Serological survey on the immunity to diphtheria of the northern Greek population

The recent outbreak of diphtheria in the Newly Independent States (NIS) of the former USSR and the immigration from these high risk areas to Greece prompted us to determine the diphtheria antitoxin levels by enzyme-linked immunosorbent assays (ELISA) in 509 healthy individuals (307 males and 202 females) from northern Greece. The population under study was divided in ten age groups from 1 day to > 60 years old. Diphtheria antitoxin levels of 0.1 IU/ml were considered as protective ones. 44.6% of the examined people were found susceptible. The children up to their twenties seem to be immune to diphtheria in a high proportion (86–88.4%). The diphtheria antitoxin levels declined sharply above this age (17.6% in the age group 21–30 years old). The level of protection in adults appeared to be higher in the oldest group (49%). According to these results, the adults are not properly protected. Booster doses of vaccine for them are recommended to improve the resistance of the northern Greek population from possible infection by toxigenic stains of Corynebacterium diphtheriae, imported or endogenous.     

北京市西城区健康人群白喉抗体水平监测

目的了解北京市西城区健康人群白喉抗体水平,为传染病预防控制工作提供科学依据。方法采集西城区10个居委会本市及外省健康人群血标本共220份,采用酶联免疫吸附试验(ELISA)测定白喉抗体,同时调查患病史、免疫史及人口学特征。结果白喉抗体阳性率为78.64%,抗体几何平均浓度(GMC)为0.421 IU/ml,不同性别、不同户籍白喉抗体阳性率和GMC比较,差异无统计学意义(χ2=0.244,P=0.622;t=0.841,P=0.401)。≥20岁人群白喉抗体阳性率和GMC随年龄增长和免疫后时间延长而逐渐下降。结论预测西城区近期不会发生白喉暴发流行;当出现白喉流行迹象时,建议对成人开展白破疫苗加强免疫。     

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。     

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。     

Identification of a novel vaccine adjuvant that stimulates and maintains diphtheria toxoid immunity

Immunomodulation by plant-derived medicines is well-documented with effects on both innate and adaptive immunity. This study reports potent and long-lasting diphtheria toxoid-specific immunity by the botanical medicinal, Rehmannia Six Formula, using an in vivo mouse model of vaccine immunity. A significant vaccine adjuvant effect was observed with an increase in serum anti-diphtheria toxoid total and IgG antibodies following oral administration of Rehmannia Six Formula to mice. This response was antigen-specific and was still detectable six months following botanical medicinal treatment, suggesting that Rehmannia Six Formula could help maintain protective antibody levels in populations where vaccine coverage is low. Rehmannia Six Formula was well-tolerated with no adverse effects on mouse weight or survival observed in this study and suggests a potential role as a novel vaccine adjuvant preparation.     

2013 年广西武鸣县全人群麻疹和白喉抗体水平调查

目的了解广西武鸣县全人群白喉和麻疹抗体水平,初步评价免疫规划效果,为麻疹预防控制提出科学的建议和对策。方法按（2013年广西部分县全人群免疫规划抗体水平调查表》抽样调查和采集血清,由自治区疾病预防控制中心（CDC）对血清样本进行白喉和麻疹检测。结果共调查600人,人群中白喉IgG和麻疹IgG抗体阳性率、保护率分别为86．50％和82．50％、43．83％。白喉IgG阳性率和麻疹IgG保护率存在地区上的差异,白喉IgG抗体阳性率双桥镇（91．5％）分别高于锣圩和灵马镇（P〈0．05）;麻疹IgG保护率三合村最高（54．55％）,王桥村最低（37．31％）。年龄分布上白喉和麻疹IgG抗体阳性率均呈现中间低、两端高的现象。男性和女性的白喉和麻疹抗体阳性率差异均无统计学意义。有含麻疹类疫苗免疫史的人群抗体阳性率高于无免疫史者和免疫史不详者。结论现阶段武鸣县仍有发生麻疹疫情暴发或流行的血清学基础。应从落实人员经费、采取常规免疫与强化免疫相结合、加强对免疫规划薄弱区域的甄别管理等行政措施和技术措施上开展预防控制工作,才能达到控制和消除麻疹的目的。     

湖北省2009年健康人群百日咳、白喉、破伤风抗体水平监测分析

目的:为了解湖北省2009年健康人群血清中百日咳、白喉和破伤风抗体水平,抽样评价预防接种质量。方法:分七个年龄组抽取黄冈地区、咸宁地区、宜昌市和十堰市四个地区部分健康人群,采用间接ELISA法(定量)检测健康人群血清中百日咳、白喉、破伤风IgG抗体水平。结果:四个地区健康人群中,百日咳、白喉、破伤风IgG抗体阳性率分别为34.5%5、9.3%和62.2%。结论:湖北省四个地区健康人群百日咳、白喉、破伤风抗体保护率比较低,提示我们要扩大接种覆盖率,提高冷链运转效率和疫苗接种质量。     

A multicentre serosurvey on diphtheria immunity in a French population of 1004 subjects

Diphtheria immunity was determined in serum specimens obtained in 1994 from 1004 subjects seen in emergency departments of three distant French cities. An enzyme immunoassay was used to measure serum diphtheria antitoxin concentrations according to the following criteria: (a) antitoxin < 0.01 IU/ml: susceptibility, (b) 0.01–0.09 IU/ml: basic protection, (c) 0.10 IU/ml: full protection. Among these patients, 20.3% were fully susceptible to diphtheria, 30.3% had basic but doubtful protection and only 49.4% were fully protected. Protection was different by age-groups: 73.5% of the subjects under 40 years of age, 46% between 40 and 65 and 33% over 65 were fully protected. Protection decreased with increasing age (p < 0.001)and was greater for men than women after 40 years of age (p < 0.001). The results of this exploratory study indicate that the enhancement of diphtheria immunity by boosters in adult population should be reconsidered in France as well as in many industrialized countries.     

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]。     

Low prevalence of diphtheria immunity in the Spanish population: results of a cross-sectional study

A seroepidemiological study was conducted on a representative sample (n = 3944) of the Spanish population to assess the immune status to diphtheria. A total of 1907 men and 2037 women in the 5-59 years age range were stratified by sex and age (5-12, 13-19, 20-29, 30-39, 40-49, 50-59 years). Concentrations of toxin antibodies were measured using a commercial ELISA kit. Samples with titres > or = 0.1 IU/ml were considered to show full protection. Only 26% (95% CI: 25-28%) of the overall population studied was fully protected. The highest number of subjects with uncertain or no protection was found in the 20-39 age group (> 85%). The prevalence of fully protected subjects progressively declined from 51% for the 5-12 year age group, to 14% for the 30-39 year age group, whereas it increased to 20% and 35% for the 40-49 and the 50-59 year age groups, respectively (p < 0.0001). These results stress the need to intensify vaccination programs in adolescents and adults with periodic booster doses of diphtheria toxoid.     

Persistence of diphtheria, Hyderabad, India, 2003-2006

During 2003-2006, diphtheria rates in Hyderabad, India, were higher among persons 5-19 years of age, women, and Muslims than among other groups. Vaccine was efficacious among those who received >/=4 doses. The proportion of the population receiving boosters was low, especially among Muslims. We recommend increasing booster dose coverage.     

The prevalence of diphtheria immunity in healthy population in Poland

The degree of seroprotection against diphtheria in Poland was evaluated by determination of IgG antibodies to Corymebacterium diphtheriae toxin (IgG-DTAb). The study population consisted of 4,829 healthy subjects aged from 1 day to 85 years from 7 regions of Poland. Serum samples collected between 1996 and 1998 were assayed for IgG-DTAb antibodies using a toxoid enzyme immunoassay. Neutralization of toxin in Vero cells was performed as a reference method with the WHO standard for human diphtheria antitoxin. The study revealed a lack of seroprotection (IgG-DTAb < 0.1 IU/ml) in 23% of individuals, basic seroprotection (0.1-1.0 IU/ml) in 64%, and effective seroprotection (> 1.0 IU/ml) in 13%. The non-protected group consisted of non-vaccinated children below 2 months of age (10%), individuals between 2 months and 18 years old (20%) and greater than 19 years old (70%). Of the adults, 32% were seronegative, 63% had basic seroprotection and only 5% were fully protected; 43% of adults between 30 and 64 years, who had not been vaccinated at least during the previous 10 years were not protected against diphtheria. The geometric mean titre (GMT) of IgG-DTAb was 0.25 IU/ml in the total population. Age-related GMTs differed significantly from each other and were higher (0.44 IU/ml) in individuals from 2 months to 18 years old, compared with 014 IU/ml and 0.17 lU/ml in children under 2 months and adults, respectively. No significant difference was found in the GMTs of men and women in all age groups. We conclude that the currently used vaccination programme in Poland is highly effective and assures protection against diphtheria in the majority of the population in the 10-year period following the last booster. However, a significant proportion of adults between 30 and 64 years lack protection and this indicates a need for booster immunization for this group.     

Booster vaccination of adults with reduced-antigen-content diphtheria,Tetanus and pertussis vaccine: Immunogenicity 5 years post-vaccination

At 60 months post-vaccination, adults (mean age 45.6 years) randomised to receive combined reduced-antigen-content diphtheria–tetanus and acellular pertussis vaccine (dTpa) versus tetanus–diphtheria (Td) + monovalent acellular pertussis (pa) were seroprotected against diphtheria (≥0.016 IU/mL Vero cell assay) and tetanus (≥0.1 IU/mL ELISA assay) in 94.4% and 96.2%, respectively (dTpa), compared with 93.7% and 90.6% (Td + pa). Anti-FHA, anti-PT and anti-PRN antibodies (≥5 EL.U/mL) were maintained in 100%, 89.5% and 95.0% of dTpa versus 100%, 85.5% and 90.6% of pa vaccine recipients. At 5 years post boosting, antibody levels to diphtheria and tetanus are similar amongst adults receiving a dTpa or dT, and pertussis antibodies remain above pre-booster levels in at least 85%.     

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。     

Comparative seroepidemiology of pertussis, diphtheria and poliovirus antibodies in Singapore: waning pertussis immunity in a highly immunized population and the need for adolescent booster doses

Background

We assessed the seroepidemiology of pertussis, diphtheria and poliovirus antibodies in a cohort of highly immunized children, together with the burden of these diseases in Singapore.

Methods

Hospital residual sera collected between August 2008 and July 2010 from 1200 children aged 1–17 years were tested for the prevalence of IgG antibodies against Bordetella pertussis, diphtheria toxoid, and all three poliovirus types by enzyme-linked immunosorbent assays.

Results

We found an overall seroprevalence of 99.4% (95% CI 98.8–99.7%) for diphtheria, and 92.3% (95% CI 90.6–93.6%) for poliomyelitis, along with no indigenous cases of these diseases since 1993. However, the seroprevalence for pertussis was 60.8% (95% CI 58.0–63.5%) only. Among the subjects who had completed three doses of pertussis vaccination by the age of 2 years (n = 1092), the pertussis seroprevalence was 85.0% (95% CI 79.7–89.2%) in those who received the last vaccination within a year before the study, and it decreased to 75.0% (95% CI 64.5–83.2%) and 63.1% (95% CI 50.9–73.8%) in those who had the last vaccination 1 year and 2 years before the study, respectively. The seroprevalence remained at about 50% for those whose last pertussis vaccination was administered 4 years and longer before the study.

Conclusions

The high seroprevalence for poliomyelitis and diphtheria confer solid herd immunity to eliminate these diseases in Singapore. In contrast, immunity against pertussis waned considerably over time, and routine boosters should be given to adolescents to ensure sustained immunity against pertussis.     

Serological survey of immunity to tetanus in adult population of Northern Halkidiki, Greece

BACKGROUND: Despite the implementation of the obligatory anti-tetanus vaccination, the tetanus cases in Greece are not eliminated. Because of the increased possibility of Clostridium tetani infection of the Northern Halkidiki population--like any other rural population the evaluation of the immunity to tetanus in the area is considered necessary. METHODS: The tetanus antitoxin levels were determined using the enzyme-linked immunosorbent assay (ELISA) in 405 healthy adult individuals attending the health center for routine laboratory tests. RESULTS: 64.4% of the studied population was found protected (tetanus antitoxin levels > or = 0.1 IU/ml). The percentage of protected people decreased as age increased from 83.3% in the 21-30 to 51.2% in the > 60 age group. 82.1% of the tested males and 52.6% of the tested females had tetanus antitoxin levels > or = 0.1 IU/ml (p < 0.0001). The percentages of immune men (100-66.2% in various age groups) were found higher than those of women (80.8-35.5% in the respective age groups). The geometrical mean titres (GMTs) were 0.44 in all of 261 immune people, 0.53 in 133 immune men and 0.37 in 128 immune women (p = 0.0021). CONCLUSION: The proportion of protection among men over 60 and women over 30 years old is inadequate, the levels of tetanus antitoxin decline with age and a significant difference was found between the proportion of protection of males and females.     

Immunity to diphtheria in Izmir, Turkey

In order to assess immunity to diphtheria in Izmir, Turkey, a total of 743 persons 1–70 years of age 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, 79.1% had fully protective antitoxin levels ( 0.1 IU/ml). Diphtheria protection rates showed a gradual age-related decrease, reaching minimum in the 30–44 age group, in which 40.2% of these subjects had antibody titre below the full protective level. The diphtheria antitoxin geometric mean titer was highest in the 5–9 year age group (1.05 IU/ml). Then, geometric mean titer decreased with increasing age, and reached the minimum level in the 30–44 age group (0.19 IU/ml). These results suggest that in Izmir, Turkey, full serological protection against diphtheria is only detectable in 60% of the adult population. The enhancement of diphtheria immunity by booster vaccinations in adolescents and adults should be considered in Turkey.     

精制锡克氏毒素人群使用效果观察及三种方法测定白喉抗毒素比较

我们发现精制白喉毒素十分稳定,用这种毒素制备的锡克氏毒素,其中和白喉抗毒素的能力恒定,符合英国药典(1980)规定,並显著地低于原制锡克氏毒素的中和力,又因其中无“类毒素”成分,故其ST的敏感性大为提高。用这种精制锡克氏毒素进行人群观察结果表明,锡克氏阳性反应及阴性反应与标准动物法测得的对应人血白喉抗毒素单位符合率分别为96.67%及90%,且无过敏反应发生。其假阳性反应与混合反应皆明显地低于用陈旧原毒素制备的锡克氏毒素。我们结果还证明,iHA试验的敏感性低于ST和动物测定,iHA试验与动物测定结果的符合率为68.83%,与ST的符合率为70.47%。     

Humoral immunity to tetanus,diphtheria and polio in adults after treatment for hematological malignancies

IntroductionAfter chemotherapy, children with acute lymphocytic leukemia lose immunity and need revaccination against tetanus and diphtheria. However, little is known about immunity in adult patients after treatment for hematological malignancies. In this study, we assessed serology levels against polio, diphtheria and tetanus in adult patients after conventional treatment for leukemia and lymphoma.PatientsOne hundred and four patients, age 61 (19–86) years, were included at a median of 18 (4–77) months after chemotherapy for acute leukemia (n = 24) or lymphoma (n = 80). Pre-treatment sera were available in 73 cases for a pre-versus post treatment comparison. Healthy, age- and sex matched controls were available for 47 pts.MethodsTetanus antibodies were quantified using ELISA, and antibody levels ≥0.01 IU/mL were considered protective. Diphtheria antibodies were analyzed using neutralization test (n = 60) or by ELISA (n = 44). In both tests values ≥0.01 IU/mL were considered protective. Antibodies against poliovirus serotype 1 and 3 were assessed by a neutralizing test. A microneutralization titer of ≥2 was considered protective.ResultsTetanus: There were significantly more non-immune patients after treatment (24%), compared to before (12%), p = 0.02. Post-treatment antibody levels were significantly lower than pre-treatment levels (p = 0.02). Diphtheria: There was a trend, p = 0.06, towards more non-immune patients after treatment (21%) compared to before (27%). Antibody levels post treatment were lower than pre treatment levels (p = 0.03) and lower than controls (p = 0.01). Polio: There was no significant difference in the number of non-immune patients before vs after chemotherapy for either PV1 or PV3. Protective immunity against serotype 1 and 3 was preserved in 90 and 97%, respectively.ConclusionsAfter standard chemotherapy for leukemia and lymphoma a significant proportion of patients had impaired humoral immunity to diphtheria and tetanus. However, polio immunity was well preserved.