%) cases. Mean duration of hospitalisation was 14.35±11.65. Mortality rate 16(21.6%) was significantly associated with shorter duration of stay (p<0.001). Mortality was high among unvaccinated children compared to vaccinated children (p=0.01). CONCLUSIONS Vaccination coverage was found to be inadequate and post-trauma immune prophylaxis had been ignored..
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Affiliation(s)
| | - Attia Bari
- The Children's Hospital and Institute of Child Health, Lahore - Pakistan
| | - Fatima Zeeshan
- The Children's Hospital and Institute of Child Health, Lahore - Pakistan
| | - Uzma Jabeen
- The Children's Hospital and Institute of Child Health, Lahore - Pakistan
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Rettig TA, Bye BA, Nishiyama NC, Hlavacek S, Ward C, Pecaut MJ, Chapes SK. Effects of skeletal unloading on the antibody repertoire of tetanus toxoid and/or CpG treated C57BL/6J mice. PLoS One 2019; 14:e0210284. [PMID: 30653556 PMCID: PMC6336310 DOI: 10.1371/journal.pone.0210284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/19/2018] [Indexed: 01/26/2023] Open
Abstract
Spaceflight affects the immune system, but the effects on the antibody repertoire, responsible for humoral immunity, has not been well explored. In particular, the complex gene assembly and expression process; including mutations, might make this process vulnerable. Complementarity determining region 3 (CDR3), composed of parts of the V-(D-)J-gene segments, is very important for antigen binding and can be used as an important measure of variability. Skeletal unloading, and the physiological effects of it, parallel many impacts of space flight. Therefore, we explored the impact of skeletal unloading using the antiorthostatic suspension (AOS) model. Animals were experimentally challenged with tetanus toxoid (TT) and/or the adjuvant CpG. Blood was analyzed for anti-TT antibody and corticosterone concentrations. Whole spleen tissue was prepared for repertoire characterization. AOS animals showed higher levels of corticosterone levels, but AOS alone did not affect anti-TT serum antibody levels. Administration of CpG significantly increased the circulating anti-TT antibody concentrations. AOS did alter constant gene usage resulting in higher levels of IgM and lower levels of IgG. CpG also altered constant gene region usage increasing usage of IgA. Significant changes could be detected in multiple V-, D-, and J-gene segments in both the heavy and light chains in response to AOS, TT, and CpG treatments. Analysis of class-switched only transcripts revealed a different pattern of V-gene segment usage than detected in the whole repertoire and also showed significant alterations in gene segment usage after challenge. Alterations in V/J pairing were also detected in response to challenge. CDR3 amino acid sequence overlaps were similar among treatment groups, though the addition of CpG lowered overlap in the heavy chain. We isolated 3,045 whole repertoire and 98 potentially TT-specific CDR3 sequences for the heavy chain and 569 for the light chain. Our results demonstrate that AOS alters the repertoire response to challenge with TT and/or CpG.
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Affiliation(s)
- Trisha A. Rettig
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - Bailey A. Bye
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - Nina C. Nishiyama
- Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, California, United States of America
| | - Savannah Hlavacek
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - Claire Ward
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - Michael J. Pecaut
- Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, California, United States of America
| | - Stephen K. Chapes
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
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Huda MN, Ahmad SM, Alam MJ, Khanam A, Afsar MNA, Wagatsuma Y, Raqib R, Stephensen CB, Laugero KD. Infant cortisol stress-response is associated with thymic function and vaccine response. Stress 2019; 22:36-43. [PMID: 29932814 PMCID: PMC6351220 DOI: 10.1080/10253890.2018.1484445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Stress can impair T cell-mediated immunity. To determine if infants with high stress responses had deficits in T-cell mediated immunity, we examined the association of pain-induced cortisol responsiveness with thymic function and vaccine responses in infants. This study was performed among 306 (male = 153 and female = 153) participants of a randomized, controlled trial examining the effect of neonatal vitamin A supplementation on immune function in Bangladesh (NCT01583972). Salivary cortisol was measured before and 20 min after a needle stick (vaccination) at 6 weeks of age. The thymic index (TI) was determined by ultrasonography at 1, 6, 10 and 15 weeks. T-cell receptor excision circle and blood T-cell concentrations were measured at 6 and 15 weeks. Responses to Bacillus Calmette-Guérin (BCG), tetanus toxoid, hepatitis B virus and oral poliovirus vaccination were assayed at 6 and 15 weeks. Cortisol responsiveness was negatively associated with TI at all ages (p < .01) in boys only, was negatively associated with naïve helper T-cell concentrations in both sexes at both 6 (p = .0035) and 15 weeks (p = .0083), and was negatively associated with the delayed-type hypersensitivity (DTH) skin test response to BCG vaccination at 15 weeks (p = .034) in both sexes. Infants with a higher cortisol response to pain have differences in the T-cell compartment and a lower DTH response to vaccination. Sex differences in the immune system were seen as early as 6 weeks of age in these healthy infants.
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Affiliation(s)
- M. Nazmul Huda
- Nutrition Department, University of California, Davis, Davis, California, U.S.A
- US Department of Agriculture, Western Human Nutrition Research Center, Davis, California, U.S.A
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shaikh M. Ahmad
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Md J. Alam
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Afsana Khanam
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Md Nure A. Afsar
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Yukiko Wagatsuma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Rubhana Raqib
- Enteric and Respiratory Infections Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Charles B. Stephensen
- Nutrition Department, University of California, Davis, Davis, California, U.S.A
- US Department of Agriculture, Western Human Nutrition Research Center, Davis, California, U.S.A
- To whom correspondence should be addressed: Dr. Charles B Stephensen, Immunity and Disease Prevention Research Unit, USDA Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, U.S.A. Phone: +1-530-754-9266. Fax: +1-530-752-4390.
| | - Kevin D. Laugero
- Nutrition Department, University of California, Davis, Davis, California, U.S.A
- US Department of Agriculture, Western Human Nutrition Research Center, Davis, California, U.S.A
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Stammen RL, Cohen JK, Meeker TL, Crane MM, Amara RR, Hicks SL, Meyer JS, Ethun KF. Effect of Chronic Social Stress on Prenatal Transfer of Antitetanus Immunity in Captive Breeding Rhesus Macaques ( Macaca mulatta). j am assoc lab anim sci 2018; 57:357-367. [PMID: 29764539 PMCID: PMC6059219 DOI: 10.30802/aalas-jaalas-17-000102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Because tetanus can cause significant morbidity and mortality in NHP, colonywide vaccination with tetanus toxoid is recommended for outdoor breeding colonies of rhesus macaques, with primary immunizations commonly given to infants at 6 mo of age followed by booster vaccines every 10 y. Maternal antibodies are thought to offer protective immunity to infants younger than 6 mo. However, historical colony data from the Yerkes National Primate Research Center show a higher incidence of tetanus among infants (≤ 6 mo old) born to subordinate dams. Whether this higher incidence of infantile tetanus is due to a higher incidence of trauma among subordinate animals or is a stress-induced impairment of maternal antibody protection is unknown. Studies in other NHP species suggest that chronic exposure to social stressors interferes with the receptor-mediated transplacental transfer of IgG. Therefore, the primary aim of this study was to determine whether chronic stress associated with social subordination impairs prenatal transfer of antitetanus immunity in breeding female rhesus macaques. Subjects included 26 high- and 26 low-ranking adult female rhesus macaques that were nearly 5 or 10 y after their initial immunization and their nonimmunized infants. We hypothesized that infants born to subordinate dams that were nearly 10 y after immunization would have the lowest infant-to-dam antibody ratios and thus would be at greatest risk for infection. Results revealed no significant intergroup differences in infant antitetanus IgG levels. However, infant-to-dam IgG ratios against tetanus were significantly lower among subordinate animals compared with dominant macaques, after accounting for the number of years since the dam's initial vaccination. In addition, higher maternal hair cortisol levels predicted lower infantto-dam tetanus toxoid IgG ratios. Together, these findings suggest that chronic social stress in female rhesus macaques may hamper the prenatal transfer of antitetanus immunity to offspring.
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Affiliation(s)
- Rachelle L Stammen
- Divisions of Animal Resources, Emory University School of Medicine, Atlanta, Georgia
| | - Joyce K Cohen
- Divisions of Animal Resources, Emory University School of Medicine, Atlanta, Georgia
| | - Tracy L Meeker
- Divisions of Animal Resources, Emory University School of Medicine, Atlanta, Georgia
| | - Maria M Crane
- Divisions of Animal Resources, Emory University School of Medicine, Atlanta, Georgia
| | - Rama R Amara
- Divisions of Microbiology and Immunology, Departments of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Sakeenah L Hicks
- Divisions of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jerrold S Meyer
- Departments of Neuroscience and Behavior Program, Department of Psychology, University of Massachusetts, Amherst, Massachusetts
| | - Kelly F Ethun
- Divisions of Animal Resources, Developmental and Cognitive Neurosciences, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, Georgia, Departments of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia;,
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Cela EM, Gonzalez CD, Friedrich A, Ledo C, Paz ML, Leoni J, Gómez MI, González Maglio DH. Daily very low UV dose exposure enhances adaptive immunity, compared with a single high-dose exposure. Consequences for the control of a skin infection. Immunology 2018; 154:510-521. [PMID: 29377107 PMCID: PMC6002207 DOI: 10.1111/imm.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/25/2017] [Revised: 12/24/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Ultraviolet radiation (UVr) promotes several well-known molecular changes, which may ultimately impact on health. Some of these effects are detrimental, like inflammation, carcinogenesis and immunosuppression. On the other hand, UVr also promotes vitamin D synthesis and other beneficial effects. We recently demonstrated that exposure to very low doses of UVr on four consecutive days [repetitive low UVd (rlUVd)] does not promote an inflammatory state, nor the recruitment of neutrophils or lymphocytes, as the exposure to a single high UV dose (shUVd) does. Moreover, rlUVd reinforce the epithelium by increasing antimicrobial peptides transcription and epidermal thickness. The aim of this study was to evaluate the adaptive immune response after shUVd and rlUVd, determining T-cell and B-cell responses. Finally, we challenged animals exposed to both irradiation procedures with Staphylococcus aureus to study the overall effects of both innate and adaptive immunity during a cutaneous infection. We observed, as expected, a marked suppression of T-cell and B-cell responses after exposure to an shUVd but a novel and significant increase in both specific responses after exposure to rlUVd. However, the control of the cutaneous S. aureus infection was defective in this last group, suggesting that responses against pathogens cannot be ruled out from isolated stimuli.
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Affiliation(s)
- Eliana M. Cela
- Universidad de Buenos AiresFacultad de Farmacia y BioquímicaCátedra de InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Estudios de la Inmunidad Humoral (IDEHU)Buenos AiresArgentina
| | - Cintia Daniela Gonzalez
- Universidad de Buenos AiresFacultad de MedicinaDepartamento de Microbiología, Parasitología e InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Microbiología y Parasitología Médica (IMPaM)Buenos AiresArgentina
| | - Adrian Friedrich
- Universidad de Buenos AiresFacultad de Farmacia y BioquímicaCátedra de InmunologíaBuenos AiresArgentina
| | - Camila Ledo
- Universidad de Buenos AiresFacultad de MedicinaDepartamento de Microbiología, Parasitología e InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Microbiología y Parasitología Médica (IMPaM)Buenos AiresArgentina
| | - Mariela Laura Paz
- Universidad de Buenos AiresFacultad de Farmacia y BioquímicaCátedra de InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Estudios de la Inmunidad Humoral (IDEHU)Buenos AiresArgentina
| | - Juliana Leoni
- CONICET – Universidad de Buenos AiresInstituto de Estudios de la Inmunidad Humoral (IDEHU)Buenos AiresArgentina
| | - Marisa Inés Gómez
- Universidad de Buenos AiresFacultad de MedicinaDepartamento de Microbiología, Parasitología e InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Microbiología y Parasitología Médica (IMPaM)Buenos AiresArgentina
| | - Daniel H. González Maglio
- Universidad de Buenos AiresFacultad de Farmacia y BioquímicaCátedra de InmunologíaBuenos AiresArgentina
- CONICET – Universidad de Buenos AiresInstituto de Estudios de la Inmunidad Humoral (IDEHU)Buenos AiresArgentina
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Vizzotti C, Katz N, Stecher D, Aquino A, Juárez MDV, Urueña A. [Assessment of the use in adults of four vaccines: a population survey in Argentina]. Medicina (B Aires) 2018; 78:76-82. [PMID: 29659355] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Vaccination is one of the most effective strategies for disease prevention. Argentina initiated the transition from child vaccination to family vaccination through the incorporation of an adult schedule. One of the difficulties with this last group is to assess the percentage of use (PU) of the vaccines. With the aim of determining the PU of adult vaccines in Argentina, a vaccination module was included in the National Survey of Risk Factors carried out in 2013 by the National Ministry of Health. The sampling had a stratified multistage design. A total of 32 365 people = 18 year-old were surveyed about the use of four vaccines included in the National Vaccination Calendar: hepatitis B, tetanus, influenza, and pneumococcus. The entire population was surveyed for tetanus and hepatitis B while certain groups at risk were evaluated for influenza and pneumococcus, according to current recommendations. PU varied according to the vaccine analyzed: tetanus 49.8%, hepatitis B 21.7%, influenza 51.6% and pneumococcus 16.2%. The main information sources on adult vaccination were media (television, internet, etc.) followed by health personnel (70.8% and 27.9%, respectively). The survey is a suitable tool to assess the use of vaccines by adults, identify low coverage populations, and to plan and implement strategies to improve coverage.
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Affiliation(s)
- Carla Vizzotti
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Nathalia Katz
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Daniel Stecher
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Analía Aquino
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - María Del Valle Juárez
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Analía Urueña
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
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Pirouzmand H, Khameneh B, Tafaghodi M. Immunoadjuvant potential of cross-linked dextran microspheres mixed with chitosan nanospheres encapsulated with tetanus toxoid. Pharm Biol 2017; 55:212-217. [PMID: 27927058 PMCID: PMC6130596 DOI: 10.1080/13880209.2016.1257032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Nasal mucosa is a desirable route for mucosal vaccine delivery. Mucosal co-administration of chitosan nanoparticles with absorption enhancers such as cross-linked dextran microspheres (CDM, Sephadex®) is a promising antigen delivery system. OBJECTIVE In the current study, the chitosan nanospheres loaded with tetanus toxoid (CHT:TT NPs) was prepared and characterized. The immune responses against tetanus toxoid after nasal administration of CHT:TT NPs alone or mixed with CDM were also determined. MATERIALS AND METHODS Chitosan nanospheres were prepared by ionic gelation method. Particle size, releasing profile and antigen stability were evaluated by dynamic light scattering, diffusion chamber and SDS-PAGE methods, respectively. Rabbits were nasally immunized with different formulations loaded with 40 Lf TT. After three times immunizations with 2 weeks intervals, sera IgG titres and nasal lavage sIgA titres were determined. RESULTS Mean size of CHT NPs and CHT:TT NPs were 205 ± 42 nm and 432 ± 85 nm, respectively. The release profile showed that 42.4 ± 10.5% of TT was released after 30 min and reached to a steady state after 1.5 h. Stability of encapsulated TT in nanospheres was confirmed by SDS-PAGE. The antibody titres showed that CHT:TT NPs-induced antibody titres were higher than TT solution. CHT NPs mixed with CDM induced the systemic IgG and nasal lavage sIgA titres higher than intranasal administration of TT solution (p < 0.001). DISCUSSION AND CONCLUSION As the results indicated, these CHT:TT NPs when co-administered with CDM were able to induce more immune responses and have the potential to be used in mucosal immunization.
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Affiliation(s)
- Haniyeh Pirouzmand
- Student Research Committee, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahman Khameneh
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Tafaghodi
- Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Abir T, Ogbo FA, Stevens GJ, Page AN, Milton AH, Agho KE. The impact of antenatal care, iron-folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh. PLoS One 2017; 12:e0187090. [PMID: 29091923 PMCID: PMC5665518 DOI: 10.1371/journal.pone.0187090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women's and newborn health outcomes. The study aimed to investigate the impact of ANC, iron-folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh. METHOD A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0-28 days (neonatal), 1-11 months (post-neonatal) and 12-59 months (child). RESULTS Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43-0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45-0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49-0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51-0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48-0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36-0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups. CONCLUSION The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.
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Affiliation(s)
- Tanvir Abir
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Garry John Stevens
- Humanitarian and Development Research Initiative (HADRI), Western Sydney University, School of Social Science and Psychology, Penrith, New South Wales, Australia
| | - Andrew Nicolas Page
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology & Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
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Pawłowski B, Nowak J, Borkowska B, Augustyniak D, Drulis-Kawa Z. Body height and immune efficacy: testing body stature as a signal of biological quality. Proc Biol Sci 2017; 284:20171372. [PMID: 28724741 PMCID: PMC5543236 DOI: 10.1098/rspb.2017.1372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 12/23/2022] Open
Abstract
According to the good genes hypothesis and energy allocation theory, human adult body height may reflect biological quality. An important aspect of this quality is immune system functioning (ISF). The aim of this study was to evaluate the relationship between ISF and body height in healthy people. The ISF was determined by several important innate (total complement and lysozyme activity, neutrophil function) and adaptive immune parameters (lymphocytes, IgA and IgG, and response to the flu vaccine). Overall, 96 males and 97 females were subjected to flu vaccination, and of these, 35 males and 34 females were subjected to tetanus. Blood samples were collected before and four weeks after vaccination. Immunomodulatory factors, participant's age, body fat, and free testosterone levels, were controlled. There was no association between body height and all analysed immune parameters for both sexes. That might suggest that in Western society, a women's preference for taller men is not related to 'good genes for immune competence'. We propose the novel Immunity Priority Hypothesis that explains the lack of relationship between adult body stature and ISF. This hypothesis, however, does not contradict the signalling role of a man's body height as a morphological marker of biological quality.
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Affiliation(s)
| | - Judyta Nowak
- Department of Human Biology, University of Wroclaw, Wroclaw, Poland
| | | | - Daria Augustyniak
- Department of Pathogen Biology and Immunology, University of Wroclaw, Wroclaw, Poland
| | - Zuzanna Drulis-Kawa
- Department of Pathogen Biology and Immunology, University of Wroclaw, Wroclaw, Poland
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Grandjean P, Heilmann C, Weihe P, Nielsen F, Mogensen UB, Budtz-Jørgensen E. Serum Vaccine Antibody Concentrations in Adolescents Exposed to Perfluorinated Compounds. Environ Health Perspect 2017; 125:077018. [PMID: 28749778 PMCID: PMC5744724 DOI: 10.1289/ehp275] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/06/2016] [Accepted: 07/12/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Postnatal exposure to perfluorinated alkylate substances (PFASs) is associated with lower serum concentrations of specific antibodies against certain childhood vaccines at 7 y. OBJECTIVES We prospectively followed a Faroese birth cohort to determine these associations at 13 y. METHODS In 516 subjects (79% of eligible cohort members) who were 13 years old, serum concentrations of PFASs and of antibodies against diphtheria and tetanus were measured and were compared with data from the previous examination at 7 y. Multiple regression analyses and structural equation models were applied to determine the association between postnatal PFAS exposures and antibody concentrations. RESULTS Serum concentrations of PFASs and antibodies generally declined from 7 y to 13 y. However, 68 subjects had visited the emergency room and had likely received a vaccination booster, and a total of 202 children showed higher vaccine antibody concentrations at 13 y than at 7 y. Therefore, separate analyses were conducted after exclusion of these two subgroups. Diphtheria antibody concentrations decreased at elevated PFAS concentrations at 13 y and 7 y; the associations were statistically significant for perfluorodecanoate (PFDA) at 7 y and for perfluorooctanoate (PFOA) at 13 y, both suggesting a decrease by ∼25% for each doubling of exposure. Structural equation models showed that a doubling in PFAS exposure at 7 y was associated with losses in diphtheria antibody concentrations at 13 y of 10–30% for the five PFASs. Few associations were observed for anti-tetanus concentrations. CONCLUSIONS These results are in accord with previous findings of PFAS immunotoxicity at current exposure levels. https://doi.org/10.1289/EHP275.
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Affiliation(s)
- Philippe Grandjean
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carsten Heilmann
- Paediatric Clinic, Rigshospitalet – National University Hospital, Copenhagen, Denmark
| | - Pal Weihe
- Department of Occupational Medicine and Public Health, Faroese Hospital System, Tórshavn, Faroe Islands, Denmark
| | - Flemming Nielsen
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Ulla B Mogensen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Major T. Clinical Experience With Management of 20 Brown Recluse Spider Bites: An Effective Treatment Regimen. Mo Med 2017; 114:258-259. [PMID: 30228603 PMCID: PMC6140087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Vouking MZ, Tadenfok CN, Ekani JME. Strategies to increase immunization coverage of tetanus vaccine among women in Sub Saharan Africa: a systematic review. Pan Afr Med J 2017; 27:25. [PMID: 29296160 PMCID: PMC5745987 DOI: 10.11604/pamj.supp.2017.27.3.11535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/16/2017] [Indexed: 12/17/2022] Open
Abstract
World Health Organization (WHO) estimated in 2013 that 49,000 deaths all over the world were caused by neonatal tetanus. Only as recently as the year 2000, neonatal tetanus was a public health problem in 59 countries, but since then it has been eliminated in 36 of the countries concerned. The objective of this piece of work, therefore, was to investigate which strategies intended to increase demand for vaccination are effective in increasing anti-tetanus vaccination coverage of women in Sub Saharan Africa. We searched the following electronic databases from January 1989 to July 2016: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Our search strategy yielded 191 records and after assessment for eligibility, 6 papers met the criteria for inclusion. In Ivory Coast, after reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96% of cases, respectively. In Kenya, the main factors contributing to having sufficiently immunized part of the population against tetanus are lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Particularly in Ethiopia, compared with other member countries, the size of the unimmunized population, reporting quality, fragileness of the health system, resource limitation, and others deserve further concerted attention. In Nigeria, the prevalence of missed opportunities was 66%. The factors responsible for missed opportunities were; poor history taking, lack of knowledge of the current immunization schedule, dependence on physician referral for immunization and inefficient immunization records keeping system. In Nigeria, socio-logistic variables found to be important in Expanded Programme on Immunization implementations included scheduling, health staff attitude, intersectoral collaboration, and health education. Lack of community participation was also found to be a crucial constraining factor. There are many challenges to increase immunization coverage of tetanus vaccine for women. So far very few interventions addressing these challenges have been evaluated scientifically. Community mobilization interventions to change or impact beliefs and attitudes of women are absolutely needed. Additionally, improving accessibility, affordability, availability and accommodation of vaccination service venues will make them more attractive.
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Affiliation(s)
- Marius Zambou Vouking
- Center for the Development of Best Practices in Health, Yaoundé Central Hospital, Henri-Dunant Avenue, Messa, Yaoundé, Cameroon
- Regional Unit of Expanded Programme on Immunization Centre Regional Delegation of Public Health, Yaoundé, Cameroon
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Norris T, Vahratian A, Cohen RA. Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015. NCHS Data Brief 2017:1-8. [PMID: 28696200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Data from the National Health Interview Survey ? Among adults aged 65 and over, more than two-thirds had an influenza vaccine in the past 12 months (69.0%). ? More than one in two adults aged 65 and over had a tetanus vaccine in the past 10 years (56.9%). ? More than 6 of 10 adults aged 65 and over had ever had a pneumococcal vaccine (63.6%), while a little more than one-third had ever had a shingles vaccine (34.2%). ? Among adults aged 65 and over, vaccination coverage was highest for non-Hispanic white adults compared with non- Hispanic black and Hispanic adults. ? Vaccination coverage was lowest among poor adults aged 65 and over.
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Yaffee AQ, Day DL, Bastin G, Powell M, Melendez S, Allen N, Miracle J, Jones M, Brawley R. Notes from the Field: Obstetric Tetanus in an Unvaccinated Woman After a Home Birth Delivery - Kentucky, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:307-308. [PMID: 28333909 PMCID: PMC5657886 DOI: 10.15585/mmwr.mm6611a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tetanus vaccines: WHO position paper – February 2017. Wkly Epidemiol Rec 2017; 92:53-76. [PMID: 28185446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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30
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Maternal and neonatal tetanus elimination: validation in Punjab Province, Pakistan, November 2016. Wkly Epidemiol Rec 2017; 92:21-34. [PMID: 28116893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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RICCÒ M, CATTANI S, VERONESI L, COLUCCI ME. Knowledge, attitudes, beliefs and practices of construction workers towards tetanus vaccine in Northern Italy. Ind Health 2016; 54:554-563. [PMID: 27251030 PMCID: PMC5136613 DOI: 10.2486/indhealth.2015-0249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 05/26/2023]
Abstract
Construction workers (CWs) are both more exposed to tetanus and at higher risk to be inadequately immunized. Our aim was to evaluate tetanus immunization status and knowledge/attitudes towards tetanus vaccination in CWs in Italy. In this field report, the immunization status of 554 unskilled CWs (i.e. labourers). Immunization status was assessed recalling immunization booklets/certificates. Attitudes and knowledge were collected through a standardized questionnaire. In 240/554 CWs, immunization status was inadequate/not documented: in 184 subjects (33.2%), the last vaccination shot was older than 10 years, whereas basal immunization was incomplete in 20 cases, more frequently in foreign-born people (FBP) than in Italian born (IBP) (OR=7.116). In 198 cases (35.7%), an Occupational Physician (OPh) performed last booster, usually with monovalent (T, n=173) vaccine. The main reason for inadequate immunization was having forgotten the periodic booster (148/554; 26.7%), whereas 42 subjects (7.6%) deliberately avoided tetanus vaccine because of personal/religious beliefs, more frequently in FBP than in IBP (OR=3.182). In summary, the prevalence of inadequate immunization status was relatively high (43.4%): the high prevalence of "forgotten boosters" enlightens the key role of OPh in recalling and promoting vaccination policies. Moreover, the inappropriate use of Td vaccine points out the opportunity for educational campaigns in OPh.
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Affiliation(s)
- Matteo RICCÒ
- Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento Unità Operativa di Prevenzione e Sicurezza degli Ambienti di Lavoro, Italy
| | - Silvia CATTANI
- Department of Clinical Surgery, General Surgery and Surgical Therapy, School of Nursing Sciences, Parma University Hospital, Italy
| | - Licia VERONESI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
| | - Maria Eugenia COLUCCI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
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van Ravenhorst MB, Marinovic AB, van der Klis FRM, van Rooijen DM, van Maurik M, Stoof SP, Sanders EAM, Berbers GAM. Long-term persistence of protective antibodies in Dutch adolescents following a meningococcal serogroup C tetanus booster vaccination. Vaccine 2016; 34:6309-6315. [PMID: 27817957 DOI: 10.1016/j.vaccine.2016.10.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 09/06/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Due to waning immunity, infant vaccination with meningococcal serogroup C conjugated (MenCC) vaccines is insufficient to maintain long-term individual protection. Adolescent booster vaccination is thought to offer direct protection against invasive meningococcal disease (IMD) but also to reduce meningococcal carriage and transmission and in this way establish herd protection in the population. Previously, we studied antibody levels after adolescent MenCC booster vaccination. In the present study, the adolescent vaccinees were revisited after three years to determine antibody persistence and to predict long-term protection. METHODS Meningococcal serogroup C tetanus toxoid conjugated (MenC-TT) vaccine was administered to 10-, 12- and 15-year old participants who had been primed nine years earlier with a single dose of MenC-TT vaccine. Blood samples were collected before, 1month, 1year and 3years after the adolescent booster vaccination. Functional antibody levels were measured with serum bactericidal assay using rabbit complement (rSBA). Meningococcal serogroup C polysaccharide and tetanus toxoid specific antibody levels were measured using fluorescent-bead-based multiplex immunoassay. Long-term protection was estimated using longitudinal multilevel antibody decay modeling. RESULTS Of the original 268 participants, 201 (75%) were revisited after 3years. All participants still had an rSBA titer above the protective threshold of ⩾8 and 98% ⩾128. The 15-year-olds showed the highest antibody titers. Using a bi-exponential decay model, the median time to fall below the protection threshold (rSBA titer <8) was 16.3years, 45.9years and around 270years following the booster for the 10-, 12- and 15-year-olds, respectively. CONCLUSIONS After a first steep decline in antibody levels in the first year after the booster, antibody levels slowly declined between one and three years post-booster. A routine MenC-TT booster vaccination for adolescents in the Netherlands will likely provide long-term individual protection and potentially reduce the risk of resurgence of MenC disease in the general population.
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Affiliation(s)
- Mariëtte B van Ravenhorst
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
| | - Axel Bonacic Marinovic
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Debbie M van Rooijen
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marjan van Maurik
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Susanne P Stoof
- Department of Medical Microbiology and Infection Control, VU University Medical Center, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Rhodes J, Gupta R. Building Resilient Communities: Preparedness and Response for Health Care and Public Health Professionals. W V Med J 2016; 112:24-25. [PMID: 29368474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Nasir JA, Imran M. Tetanus Toxoid Vaccination of Pregnant Women in Pakistan. J Coll Physicians Surg Pak 2016; 26:800. [PMID: 27671192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 04/11/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Jamal Abdul Nasir
- Department of Statistics, Sub Campus Rahim Yar Khan, The Islamia University of Bahawalpur,Bahawalpur
| | - Muhammad Imran
- Department of Statistics, Sub Campus Rahim Yar Khan, The Islamia University of Bahawalpur,Bahawalpur
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Milat M, Mulić R. [EPIDEMIOLOGICAL CHARACTERISTICS OF TETANUS IN THE REPUBLIC OF CROATIA]. Lijec Vjesn 2016; 138:188-194. [PMID: 30091887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study was to determine the epidemiological characteristics of tetanus in Croatia and to determine changes in the age and sex structure, morbidity and mortality after the introduction of mandatory immunization and after the introduction of additional immunization for persons aged ≥ 60. The retrospective study was undertaken and the data on the number of patients and deaths from tetanus in the period 1946–2014 in Croatia were analyzed. The data considering age, gender and geographical location of disease occurrence were also analyzed. The study confirmed the reduction of morbidity, mortality and fatality rate from tetanus after the introduction of mandatory immunization. In the last twenty years the average morbidity rate was 1.68/1 000 000 population. A higher incidence of tetanus was observed in female patients. During the last ten years all patients were in the age group of 60 and above. The distribution of patients according to the geographical location showed a higher incidence of tetanus in continental Croatia (26/31; 84%) than in coastal area. The less reported number occurred during the winter months. This preventive measure is very effective and economically justified.
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Maternal and neonatal tetanus validation assessment in Region 4, Indonesia, May 2016. Wkly Epidemiol Rec 2016; 91:317-28. [PMID: 27348870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saad B Omer
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
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Affiliation(s)
- Yanmin Zhu
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
| | - Sascha van Boemmel-Wegmann
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
| | - Yasser Albogami
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
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Vesikari T, Forsten A, Bianco V, Van der Wielen M, Miller JM. Antibody persistence up to 5 years after vaccination of toddlers and children between 12 months and 10 years of age with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine. Hum Vaccin Immunother 2016; 12:132-9. [PMID: 26575983 PMCID: PMC4962747 DOI: 10.1080/21645515.2015.1058457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/15/2015] [Accepted: 05/30/2015] [Indexed: 11/07/2022] Open
Abstract
We studied the persistence of serum bactericidal antibody using rabbit and human complement (rSBA/hSBA, cut-offs 1:8) 5 y after a single dose of meningococcal serogroups A, C, W, Y tetanus toxoid conjugate vaccine (MenACWY-TT) compared with age-appropriate control vaccines in toddlers and children (NCT00427908). Children were previously randomized (3:1) to receive either MenACWY-TT or control vaccine (MenC-CRM197 in 1-<2 y olds; MenACWY-polysaccharide vaccine [Men-PS] in 2-<11 y olds). Subjects with rSBA-MenC titers <1:8 at any time point were revaccinated with MenC conjugate vaccine and discontinued from the study. A repeated measurement statistical model assessed potential selection effects due to drop-outs. At year 5 in MenACWY-TT-vaccinated-toddlers for serogroups A, C, W, and Y respectively, percentages with rSBA titers ≥1:8 were 73.5%, 77.6%, 34.7%, and 42.9%, hSBA ≥1:8 were 35.6%, 91.7%, 82.6% and 80.0%. For MenC-CRM197 recipients, 63.6% had persisting rSBA-MenC titers ≥1:8 and 90.9% had hSBA-MenC ≥1:8 (not significantly different versus MenACWY-TT for either assay: exploratory analyses). In 2-<11 y olds rSBA titers ≥1:8 in MenACWY-TT-vaccinees were 90.8%, 90.8%, 78.6%, and 78.6% and 15.4%, 100%, 0.0%, 7.7% in Men-PS-vaccinees (significantly different for serogroups A, W and Y, exploratory analyses). Serogroups A, W and Y rSBA GMTs were ≥ 26-fold higher in MenACWY-TT-vaccinees. As expected, GMTs modeled at year 5 to assess the impact of subject drop out (mainly for revaccination), appeared lower for serogroup C. No vaccine-related SAEs were reported. Antibody persistence was observed for all serogroups up to 5 y after MenACWY-TT vaccination.
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Affiliation(s)
- Timo Vesikari
- Vaccine Research Center; University of Tampere; Medical School; Tampere, Finland
| | - Aino Forsten
- Vaccine Research Center; University of Tampere; Medical School; Tampere, Finland
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Mbuagbaw L, Medley N, Darzi AJ, Richardson M, Habiba Garga K, Ongolo‐Zogo P. Health system and community level interventions for improving antenatal care coverage and health outcomes. Cochrane Database Syst Rev 2015; 2015:CD010994. [PMID: 26621223 PMCID: PMC4676908 DOI: 10.1002/14651858.cd010994.pub2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy.This review focused on community-based interventions and health systems-related interventions. OBJECTIVES To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no interventionWe found marginal improvements in ANC coverage of at least four visits (average odds ratio (OR) 1.11, 95% confidence interval (CI) 1.01 to 1.22; participants = 45,022; studies = 10; Heterogeneity: Tau² = 0.01; I² = 52%; high quality evidence). Sensitivity analysis with a more conservative intra-cluster correlation co-efficient (ICC) gave similar marginal results. Excluding one study at high risk of bias shifted the marginal pooled estimate towards no effect. There was no effect on pregnancy-related deaths (average OR 0.69, 95% CI 0.45 to 1.08; participants = 114,930; studies = 10; Heterogeneity: Tau² = 0.00; I² = 0%; low quality evidence), perinatal mortality (average OR 0.98, 95% CI 0.90 to 1.07; studies = 15; Heterogeneity: Tau² = 0.01; I² = 58%; moderate quality evidence) or low birthweight (average OR 0.94, 95% CI 0.82 to 1.06; studies = five; Heterogeneity: Tau² = 0.00; I² = 5%; high quality evidence). Single interventions led to marginal improvements in the number of women who delivered in health facilities (average OR 1.08, 95% CI 1.02 to 1.15; studies = 10; Heterogeneity: Tau² = 0.00; I² = 0%; high quality evidence), and in the proportion of women who had at least one ANC visit (average OR 1.68, 95% CI 1.02 to 2.79; studies = six; Heterogeneity: Tau² = 0.24; I² = 76%; moderate quality evidence). Results for ANC coverage (at least four and at least one visit) and for perinatal mortality had substantial statistical heterogeneity. Single interventions did not improve the proportion of women receiving tetanus protection (average OR 1.03, 95% CI 0.92 to 1.15; studies = 8; Heterogeneity: Tau² = 0.01; I² = 57%). No study reported onintermittent prophylactic treatment for malaria. Comparison 2: Two or more interventions versus no interventionWe found no improvements in ANC coverage of four or more visits (average OR 1.48, 95% CI 0.99 to 2.21; participants = 7840; studies = six; Heterogeneity: Tau² = 0.10; I² = 48%; low quality evidence) or pregnancy-related deaths (average OR 0.70, 95% CI 0.39 to 1.26; participants = 13,756; studies = three; Heterogeneity: Tau² = 0.00; I² = 0%; moderate quality evidence). However, combined interventions led to improvements in ANC coverage of at least one visit (average OR 1.79, 95% CI 1.47 to 2.17; studies = five; Heterogeneity: Tau² = 0.00; I² = 0%; moderate quality evidence), perinatal mortality (average OR 0.74, 95% CI 0.57 to 0.95; studies = five; Heterogeneity: Tau² = 0.06; I² = 83%; moderate quality evidence) and low birthweight (average OR 0.61, 95% CI 0.46 to 0.80; studies = two; Heterogeneity: Tau² = 0.00; I² = 0%; moderate quality evidence). Meta-analyses for both ANC coverage four or more visits and perinatal mortality had substantial statistical heterogeneity. Combined interventions improved the proportion of women who had tetanus protection (average OR 1.48, 95% CI 1.18 to 1.87; studies = 3; Heterogeneity: Tau² = 0.01; I² = 33%). No trial in this comparison reported on intermittent prophylactic treatment for malaria. Comparison 3: Two interventions compared head to head. No trials found. Comparison 4: One intervention versus a combination of interventionsThere was no difference in ANC coverage (four or more visits and at least one visit), pregnancy-related deaths, deliveries in a health facility or perinatal mortality. No trials in this comparison reported on low birthweight orintermittent prophylactic treatment of malaria. AUTHORS' CONCLUSIONS Implications for practice - Single interventions may improve ANC coverage (at least one visit and four or more visits) and deliveries in health facilities. Combined interventions may improve ANC coverage (at least one visit), reduce perinatal mortality and reduce the occurrence of low birthweight. The effects of the interventions are unrelated to whether they are community or health system interventions. Implications for research - More details should be provided in reporting numbers of events, group totals and the ICCs used to adjust for cluster effects. Outcomes should be reported uniformly so that they are comparable to commonly-used population indicators. We recommend further cluster-RCTs of pregnant women and women in their reproductive years, using combinations of interventions and looking at outcomes that are important to pregnant women, such as maternal and perinatal morbidity and mortality, alongside the explanatory outcomes along the pathway of care: ANC coverage, the services provided during ANC and deliveries in health facilities.
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Affiliation(s)
- Lawrence Mbuagbaw
- Yaoundé Central HospitalCentre for the Development of Best Practices in Health (CDBPH)Henri Dunant AvenuePO Box 87YaoundéCameroon
- South African Medical Research CouncilSouth African Cochrane CentreTygerbergSouth Africa
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Andrea J Darzi
- Clinical Research Institute (American University of Beirut Medical Center)Clinical Epidemiological UnitGefinor 4th FloorHamraBeirutLebanon
| | - Marty Richardson
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Kesso Habiba Garga
- Yaoundé Central HospitalCentre for the Development of Best Practices in Health (CDBPH)Henri Dunant AvenuePO Box 87YaoundéCameroon
| | - Pierre Ongolo‐Zogo
- Yaoundé Central HospitalCentre for the Development of Best Practices in Health (CDBPH)Henri Dunant AvenuePO Box 87YaoundéCameroon
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Maternal and neonatal tetanus elimination: validation survey in 4 States and 2 union territories in India, May 2015. Wkly Epidemiol Rec 2015; 90:589-608. [PMID: 26521303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, Weintraub ES, Bednarczyk RA, King JP, DeStefano F, Orenstein WA, Omer SB. Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizations. JAMA 2015; 314:1581-7. [PMID: 26501534 PMCID: PMC6586223 DOI: 10.1001/jama.2015.12790] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Advisory Committee on Immunization Practices (ACIP) recommends the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for pregnant women during each pregnancy, regardless of prior immunization status. However, safety data on repeated Tdap vaccination in pregnancy is lacking. OBJECTIVE To determine whether receipt of Tdap vaccine during pregnancy administered in close intervals from prior tetanus-containing vaccinations is associated with acute adverse events in mothers and adverse birth outcomes in neonates. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study in 29,155 pregnant women aged 14 through 49 years from January 1, 2007, through November 15, 2013, using data from 7 Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin. EXPOSURES Women who received Tdap in pregnancy following a prior tetanus-containing vaccine less than 2 years before, 2 to 5 years before, and more than 5 years before. MAIN OUTCOMES AND MEASURES Acute adverse events (fever, allergy, and local reactions) and adverse birth outcomes (small for gestational age, preterm delivery, and low birth weight) were evaluated. Women who were vaccinated with Tdap in pregnancy and had a prior tetanus-containing vaccine more than 5 years before served as controls. RESULTS There were no statistically significant differences in rates of medically attended acute adverse events or adverse birth outcomes related to timing since prior tetanus-containing vaccination. [table: see text]. CONCLUSIONS AND RELEVANCE Among women who received Tdap vaccination during pregnancy, there was no increased risk of acute adverse events or adverse birth outcomes for those who had been previously vaccinated less than 2 years before or 2 to 5 years before compared with those who had been vaccinated more than 5 years before. These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia2Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | - Simon J Hambidge
- Department of Ambulatory Care Services, Denver Health, Denver, Colorado 8Institute for Health Research, Kaiser Permanente Colorado, Denver9Department of Pediatrics, University of Colorado, Denver
| | - Marlene M Lugg
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rongxia Li
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jennifer P King
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Saad B Omer
- Rollins School of Public Health, Emory University, Atlanta, Georgia13Emory Vaccine Center, Emory University, Atlanta, Georgia
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Animasahun BA, Gbelee OH, Ogunlana AT, Njokanma OF, Odusanya O. Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge? Pan Afr Med J 2015; 21:254. [PMID: 26526006 PMCID: PMC4607788 DOI: 10.11604/pamj.2015.21.254.6488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/28/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja. METHODS A prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p<0.05. RESULTS A total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age±SD of 6.5±3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%. CONCLUSION Tetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.
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Affiliation(s)
- Barakat Adeola Animasahun
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olusegun Henry Gbelee
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | | | - Olisamedua Fidelis Njokanma
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olumuyiwa Odusanya
- Department of Community Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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Mustapha AF, Eegunranti BA, Fawale MB. Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria. Nig Q J Hosp Med 2015; 25:151-155. [PMID: 27295807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tetanus, though an eminently preventable disease still ranks as a leading cause of death in Nigeria as well as in other developing countries. Reported mortality for severe tetanus varies from 20-60% and depends on the availability and quality of intensive care. Farmers and artisans are mostly affected. OBJECTIVES This retrospective study was carried out to determine the pattern of clinical presentation of tetanus, the immunization status, case fatality rate and factors influencing mortality. METHODS Case notes of patients (age > 10 and above) managed for tetanus from 2004-2008 at LAUTECH Teaching Hospital Osogbo were retrieved. Demographic, clinical data, laboratory investigation results and response to treatment were collated. The data obtained were analysed using the SPSS version 15 Statistical package. RESULTS Over the 5-year period,80 cases of tetanus were managed in the medical wards of LAUTECH Hospital Teaching Osogbo. However, the medical records of 12 of them could not be retrieved, leaving 68(85%) for analysis. This comprised of 45 males and 23 females. Tetanus was highest in the third decade of life. The commonest portal of entry was the lower limb (n = 43). Only one subject was fully vaccinated and received booster dose of vaccine. Thirty-one (31)out of the 68 patients died giving a case fatality rate of 51.5%. CONCLUSION The mortality of tetanus is still very high from this retrospective study. The rate of immunization against tetanus was dismally low. Active immunization should be given to all Nigerians particularly those in the vulnerable group.
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Abstract
Animal and human bites are common in the United States. Although evidence-based practice guidelines have not been developed, bite wounds warrant an organized, standardized approach to care to help prevent complications. Such an approach involves first eliciting a history of the circumstances surrounding the bite and the patient's medical history. Next, basic bite wound care should be performed, including cleansing and irrigation of the wound. A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important. Finally, rabies and tetanus prophylaxis should be considered and appropriate follow-up care ensured.
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Affiliation(s)
- Randy A Taplitz
- Division of Infectious Diseases, Oregon Health & Science University School of Medicine, Portland 97239, USA.
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Abstract
Preconditioning the immune system with a tetanus/diphtheria toxoid significantly improved the effectiveness of dendritic cell immunotherapy and extended overall survival in a small, randomized study of patients with glioblastoma.
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Hu JL, Tao H, Li JX, Dai WM, Song B, Sun JF, Liu P, Tang J, Liu WY, Wang SY, Zhu FC. Safety and immunogenocity of a novel combined Haemophilus influenzae type b-Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine in healthy Chinese children aged 6 months to 5 years old. Hum Vaccin Immunother 2015; 11:1120-8. [PMID: 25833163 PMCID: PMC4514299 DOI: 10.1080/21645515.2015.1033592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/07/2015] [Revised: 03/06/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022] Open
Abstract
A novel combined Haemophilus influenzae type b-Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine (Hib-MenAC vaccine) has been developed to protect children against diseases caused by Hib, MenA, and MenC. This study investigated the safety and immunogenicity of the Hib-MenAC vaccine administered in 2-dose series to children aged 6-23 months and in a single dose to children aged 2-5 y. A randomized, positive-controlled, non-inferiority clinical trial was conducted for 1200 healthy participants in each age group. Within each age group, participants were randomly allocated to the Hib-MenAC group or the control group at a ratio of 1:1. Adverse reactions were recorded within 28 d after each dose. Blood samples were obtained to assess immunogenicity on day 0 and at 28 d after a complete vaccination course. For the investigational vaccine, the incidence of total adverse reactions in vaccinees aged 6-23 months was 46.8% and that in vaccinees aged 2-5 y was 29.8%. Most adverse reactions were mild or moderate. One non-fatal serious adverse event occurred in the Hib-MenAC group, but was unrelated to vaccination. The seroconversion rate to the 3 components reached 94.0%, and the proportion of vaccinees with rSBA titers ≥ 1:8 and PRP ≥ 0.15 g/mL reached 97.0% in both age groups. The safety and immunogenicity of the Hib-MenAC vaccine were non-inferior when compared to the licensed vaccines. It was concluded that the novel vaccine would be expected to protect children against all of the targeted diseases.
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Key Words
- ATP, according to protocol
- CI, confidence interval
- EPI, Expanded Program on Immunization
- GMCs, geometric mean concentrations
- GMTs, geometric mean titers
- Haemophilus influenzae type b
- Hib, Haemophilus influenzae
- Hib-MenAC vaccine, combined Haemophilus influenzae
- MenA, Neisseria meningitidis serogroup A
- MenC, Neisseria meningitidis serogroup C
- Neisseria meningitidis
- PRP, polyribosylribitol phosphate
- RD, rate difference
- SAEs, serious adverse events
- children
- china
- conjugate vaccine
- rSBA, a serum bactericidal assay using baby rabbit complement
- type b
- type b–Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine
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MESH Headings
- Antibodies, Bacterial/blood
- Child, Preschool
- China
- Drug-Related Side Effects and Adverse Reactions/epidemiology
- Drug-Related Side Effects and Adverse Reactions/pathology
- Female
- Haemophilus Infections/prevention & control
- Haemophilus Vaccines/administration & dosage
- Haemophilus Vaccines/adverse effects
- Haemophilus Vaccines/immunology
- Haemophilus influenzae type b/immunology
- Humans
- Incidence
- Infant
- Male
- Meningococcal Infections/prevention & control
- Meningococcal Vaccines/administration & dosage
- Meningococcal Vaccines/adverse effects
- Meningococcal Vaccines/immunology
- Neisseria meningitidis, Serogroup A/immunology
- Neisseria meningitidis, Serogroup C/immunology
- Tetanus Toxoid/administration & dosage
- Tetanus Toxoid/immunology
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/adverse effects
- Vaccines, Combined/immunology
- Vaccines, Conjugate/administration & dosage
- Vaccines, Conjugate/adverse effects
- Vaccines, Conjugate/immunology
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Affiliation(s)
- Jian-li Hu
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Hong Tao
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Jing-xin Li
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
- College of Pharmacy; Third Military Medical University & National Engineering Research Center for Immunological Products; Chongqing, China
| | - Wei-ming Dai
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Bin Song
- Royal (Wuxi) Biological Co., Ltd.; Wuxi, Jiangsu, China
| | - Jin-fang Sun
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Pei Liu
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Jie Tang
- Funing County Center for Disease Control and Prevention; Yancheng, Jiangsu, China
| | - Wen-yu Liu
- Funing County Center for Disease Control and Prevention; Yancheng, Jiangsu, China
| | - Shi-yuan Wang
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Feng-cai Zhu
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
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Ishikawa K, Ohsaka H, Omori K, Obinata M, Mishima K, Oode Y, Yanagawa Y. Pregnant Woman Bitten by a Japanese Mamushi (Gloydius blomhoffii). Intern Med 2015; 54:2517-20. [PMID: 26424315 DOI: 10.2169/internalmedicine.54.4708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the fourth case of a pregnant woman bitten by a mamushi. A 33-year-old pregnant woman in the 25th week of gestation was bitten by a mamushi. Her vital signs were stable; however, biochemical analyses of the blood showed mild deterioration of anemia and hypoproteinemia. The effects of envenomation were limited to the extremities, the administration of supportive therapy without antivenom fortunately resulted in a favorable outcome. As there are differences in the maternal medical condition and weeks of gestation, further research is needed to clarify the optimal management strategy for administering antivenom in pregnancy.
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Affiliation(s)
- Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
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