Safety and immunogenicity of Haemophilus influenzae-tetanus toxoid conjugate vaccine given separately or in combination with a three-component acellular pertussis vaccine combined with diphtheria and tetanus toxoids and inactivated poliovirus vaccine for the first four doses. (1/76)

The purpose of this randomized, controlled trial was to assess the safety and immunogenicity of a three-component acellular pertussis vaccine combined with diphtheria and tetanus toxoids and inactivated poliovirus vaccine given either separately or combined as a single injection with a Haemophilus influenzae type b-tetanus toxoid conjugate vaccine. A total of 180 infants were immunized at 2, 4, and 6 months of age; 129 were given a booster dose at 16-19 months of age. Vaccine-associated adverse events were similar whether the vaccines were combined as a single injection or given separately. There were no differences in levels of antibodies to Bordetella pertussis antigens (pertussis toxoid, filamentous hemagglutinin, and pertactin), diphtheria toxoid, or the three poliovirus types. The tetanus antitoxin level after the primary three-dose series was higher in recipients of the combined vaccine (2.37 IU/mL) than in recipients of the separate injections (1.32 IU/mL; two-sided P = .0001). In contrast, combined vaccine recipients had lower levels of antibody to H. influenzae type b polysaccharide after the third dose (1.57 microg/mL) than did those given separate injections (3.22 microg/mL; two-sided P = .0026). The antibody levels were not significantly different before or 1 month after the booster dose (32.9 microg/mL vs. 47.8 microg/mL, respectively; two-sided P = .07). We conclude that the vaccines were immunogenic and well tolerated. Despite lower levels of antibody to the H. influenzae type b polysaccharide after the primary three-dose series, mixing of the vaccines in a single syringe likely induced immunologic priming, as suggested by the high antibody levels after the booster dose.  (+info)

Lymphoid cell dependence of eosinophil response to antigen. VI. The effect of selective removal of T or B lymphocytes on the capacity of primed spleen cells to adoptively transferred immunity to tetanus toxoid. (2/76)

Spleens from mice primed with tetanus toxoid 30 days earlier contain memory cells capable of adoptively transferring secondary type cell-mediated (eosinophil) and humoral (antitoxin) responses to irradiated, reconstituted recipients. Spleen cells derived from 10-day-primed donors, on the other hand, possess the capacity after transfer to elicit secondary type eosinophil responses, but not anamnestic antitoxin responses. Treatment of 30-day-primed cells with anti-theta serum and C' prevented transfer of memory for both responses, whereas similar treatment with rabbit anti-mouse IgG (RAM-IgG) serum and C' only inhibited transfer of memory for the antitoxin response. Addition of non-primed spleen cells to antisera-treated primed cells failed to restore secondary type responses. Recombination of 30-day-primed anti-theta and RAM-IgG-treated cells re-established the capacity to transfer these responses. To determine whether the same T cells which mediate the eosiniphil response also act as helper cells in antitoxin production, antisera treated 10- and 30-day-primed cells were combined prior to transfer. Ten-day-primed T cells induced eisoniphil responses and also co-operated with 30-day-primed B cells to produce antitoxin. In contrast, 30-day-primed T cells elicited eisinophil responses, but were unable to induce antitoxin production when combined with anti-theta-treated 10-day-primed cells. These results indicate that B memory cells are not present in the spleens of the donor mice 10 days after priming, but T memory cells are present. It is concluded that primed T cells mediated both eosinophil and antitoxin responses, while B memory cells are involved only with antitoxin production. Following subcutaneous priming T memory cells are present in the spleen prior to B memory cells, and T memory cells which mediate the eosinophil response at 10 days after priming also augment the production of antitoxin by B memory cells.  (+info)

Prevention of tetanus in the wounded. (3/76)

Recommendations for the prevention of tetanus in the wounded have been revised to incorporate the use of human tetanus immunoglobulin, which is now available in the United Kingdom. Surgical toilet is of prime importance for all wounds, and is usually sufficient for tetanus prophylaxis in patients with wounds that are less than six hours old, clean, non-penetrating, and with negligible tissue damage. Human tetanus immunoglobulin should be given to patients with more serious wounds sho have had toxoid injections over 10 years earlier, had an incomplete course, or do not know their immunity status. The importance of active immunization is emphasized. The recommendations should be regarded as guidelines as the circumstances in individual cases will differ.  (+info)

Time resolved fluorometric immunoassay, using europium labelled antihuman IgG, for the detection of human tetanus antitoxin in serum. (4/76)

A time resolved fluorometric immunoassay (TRFIA) has been developed and compared with an in house enzyme linked immunosorbent assay (ELISA) and commercial ELISA (Bindazyme) for the detection of tetanus antitoxin in human sera. A panel of 132 sera submitted for routine testing was used. Scatterplots showed a high degree of correlation between all three assays, although some divergence of results was apparent for low titre sera when comparing in house ELISA results with Bindazyme ELISA and TRFIA results. The TRFIA appeared to be more sensitive than the in house ELISA, and the Bindazyme assay compared well with the TRFIA. The intra-assay precision of all three assays, in terms of percentage coefficient of variation (%CV), was between 2.0% and 4.0%. The interassay precision ranged from 5% to 8% for the in house ELISA, 13% to 19% for the Bindazyme assay, and 11% to 13% for TRFIA. Both Bindazyme and TRFIA assays were simple to perform, accurate, reproducible, and amenable to automation. A particular benefit of the TRFIA was its large dynamic range, enabling tetanus antitoxin values of 0.01 IU/ml to 50 IU/ml to be measured with just one dilution of serum. TRFIA appears to be a useful serological technique worthy of further development.  (+info)

Detection and quantitation of tetanus antitoxin in blood donations. (5/76)

Passive haemagglutination and IEOP have been used both to detect and to measure tetanus antitoxin in human donor sera. Forty percent of blood donors had detectable antitoxin but only 9% had levels suitable for production of human antitetanus immuoglobulin (larger than or equal to 2 IU/ml). The incidence of high titre antitoxin was significantly greater in men and was unrelated to the ABO blood group system. The prevalence of antitoxin in selected donor groups and immunized staff is shown.  (+info)

Immunogenicity test of tetanus component in adsorbed vaccines by toxin binding inhibition test. (6/76)

Samples from 20 lots of diphtheria-tetanus (adult use dT) vaccine and from 20 lots of diphtheria-tetanus-pertussis (DTP) vaccine were used to standardize and validate the in vitro toxin binding inhibition (ToBI) test for the immunogenicity test of the tetanus component. The levels of tetanus antitoxin obtained by ToBI test were compared to those obtained using the toxin neutralization (TN) test in mice routinely employed to perform the quality control of the tetanus component in adsorbed vaccines. The results ranged from 1.8 to 3.5 IU/ml for dT and 2 to 4 IU/ml for DTP by ToBI test and 1.4 to 3 IU/ml for dT and 1.8 to 3.5 IU/ml for DTP by TN in mice. These results were significantly correlated. From this study, it is concluded that the ToBI test is an alternative to the in vivo neutralization procedure in the immunogenicity test of the tetanus component in adsorbed vaccines. A substantial refinement and a reduction in use of animals can be achieved.  (+info)

Tetanus surveillance--United States, 1991-1994. (7/76)

PROBLEM/CONDITION: Despite the widespread availability of a safe and effective vaccine against tetanus, 201 cases of the disease were reported during 1991-1994. Of patients with known illness outcome, the case-fatality rate was 25%. REPORTING PERIOD COVERED: 1991-1994. DESCRIPTION OF SYSTEM: Physician-diagnosed cases of tetanus are reported to local and state health departments, the latter of which reports these cases on a weekly basis to CDC's National Notifiable Disease Surveillance System. Since 1965, state health departments also have submitted supplemental clinical and epidemiologic information to CDC's National Immunization Program. RESULTS: During 1991-1994, 201 cases of tetanus were reported from 40 states, for an average annual incidence of 0.02 cases per 100,000 population. Of the 188 patients for whom age was known, 101 (54%) were aged > or = 60 years and 10 (5%) were aged < 20 years. No cases of neonatal tetanus were reported. Among adults, the risk for tetanus increased with age; the risk for persons aged > or = 80 years was more than 10 times greater than the risk for persons aged 20-29 years. All deaths occurred among persons aged > or = 30 years. The case-fatality rate (overall: 25%) increased with age, from 11% in persons aged 30-49 years to 54% in persons aged > or = 80 years. Only 12% of all patients were reported to have received a primary series of tetanus toxoid before onset of illness. For 77% of patients, tetanus occurred after an acute injury was sustained. Of patients who obtained medical care for their injury, only 43% received tetanus toxoid as part of wound prophylaxis. INTERPRETATION: The epidemiology of reported tetanus in the United States during 1991-1994 was similar to that during the 1980s. Tetanus continued to be a severe disease primarily of older adults who were unvaccinated or inadequately vaccinated. Most tetanus cases occurred after an acute injury was sustained, emphasizing the need for appropriate wound management. ACTIONS TAKEN: In addition to decennial booster doses of tetanus-diphtheria toxoid during adult life, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination visits for adolescents at age 11-12 years and for adults at age 50 years to enable health-care providers to review vaccination histories and administer any needed vaccine. Full implementation of the ACIP recommendations should virtually eliminate the remaining tetanus burden in the United States.  (+info)

Recently occurring adult tetanus in Korea: emphasis on immunization and awareness of tetanus. (8/76)

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diphtheria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.  (+info)