Age-specific seroprevalence of poliomyelitis,diphtheria and tetanus antibodies in Spain

In 1996, a seroepidemiological study was undertaken in Spain, with the main aim of estimating the population's immunity against poliomyelitis, tetanus and diphtheria. A population-based cross-sectional study was conducted, covering the population aged 2-39 years. The sample was stratified by age and rural-urban environment, and informed consent obtained to take blood specimens from subjects attending phlebotomy centres. The study included 3,932 persons and the prevalence of antibodies against all three types of poliovirus exceeded 94% across all age groups. From a high of 96% in subjects under the age of 15 years, immunity against diphtheria steadily declined to a low of 32.3% in subjects aged 30-39 years. Similarly, tetanus antitoxin concentrations indicating basic protection were present in 98.9% of the under-14 years age group; thereafter, immunity declined, until reaching 54.6% in the 30-39 years age group.     

临沂市健康人群白喉和破伤风抗体水平调查

目的为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法采用分层随机抽样的方法,2001、2003、2004年调查了临沂市10个县(区)0~39岁847人的白喉和破伤风抗体水平。结果白喉和破伤风抗体总阳性率分别为77.80%和74.03%,阳性率均是0~4岁组最高,20~39岁组最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.0997U/ml和0.0674U/ml,均是8~10岁组最高,20~39岁组最低。结论临沂市白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强百日咳、白喉的免疫,并在新生儿破伤风高危县区对育龄期妇女开展破伤风疫苗免疫。     

河南省健康人群白喉和破伤风抗体水平调查

目的为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法采用分层整群随机抽样的方法,1998~2002年调查了河南省21个县(区、市)2~39岁3 510人的白喉和破伤风抗体水平。结果白喉和破伤风抗体总阳性率分别为80.5%和77.9%,阳性率均是2~3岁最高,25~39岁最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.101IU/ml和0.073IU/ml,均是8~9岁最高,25~39岁最低。结论河南省白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强白喉疫苗的免疫,并在新生儿破伤风高危县对育龄期妇女开展破伤风疫苗免疫。     

临沂市健康人群白喉和破伤风抗体水平调查

目的 为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法 采用分层随机抽样的方法,2001、2003、2004年调查了临沂市10个县（区）0-39岁847人的白喉和破伤风抗体水平。结果 白喉和破伤风抗体总阳性率分别为77.80%和74.03%,阳性率均是0-4岁组最高,20-39岁组最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.0997U/ml和0.0674U/ml,均是8-10岁组最高,20-39岁组最低。结论 临沂市白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强百日咳、白喉的免疫,并在新生儿破伤风高危县区对育龄期妇女开展破伤风疫苗免疫。     

Immunity to diphtheria and tetanus in England and Wales

The immunity profile of the English and Welsh population to diphtheria and tetanus has been determined by measuring diphtheria and tetanus antitoxin levels for 3088 and 3142 sera, respectively. Time-resolved fluorimetric immunoassay - DELFIA was used to measure diphtheria antitoxin levels and an in-house, indirect ELISA to measure tetanus antitoxin levels. More than 80% of those aged between 2 and 20-24 years had protective diphtheria antitoxin levels of 0.01 IU/ml, or greater, and more than 80% of those aged between 4 and 35-39 years had protective tetanus antitoxin levels of 0.1 IU/ml, or greater. Only 29% and 53% of those aged 60 and over were protected against diphtheria and tetanus. Two increases of diphtheria antitoxin levels greater than 0.1 IU/ml and tetanus antitoxin levels greater than 1.0 IU/ml were apparent, starting at 4 and 14 years of age, which correspond with the policy of giving a diphtheria and tetanus toxoid booster on school entry and a tetanus plus low-dose diphtheria toxoid (recently introduced) booster to school leavers. This is the first comprehensive study of diphtheria and tetanus immunity in the English and Welsh population and shows that the accelerated schedule of immunisation, introduced in 1990, has effectively primed immunological memory against both these antigens and that boosting at school entry and at school leaving is effective in increasing levels of immunity.     

Seroprevalence and determinants of diphtheria, tetanus and poliomyelitis antibodies among adults in Berlin, Germany

The immunity levels against diphtheria, tetanus and poliomyelitis were investigated among blood donors (n = 2079) in Berlin. Of all participants, only 60% had full, long-term protection against diphtheria, 72% against tetanus, 87% against poliomyelitis type 1, 77% against poliomyelitis type 2 and 73% against type 3. There was a striking decrease of tetanus and diphtheria immunity levels by age. Immunity levels against tetanus were higher among males, whereas females were better protected against poliomyelitis. After adjusting for confounding effects in logistic regression diphtheria immunity in those aged <40 years was significantly higher in participants from East-Berlin, whereas the immunity levels against poliomyelitis were higher in West-Berlin. These differences reflect the different vaccination policies in East-Germany and West-Germany before 1989. There is a need to improve the immunity levels of the adult population in Berlin.     

2011年湖北省麻城市健康人群百日咳、白喉、破伤风抗体水平调查

目的调查评估麻城市2011年健康人群中百日咳、白喉和破伤风抗体水平。方法随机抽取健康人群血清480人份,分为六个年龄组,采用ELISA法检测百日咳IgG、白喉IgC和破伤风IgG。结果百日咳IgG、白喉IgG和破伤风IgG保护率分别为21．04％、73．33％和67．71％。3-6岁与7-14岁白喉抗体保护率分别为90％和76．67％,两年龄段抗体保护率差异有统计学意义（X^2=29．73,P〈0．01）;3-6岁与7-14岁破伤风抗体保护率分别为93．33％和66．67％,两年龄段抗体保护率差异有统计学意义（X^2=40．52,P〈0．01）。结论麻城市人群中百日咳抗体水平较低,6岁以后人群中白破抗体水平下降明显。     

Immunity against diphtheria among children and adults in Izmir, Turkey

The aim of this study was to evaluate diphtheria immunity in a sample of the Turkish population having high childhood immunization coverage, including a booster dose of diphtheria toxoid at 12-15 years of age. A total of 599 persons aged 1-70 years were selected with cluster sampling. The information on socio-demographic characteristics, vaccination status and diphtheria history was gathered for each participant. Diphtheria antitoxin levels were measured qualitatively by using micro-enzyme immune assay. Of studied population, 72.3% had fully protective antitoxin levels (≥0.1 IU/ml). The rate of protection was 92.5% in the children aged 0-2 years, 93.2% in the primary school children aged 7-9 years, and 86.0% in the adolescents aged 15-19 years. After 20 years of age, diphtheria protection rates showed a significant age-related decrease, reaching minimum in the 30-39 age group, in which 47.3% of these subjects had fully protective antitoxin levels. The diphtheria antitoxin geometric mean titer (GMT) was highest in the 0-2 year age group (1.18 IU/ml). In the adolescents aged 15-19 years, diphtheria antitoxin GMT was 0.71 IU/ml. Then, geometric mean titer decreased with increasing age, and reached the minimum level in the 40-59 years age group (0.18 IU/ml). The protection rate among females was significantly lower than males (67.1% vs. 80.9%). The difference was apparent in the 20-29 and the 30-39 years age group: 80% of the males and 46.2% of the females in the 20-29 years age group, and 60% of males and 44.1% of females in the 30-39 years age group were fully protected against diphtheria (p < 0.0001). These results suggest that in Izmir, Turkey, full serological protection against diphtheria is only detectable in <50% of the young adult population, even though childhood immunization coverage is relatively high. Potentially, there is still risk of diphtheria outbreaks among the adults in our country. Therefore, a revaccination of adults with reduced doses of diphtheria toxoid should be considered to sustain diphtheria immunity.     

Immunity of children aged 6-8 against pertussis,tetanus and diphtheria

Vaccination against pertussis has been performed since 1960. Whole cell pertussis vaccine produced by Plant of Sera and Vaccines Biomed S.A. in Kraków, has been used. After vaccination has been introduced, epidemiological situation of pertussis in Poland improved, but in 90's the decrease of immunity was observed. The aim of this work was to determine pertussis immunity of children after several years from the last dose of pertussis vaccine. For comparison purposes immunity against tetanus and diphtheria was tested. Protective antibody levels were detected in 70%, 58%, and 45% children aged 6, 7, and 8, respectively. It shows that decrease of immunity may cause increasing number of pertussis in children above 5. Taking into consideration our results, it seems necessary to introduce additional dose of pertussis vaccine among children aged 5 years. The level of tetanus and diphtheria antibodies was high in all tested groups.     

Immunity to tetanus and diphtheria in the UK in 2009

Introduction

This study aimed to estimate the immunity of the UK population to tetanus and diphtheria, including the potential impact of new glycoconjugatate vaccines, and the addition of diphtheria to the school leaver booster in 1994.

Methods

Residual sera (n = 2697) collected in England in 2009/10 were selected from 18 age groups and tested for tetanus and diphtheria antibody. Results were standardised by testing a panel of sera (n = 150) to enable comparison with a previously (1996) published serosurvey. Data were then standardised to the UK population.

Results

In 2009, 83% of the UK population were protected (≥0.1 IU/mL) against tetanus compared to 76% in 1996 (p = 0.079), and 75% had at least basic protection against diphtheria (≥0.01 IU/mL) in 2009 compared to 60% in 1996 (p < 0.001). Higher antibody levels were observed in those aged 1–3 years in 2009 compared to 1996 for both tetanus and diphtheria. Higher diphtheria immunity was observed in those aged 16–34 years in 2009 compared to 1996 (geometric mean concentration [GMC] 0.15 IU/mL vs. 0.03 IU/mL, p < 0.001). Age groups with the largest proportion of susceptible individuals to both tetanus and diphtheria in 2009 were <1 year old (>29% susceptible), 45–69 years (>20% susceptible) and 70+ years (>32% susceptible). Low immunity was observed in those aged 10–11 years (>19% susceptible), between the scheduled preschool and school leaver booster administration.

Discussion

The current schedule appears to induce protective levels; increases in the proportions protected/GMCs were observed for the ages receiving vaccinations according to UK policy. Glycoconjugate vaccines appear to have increased immunity, in particular for diphtheria, in preschool age groups. Diphtheria immunity in teenagers and young adults has increased as a result of the addition of diphtheria to the school leaver booster. However, currently older adults remain susceptible, without any further opportunities for immunisations planned according to the present schedule.     

Prevalence of IgG diphtheria antitoxin in blood donors in Rio de Janeiro

The lack of information on the immunity of adults in Brazil against diphtheria prompted us to analyse sera from 234 blood donors aged 18-61 years (30.3% females and 69.7% males). IgG diphtheria antitoxin levels determined by means of an ELISA, validated by toxin neutralization test in Vero cells, showed that 30.7% (95% CI 25.0-37.1) of the population was fully protected (>or=1 IU/ml). The highest percentage of subjects fully protected was in the 31-40 years age group. Most of the subjects with uncertain or no protection (<1 IU/ml) were found in the 18-30 years age group (43.8%, OR 2.18, P=0.01). Antitoxin levels were not influenced by the increase in age. Males were more protected than females (80.5%, OR 0.44, P=0.01). The prevalence of 30% of individuals fully protected against diphtheria in blood donors in Rio de Janeiro supports the fact that immunity to diphtheria among healthy Brazilian adults is inadequate. To avoid diphtheria epidemics in the future the immunity among adults should be raised in the coming years.     

Tetanus and pertussis vaccination coverage among adults aged ≥ 18 years --- United States, 1999 and 2008

In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended that the newly licensed tetanus, diphtheria, and acellular pertussis (Tdap) vaccine replace a single decennial dose of tetanus diphtheria (Td) vaccine for persons aged 10-64 years. According to these recommendations, Tdap may be used to protect against pertussis even when <10 years have passed since the most recent tetanus vaccination. For adults with infant contact and health-care personnel (HCP) with direct patient contact (two groups at increased risk for transmitting pertussis to those who are most susceptible), the single recommended Tdap dose is suggested to be administered as soon as 2 years after the last tetanus vaccination. To assess changes in tetanus vaccination coverage and the use of Tdap among U.S. adults, CDC analyzed data from the National Health Interview Survey (NHIS) for 1999 and 2008. This report summarizes the results of that analysis, which indicated that self-reported tetanus vaccination coverage (vaccination within the preceding 10 years) was 60.4% in 1999 and 61.6% in 2008. Among adults aged 18-64 years, Tdap coverage was estimated to be 5.9% in 2008. Of those who reported receiving a tetanus vaccination during 2005-2008, 52.0% reported receiving Tdap. Tdap vaccination coverage among adults with infant contact was 5.0% and among HCP was 15.9%. Of those adults with infant contact and HCP who had received a tetanus vaccination during 2005-2008, 60.0% and 60.3% reported receiving Tdap, respectively. Health-care providers should recommend Tdap vaccination to adults aged 18-64 years whose most recent tetanus vaccination was ≥10 years prior; the interval for HCP and persons with infant contact can be as short as 2 years.     

杭州市1995--2006年健康人群百日咳白喉破伤风抗体水平监测分析

目的了解杭州市健康人群百日咳、白喉、破伤风抗体水平。方法1995～2006年,在不同区（县、市）,分2～4岁、6～8岁、13～15岁、25～39岁4个年龄组开展百日咳、白喉、破伤风抗体监测。结果百日咳抗体共监测1942人,保护率为93．87％,几何平均摘度为1：1037．36。其中农村2～4岁保护率低于其它三个年龄组,与6～8岁、13～15岁组保护率差异有非常显著的统计学意义（χ^2=8．80、6．13;P均〈0．01）。白喉抗体监测2141人,阳性率91．59％,几何平均浓度（GMC）为0．291国际单位／毫升（IU／m1）。破伤风抗体监测2141人,阳性率72．35％,GMC为0．095IU／ml。结论应加强农村地区的免疫规划管理及预防接种工作。     

Tetanus incidence and immunity in Poland

The level of tetanus antibody was determined with the passive hemagglutination method in 503 sera of 10 to 90-year-old persons. Immunity to tetanus was age-dependent: the percentage of immune persons amounted to 90% –100% in persons below 40 years and then declined to 70% and 60% in persons in the 40 – 50 and above 50 year-old groups, respectively. Males above 30 years are better immunized than females. The comparison of the results of the present study with results of several periodic surveys performed in the last 27 years showed gradually increasing immunity level in all age groups. The findings are in agreement with age-dependent incidence of tetanus, which has become now, in Poland, a disease primarily of older people.     

Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: Nationwide population-based survey, 2010

Background

Tajikistan had a major diphtheria outbreak (∼10,000 cases) in the 1990s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus.

Methods

Residents of all regions of Tajikistan aged 1–24 years were included in the serosurvey implemented during September–October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥0.1 IU/mL were considered seropositive.

Results

Overall, 51.4% (95% CI, 47.1%–55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%–82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10–19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%–43.7%) among 10–14 year-olds, and 35.3% (95% CI, 29.9%–41.1%) among 15–19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%–71.6%) and 70.1% (95% CI, 64.5%–75.2%).

Conclusions

Population immunity for diphtheria in Tajikistan is low, particularly among 10–19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10–19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1–19 years in 2010 (3–21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.     

Tetanus immunity in individuals aged 50 years or older in Kashan, Iran

Tetanus can be only prevented by vaccination because immunity against this disease is rarely acquired, even by natural infections. To maintain long-term protective immunity against tetanus, booster immunization is essential for adolescents and adults. Most hospitalized cases and virtually all deaths occur in people over 60 years of age. The purpose of this study was to investigate the degree of protective tetanus immunity among 50 years of age and older people in Kashan city, Iran. This cross-sectional study carried out on 180 randomly individuals aged 50 years or older who were visiting a central laboratory for health examinations in 2008. Participants' serum levels of tetanus antitoxin were measured by enzyme linked immunosorbent assay. A standard questionnaire was used to collect demographic data and information about risk factors. The prevalence of protective tetanus immunity in various age groups was described and sociodemographic factors that potentially influenced the degree of tetanus immunity were analyzed. Overall, 180 persons were included. Of these, 72 (40%) had never received a toxoid booster, while 47 (26.1%) had received a booster at least once. Among all participants, 30 (16.7%) had protective tetanus antitoxin levels (≥ 0.11 IU/mL), and 34 (18.9%) had protective antitoxin levels without the need of an immediate booster ≥0.51 IU/mL. Among 86 participants aged >60 years, 6 (7%) had protective antitoxin levels ≥0.1-1 IU/mL, and 5(5.8%) had protective antitoxin levels ≥1 IU/mL. Male gender and prior receipt of toxoid booster(s) were associated with protective tetanus immunity. Tetanus antitoxin levels declined with age. It appears that most 50 years of age and older adults do not have protective levels of tetanus antitoxin because of inadequate vaccination coverage. There is a need to improve the immunity levels of this age group. It is recommended to vaccinate elderly people against tetanus.     

Notes from the field : use of tetanus, diphtheria, and pertussis vaccine (Tdap) in an Emergency Department - Arizona, 2009-2010

Because of an increasing incidence of reported pertussis cases attributed to waning immunity among adults and adolescents, the Advisory Committee on Immunization Practices (ACIP) in 2005 recommended administration of a new, combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) for adolescents and adults aged 11-64 years. ACIP recommended that they receive a single dose of Tdap to replace tetanus and diphtheria toxoid vaccine (Td) for booster immunization against tetanus and diphtheria if they had not previously received Tdap. Adults aged ≥65 years were to receive Td according to ACIP recommendations. To learn whether these age-specific recommendations were being followed in an emergency department (ED), the charts of a sample of patients receiving tetanus vaccines at a large ED were reviewed.     

2010年白山市健康人群百日咳、白喉及破伤风IgG抗体水平监测

目的了解白山市健康人群百日咳、白喉、破伤风血清抗体水平。方法在全市6个县(市、区)采取随机抽样的方法抽取八道江区,对0～1岁、1～2岁、3～4岁、5～6岁、7～14岁、15～19岁、﹥20岁7个年龄组的健康人群进行抗体水平监测。结果百日咳IgG抗体阳性率为80.0%,白喉IgG抗体阳性率为68.10%,新生儿破伤风IgG抗体阳性率为49.52%。不同年龄组人群百日咳、白喉、破伤风抗体阳性率比较,差异有统计学意义(P﹤0.05)。结论在进一步提高常规免疫接种率的基础上,加强人群免疫水平监测,考虑对成人进行加强免疫[1]。     

Antitoxins for diphtheria and tetanus decline more slowly after vaccination with DTwP than with DTaP: A study in a Chinese population

Objectives

DTP vaccines are used for the prevention of pertussis, diphtheria and tetanus. In 2007, in Gaobeidian city, China, the DTwP vaccine was replaced with DTaP. This study described the diphtheria and tetanus sero-epidemiology in subjects vaccinated solely with DTwP or DTaP.

Methods

Blood samples were obtained between October 2012 and June 2013 from 587 healthy subjects aged 2–17 years. Serum IgG antibodies against diphtheria and tetanus were determined using ELISA. Interrupted time series analyses examined the changes in antitoxin levels over time and analyzed the alterations in diphtheria and tetanus antitoxin levels after the vaccine switch.

Results

Mean concentrations of diphtheria antitoxin and tetanus antitoxin were 0.074 IU/ml (95% CI 0.065–0.084) and 0.063 IU/ml (95% CI 0.053–0.076). The protection rates (antitoxins >0.01 IU/ml) for diphtheria and tetanus were 88.25% and 82.11%. Mean antitoxin levels for both diphtheria and tetanus decreased with increasing age, but this decrease was much slower for DTwP than DTaP.

Conclusions

Although the observed protection rates for diphtheria and tetanus were sufficient to prevent an outbreak at present, the means levels of diphtheria and tetanus antitoxins decreased with increasing age; therefore, booster vaccinations at 7 and 12 years of age would be strengthened in Gaobeidian city, China.     

深圳市南山区健康人群百日咳、白喉、破伤风抗体水平监测

目的了解健康人群百日咳、白喉和破伤风的免疫状况。方法随机抽查部分1～40岁健康人群进行百日咳、白喉和破伤风的抗体水平监测。结果百日咳抗体几何平均滴度1:77.63,抗体保护率21.97%;白喉、破伤风抗毒素平均滴度1.33IU/ml和0.73IU/ml,阳性率99.08%和81.92%。结论对百日咳、白喉和破伤风已经形成了较好的免疫屏障,但人群百日咳抗体水平偏低,应大力推广百白破联合疫苗。