Epidemiologic data for tetanus prophylaxis. Assessment of the need for vaccination

OBJECTIVE: In spite of the low morbidity secondary to tetanus, the high fatality rate (about 50%) requires effective and extensive protection of the population by vaccination. Since documentation is often lacking, booster tetanus vaccination is frequently applied in cases of minor injury. This leads to vaccination associated complications such as hyperergic reactions. The more intense the vaccination-associated side effects are, the less revaccination is possible. We investigated the tetanus immune status of a selected Austrian population. MATERIALS AND METHODS: Tetanus antitoxin antibodies were measured with ELISA (Immunozym Tetanus, Immuno AG) in serum samples from 218 subjects who were hospitalised in a dermatology unit. In addition, patient history and data concerning vaccination were collected. RESULTS: Based on the assumption that an antitoxin level of 0.1 IU/ml provides sufficient protection, 63% of the subjects were found to be adequately protected. 56% showed high antibody concentrations above 0.5 IU/ml. However, the data also revealed no protection by vaccination in 37% of the subjects. Data obtained by case history or vaccination certificates could not serve as a discrimination factor for applying revaccination or not. CONCLUSION: We strongly recommend better documentation of tetanus vaccination. In some cases, a search for tetanus antibodies before applying booster tetanus vaccination might be necessary.     

Seroprevalence of tetanus toxoid antibody and booster vaccination efficacy in Japanese travelers

Tetanus can be prevented by vaccination, which is especially important for overseas travelers. However, despite booster vaccination every 10 years being recommended, most Japanese adults do not receive it in the absence of physical injury or overseas travel. We aimed to investigate the level of protective immunity against tetanus among Japanese travelers, which may provide valuable information for formulating booster vaccination recommendations. 113 Japanese travelers given tetanus toxoid were recruited. The collected samples included paired samples prior to and 3–5 weeks after receiving the booster vaccination. Travelers who did not return and those lacking sample collection at the second visit were excluded. Finally, 96 paired blood samples were collected. History of immunization against tetanus, including DPT and DT vaccines, was determined from interviews or immunization records. The pre-vaccination geometric mean titer for the 96 participants was 1.07 IU/mL; 76% had a protective antitoxin level (>0.1 IU/mL), and 50% had a long-term protective antitoxin level (>1.0 IU/mL). Most participants <40 years old had protective immunity without receiving booster vaccination, whereas only 30.8% of those >50 years of age had protective immunity. Among the 23 participants without protective antitoxin levels (<0.1 IU/mL), booster vaccination was efficient in 100% of those <40 years but in only 28.6% of those >50 years of age. Although the tetanus antitoxin level decreases with age, booster vaccination helped to achieve an adequate protective antitoxin levels in Japanese travelers <40 years of age. Furthermore, the individuals who have never been vaccinated against tetanus especially in those >50 years old need to obtain protective immunity against tetanus according to a basic immunization schedule to prevent tetanus in travelers and residents of Japan.     

Antibody responses and SARS-CoV-2 infection after BNT162b2 mRNA booster vaccination among healthcare workers in Japan

IntroductionVaccine effectiveness against SARS-CoV-2 infections decreases due to waning immunity, and booster vaccination was therefore introduced. We estimated the anti-spike antibody (AS-ab) recovery by booster vaccination and analyzed the risk factors for SARS-CoV-2 infections.MethodsThe subjects were health care workers (HCWs) in a Chiba University Hospital vaccination cohort. They had received two doses of vaccine (BNT162b2) and a booster vaccine (BNT162b2). We retrospectively analyzed AS-ab titers and watched out for SARS-CoV-2 infection for 90 days following booster vaccination.ResultsAS-ab titer eight months after two-dose vaccinations had decreased to as low as 587 U/mL (median, IQR (interquartile range) 360–896). AS-ab titer had then increased to 22471 U/mL (15761–32622) three weeks after booster vaccination. There were no significant differences among age groups.A total of 1708 HCWs were analyzed for SARS-CoV-2 infection, and 48 of them proved positive. SARS-CoV-2 infections in the booster-vaccinated and non-booster groups were 1.8% and 4.0%, respectively, and were not significant. However, when restricted to those 20–29 years old, SARS-CoV-2 infections in the booster-vaccinated and non-booster groups were 2.9% and 13.6%, respectively (p = 0.04). After multivariate logistic regression, COVID-19 wards (adjusted odds ratio (aOR):2.9, 95% confidence interval (CI) 1.5–5.6) and those aged 20–49 years (aOR:9.7, 95%CI 1.3–71.2) were risk factors for SARS-CoV-2 infection.ConclusionsBooster vaccination induced the recovery of AS-ab titers. Risk factors for SARS-CoV-2 infection were HCWs of COVID-19 wards and those aged 20–49 years. Increased vaccination coverage, together with implementing infection control, remains the primary means of preventing HCWs from SARS-CoV-2 infection.     

2001-2011年浙江省宁波市新生儿破伤风流行病学特征分析

目的 了解2001-2011年浙江省宁波市新生儿破伤风(neonatal tetanus,NT)的流行病学特征以及影响因素,探讨消除NT的策略和措施。 方法 对2001-2011年NT监测资料进行描述性流行病学统计分析。 结果 宁波市2001-2011年共报告NT确诊病例287例,死亡77例,年平均发病率为0.35活产儿,年平均死亡率0.09活产儿,呈现出缓慢下降的趋势。病例主要发病年龄为3~9日龄,男性多于女性,男女性别比为1.66:1,主要集中在工业发达、流动人口密集的地区,外省流动人口最多(95.12%)。患儿以在家分娩,由未经过培训的人员(接生婆、家人以及邻居)为主,患儿母亲中,未接受产前检查占71.43%,未接种破伤风疫苗占86.76%。 结论 加强对流动人口,尤其是育龄期妇女以及儿童的管理,普及住院分娩、新法接生和开展高危地区、高危人群中育龄期妇女破伤风类毒素接种是宁波市消除NT的有效措施。     

Tetanus.

Tetanus is a preventable disease with proper immunization. The marked decline in the incidence over the past several decades has resulted from widespread use of tetanus prophylaxis and improved wound management in the emergency department. Emergency physicians are among the most frequent providers of tetanus vaccination. We can stress the importance of proper immunization and encourage patients to keep accurate immunization records. This can maximize protection of patients from tetanus, and minimize adverse reactions from excessive administration of booster. Tetanus can be fatal even with proper treatment. Vital treatment measures can easily be completed in the emergency department.     

Compliance with group B streptococcal disease prevention guidelines.

PURPOSE: This study assessed the degree of clinician compliance with nationally recommended guidelines for the prevention of early onset Group B Streptococcal (GBS) disease in infants. A secondary objective was to identify areas for specific educational interventions to enhance clinician compliance. STUDY DESIGN AND METHODS: A hospital-based retrospective cohort study was undertaken at a tertiary medical center. Mothers (N = 515) with any known risk factor for GBS sepsis who delivered live infants (N = 537) in a 9-month study period participated. No interventions were done. Compliance of obstetric and pediatric clinicians with nationally recommended management algorithms for pregnant women and infants at risk for GBS disease was evaluated. RESULTS: In the combined risk factor and culture-based algorithm for maternal management, clinician compliance with administration of intrapartum antibiotic prophylaxis (when indicated) ranged from 75% to 84%. Unindicated antibiotics were administered in 22% of the women. Among the women for whom antenatal cultures were indicated, 65% received them. Only 9% of the cultures were performed from the anogenital site, as recommended. In the risk factor-based maternal management algorithm, indicated antibiotics were administered to 76% of the women and unindicated antibiotics to 15% of the women. Use of penicillin, the recommended antibiotic, ranged from 0% to 9%. Among the infants, between 14% to 75% received recommended evaluations and 61% to 94% were observed for at least 48 hrs postdischarge. CLINICAL IMPLICATIONS: Clinician compliance with current GBS disease prevention guidelines for mothers and infants is less than ideal. Targeted education efforts are warranted.     

2004-2010年浙江省台州市新生儿破伤风流行病学特征分析

目的 分析台州市2004-2010年新生儿破伤风(NT)流行病学特征,提出控制NT的策略和措施。 方法 对台州市2004-2010年法定传染病报告系统和NT监测系统发病资料,用Excel软件进行统计分析。 结果 2004-2010年NT报告病例89例,发病率为0.18%,报告病例数最多的是温岭市;2、6和11月高发;报告病例男女性别比为1.41: 1;患儿母亲均未接种过破伤风类毒素,接受过产前检查者39.33%;患儿除1例以外均未在医院中出生,大多由未经培训的接生员接生。 结论 2004-2010 年台州市NT病死率无明显上升趋势。今后仍需加强NT疫情监测工作,对孕产妇加强健康教育,接种破伤风类毒素,加强基础卫生服务等综合措施,以有效地控制NT。     

Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States

BACKGROUND: Findings from animal and human studies confirm that diphtheria and tetanus toxoids and pertussis (DTP) and tetanus vaccinations induce allergic responses; associations between childhood vaccinations and subsequent allergies have been reported recently. OBJECTIVE: The association of DTP or tetanus vaccination with allergies and allergy-related respiratory symptoms among children and adolescents in the United States was assessed. METHODS: Data were used from the Third National Health and Nutrition Examination Survey on infants aged 2 months through adolescents aged 16 years. DTP or tetanus vaccination, lifetime allergy history, and allergy symptoms in the past 12 months were based on parental or guardian recall. Logistic regression modeling was performed to estimate the effects of DTP or tetanus vaccination on each allergy. RESULTS: The odds of having a history of asthma was twice as great among vaccinated subjects than among unvaccinated subjects (adjusted odds ratio, 2.00; 95% confidence interval, 0.59 to 6.74). The odds of having had any allergy-related respiratory symptom in the past 12 months was 63% greater among vaccinated subjects than unvaccinated subjects (adjusted odds ratio, 1.63; 95% confidence interval, 1.05 to 2.54). The associations between vaccination and subsequent allergies and symptoms were greatest among children aged 5 through 10 years. CONCLUSIONS: DTP or tetanus vaccination appears to increase the risk of allergies and related respiratory symptoms in children and adolescents. Although it is unlikely that these results are entirely because of any sources of bias, the small number of unvaccinated subjects and the study design limit our ability to make firm causal inferences about the true magnitude of effect.     

Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest.

BACKGROUND: In most emergency departments, tetanus prophylaxis currently relies on vaccination history. Bedside evaluation of tetanus immunity may improve this process. OBJECTIVES: (i) To determine the seroprevalence of tetanus immunity; (ii) to evaluate the accuracy of vaccination history in assessing tetanus immunity; (iii) to identify factors predictive of seroprotection and incorrect history. METHOD: In a prospective observational study, tetanus immunity was assessed in 784 adults using Tétanos Quick Stick (TQS). A questionnaire was completed to obtain vaccination and general histories. Immunity assessed by TQS and by vaccination history were compared with anti-tetanus antibody levels measured by the enzyme-linked immunosorbent assay (seroprotection threshold >0.15 IU/ml). RESULTS: Overall, 64.2% of patients were protected according to TQS results. Four independent predictors of seroprotection were identified: young age, birthplace in Belgium, male sex and occupational medicine consultation. TQS performance was good: kappa=0.71, sensitivity 85.3%, specificity 87.2%, positive predictive value 92.1% and negative predictive value 77.2%. Seven hundred and sixty-two participants responded to the vaccination history: 23.4% said they were protected, 22.1% that they were not and 54.5% did not know. History performance was poor: kappa=0.27, sensitivity 60.3%, specificity 73.3%, positive predictive value 81.8% and negative predictive value 45.8%. Compared with history, TQS offered a significantly better sensitivity, negative and positive predictive values, but specificity was similar. No predictor of an incorrect history was identified. CONCLUSION: Lack of protective immunity against tetanus is frequent but poorly evaluated by history taking. Several demographic characteristics are good predictors of seroprotection. TQS could be a valuable tool in selected patients to improve tetanus prophylaxis in the emergency department.     

Immunogenicity and Safety of SpikoGen,an Adjuvanted Recombinant SARS-CoV-2 Spike Protein,as a Heterologous Third Booster Dose in Kidney Transplant Patients: A Single-arm Clinical Trial

PurposeStudies have found that immunocompromised patients have suboptimal responses to COVID-19 vaccines, leading to approval of a need for booster doses in this population. SpikoGen® is a subunit recombinant spike protein vaccine combined with Advax-CpG55.2? adjuvant to protect against COVID-19. Previous clinical trials found this vaccine to be tolerable, immunogenic, and efficacious in reducing the risk of COVID-19, including severe disease. However, the effects of this vaccine have not been assessed in immunocompromised patients. This study sought to assess the immunogenicity and safety of the SpikoGen vaccine as a third booster dose in patients undergoing kidney transplant who were receiving immunosuppressive therapy and had received their primary vaccination based on an inactivated whole virus platform (Sinopharm).MethodsThis single-arm trial was performed with 43 patients undergoing kidney transplant. The participants received a single booster dose of the SpikoGen vaccine 1 to 3 months after primary vaccination with 2 doses of the Sinopharm vaccine. Immunogenicity assessments were performed at baseline and 30 days after the booster dose. The primary outcomes were seroconversion rates of anti-S₁ and surrogate virus neutralizing antibodies. Safety outcomes included the incidence of solicited and unsolicited adverse events in the 7 days and 1 month after the booster dose, respectively.FindingsThe SpikoGen vaccine induced positive humoral and cellular responses 30 days after the booster dose in those patients who were seropositive or seronegative after 2 primary doses of the Sinopharm vaccine. Thirty days after the SpikoGen vaccine booster, seroconversion rates were 35.29% (95% CI, 19.75%–53.51%) to anti-S₁ and 29.41% (95% CI, 13.27%–46.57%) to surrogate neutralizing antibodies. The most common local and systemic reported solicited adverse events were injection site pain and fatigue, which were largely mild and transient. No serious adverse events were reported.ImplicationsA single booster dose of SpikoGen vaccine given 1 to 3 months after primary vaccination with 2 doses of Sinopharm vaccine induced positive humoral and cellular immune responses in immunosuppressed patients undergoing renal transplant, thereby achieving spike antibody levels predictive of protection. This study was performed as a single-center study, and it will be important for future large multicenter studies to extend these results to other immunocompromised patient groups.     

Vaccination during pregnancy

Question One of my patients is studying to become a dental hygienist. Owing to the program requirements, she received several vaccinations last week, including measles-mumps-rubella, varicella, and hepatitis B (HB) vaccines, as well as a tetanus booster. However, today a blood test confirmed that she is currently 6 weeks pregnant. What is known about the safety of these vaccines during pregnancy, and are there any general recommendations for vaccines for women who are planning to become pregnant or who are currently pregnant?Answer The combination measles-mumps-rubella vaccine and the varicella vaccine are live attenuated vaccines, and are contraindicated during pregnancy owing to theoretical concerns. However, there is no evidence that there are increased risks of malformations, congenital rubella syndrome, or varicella syndrome attributable to these vaccines. The HB and tetanus vaccines are composed of noninfectious particles or toxoids, and theoretically should cause no increased risk to the developing fetus. In addition, limited observational data also support no increased risk of any adverse pregnancy outcomes; consequently, administration of the HB and tetanus vaccines might be, if indicated, considered during pregnancy.     

Health maintenance for postmenopausal women

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian and follicular activity. It usually occurs when women reach their early 50s. Vasomotor symptoms and vaginal dryness are frequently reported during menopause. Estrogen is the most effective treatment for management of hot flashes and night sweats. Local estrogen is preferred for vulvovaginal symptoms because of its excellent therapeutic response. Bone mineral density screening should be performed in all women older than 65 years, and should begin sooner in women with additional risk factors for osteoporotic fractures. Adequate intake of calcium and vitamin D should be encouraged for all postmenopausal women to reduce bone loss. Coronary artery disease is the leading cause of death in women. Postmenopausal women should be counseled regarding lifestyle modification, including smoking cessation and regular physical activity. All women should receive periodic measurement of blood pressure and lipids. Appropriate pharmacotherapy should be initiated when indicated. Women should receive breast cancer screening every one to two years beginning at age 40, as well as colorectal cancer screening beginning at age 50. Women younger than 65 years who are sexually active and have a cervix should receive routine cervical cancer screening with Papanicolaou smear. Recommended immunizations for menopausal women include an annual influenza vaccine, a tetanus and diphtheria toxoid booster every 10 years, and a one-time pneumococcal vaccine after age 65 years.     

An open-label,nonrandomized, single-center,prospective extension,clinical trial of booster dose schedules to assess the safety profile and immunogenicity of recombinant outer-surface protein A (OspA) Lyme disease vaccine

BACKGROUND: An efficacy trial of an outer-surface protein A (OspA) Lyme disease vaccine demonstrated tolerability and efficacy against laboratory-confirmed Lyme disease after a primary series of 3 doses at 0, 1, and 12 months.OBJECTIVES: This extension of the efficacy study assessed the immunogenicity and tolerability of booster vaccinations administered at 24 and/or 36 months after the first vaccination. METHODS: This open-label, nonrandomized, single-center, prospective extension, clinical trial was conducted in the general community in New Haven, Connecticut, where Lyme disease is endemic. Blood samples (to determine anti-OspA titer) were collected before administration of the booster doses at months 24 and 36, and at 1 and 12 months after each booster dose was administered. Immune response was assessed via total immunoglobulin G (IgG) anti-OspA antibody titers and the proportion of subjects with titers >or=1400 EL.U/mL. Adverse events (AEs) were recorded by the study volunteers on diary cards. RESULTS: A total of 318 volunteers (173 women and 145 men) received at least 1 booster dose of Lyme disease vaccine, administered at 12 or 24 months after the third vaccination of the primary series (months 24 and 36, in relation to the primary series). Eighty-eight subjects of those who received a month-24 booster received a second booster dose at month 36 (12 months after the first booster). Overall, the mean age of the volunteers was 55 years (range, 19 to 73 years). The demographic characteristics of the groups were similar. Most AEs were limited induration and were rated by investigators and subjects as mild to moderate in severity. Administration of I or 2 booster doses did not elicit any patterns of AEs different from those reported in the efficacy trial. After the first booster dose, all volunteers had an anamnestic response and positive test results for total IgG antibody. Geometric mean titers increased at least 12-fold 1 month after the first booster dose at month 24 or 36. More than 96% of volunteers had titers>1400 EL.U/mL and 100% had titers >400 EL.U/mL (minimum seroprotective level) 1 month after the booster dose at month 24 or 36. CONCLUSIONS: All booster doses were well tolerated, and the incidence of AEs did not increase after the second booster dose. The immune response generated after the 3-dose primary series waned; booster doses administered at 12 and/or 24 months after the primary series increased antibody levels above seroprotective levels.     

Update on immunizations in adults

Vaccine-preventable diseases contribute significantly to the morbidity and mortality of U.S. adults. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention updates its recommended adult immunization schedule annually. The most recent updates include the permissive but not routine use of the quadrivalent human papillomavirus vaccine to prevent genital warts in males; a single dose of herpes zoster vaccine for adults 60 years and older, regardless of their history; replacing a single dose of tetanus and diphtheria toxoids (Td) vaccine with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine in adults 19 years and older who have not previously received Tdap; expanding the indications for pneumococcal polyvalent-23 vaccine to include all adults with asthma and all smokers; annual seasonal influenza vaccination for all adults; and booster doses of meningococcal vaccine for adults with high-risk conditions. It is vital for family physicians to implement a systematic approach to adult immunization that is patient-, staff-, and physician-focused.     

Hepatitis B vaccination: a survey of health care workers' knowledge and acceptance.

The purpose of this survey was to determine methods to improve compliance and knowledge related to Hepatitis B vaccination. A self administered questionnaire was distributed to employees of a large metropolitan hospital. The survey asked for information about the health care workers' acceptance of Hepatitis B vaccination and knowledge of appropriate follow up after a significant blood exposure occurs. According to the results, 45% of employees at risk for contracting HBV have not received the vaccination. Findings related to the methods of follow up used by employees after a blood exposure indicate a lack of knowledge about HBV. The results of this survey support the need for further education about the risk of occupationally acquired HBV.     

Effectiveness of COVID-19 Booster on the Risk of Hospitalization Among Medicare Beneficiaries

ObjectiveTo determine the effectiveness of booster vaccinations on the risk of hospitalization with coronavirus disease 2019 (COVID-19) and how it varies by enrollee characteristics and interval from the initial vaccination to receipt of a booster.Patients and MethodsThis cohort study used 100% Medicare claims from January 1, 2020, through December 31, 2021, and matched 3,940,475 individuals who received boosters to 3,940,475 controls based on week and type of original COVID-19 vaccine and demographic and clinical characteristics. We compared the association of booster vs no booster with COVID-19 hospitalization using Cox proportional hazards regression models controlling for patient characteristics. We also determined the association of time from original vaccine to booster with COVID-19 hospitalization.ResultsOver a maximum of 130 days of follow-up, boosted enrollees had 8.20 (95% CI, 7.81 to 8.60) COVID-19 hospitalizations per million days vs 43.70 (95% CI, 42.79 to 44.64) for controls (81% effectiveness). Effectiveness varied by race, prior hospitalizations, and certain comorbidities, for example, leukemia/lymphoma (53% effectiveness), autoimmune disease (73%), and dementia (73%). Boosters received between 6 and 9 months after original vaccination varied between 81% and 85% effectiveness, while boosters received at 5 to 6 months (62%) or less than 5 months (58%) were less effective.ConclusionBoosters are highly effective in the Medicare population. Approximately 69,225 hospitalizations would be prevented by boosters in the 15 million individuals aged 65 years or older currently not boosted in a period similar to the September 2020 through January 2021 period studied. Boosters provided the greatest benefits if they were received between 6 and 9 months following original vaccinations. However, boosters were associated with substantial decreases in COVID-19 hospitalizations in all categories of enrollees.     

The effects of postal and telephone reminders on compliance with pravastatin therapy in a national registry: results of the first myocardial infarction risk reduction program.

BACKGROUND: Noncompliance with cardiovascular therapy and prevention initiatives is well documented. OBJECTIVES: The purpose of the First Myocardial Infarction (MI) Risk Reduction Program, an open-label drug registry involving mainly primary-care patients at increased risk of a first MI, was to examine the effects of postal and telephone reminders, as well as demographic and other baseline characteristics, on patient self-reported compliance with pravastatin treatment. A second objective was to determine whether regimen adherence was associated with the adoption of other lifestyle modifications recommended to decrease the risk of coronary artery disease. METHODS: Patients with risk scores of > or = 4 on a scale of -1 to +16 for men and -1 to +17 for women on the First Heart Attack Risk Test were considered to be at increased risk of a first MI and eligible for enrollment in the registry program. An elevated total cholesterol level despite dietary interventions was an additional inclusion criterion. Patients were prospectively randomized (4:1) to either an intervention involving postal and telephone reminders (about coronary risk reduction and medication compliance), which were sent during the first 2 months of pravastatin treatment, or usual care. Both groups received reminder postcards at 4 and 5 months, in addition to counseling by physicians about coronary risk reduction. At 3 and 6 months (or study discontinuation), patients completed and mailed to the program-coordinating center questionnaires concerning compliance with care, including current use of prescribed pravastatin, as well as self-reported adoption of other lifestyle modifications, such as changing eating habits, losing weight, increasing physical activity, and/or quitting smoking. Compliance with pravastatin therapy and with these coronary risk-reducing behaviors was also assessed by physicians at the 3-month follow-up visit. RESULTS: A total of 10,335 patients were in the intervention group, and 2765 received usual care. The 2 groups were well balanced at baseline with respect to age, race, and total cholesterol values. Neither early reminders nor baseline patient characteristics were significantly associated with reported pravastatin compliance rates, which were approximately 79% overall. However, according to self-reports at 6 months, regimen compliance was associated with the adoption of other coronary risk-reducing behaviors. CONCLUSIONS: The results of this study suggest that early telephone and postal reminders do not improve compliance with drug treatment or with recommended coronary risk-reducing behaviors.     

Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease.

BACKGROUND: Many patients with coronary heart disease (CHD) are not managed adequately, and we often fail to reach treatment targets. AIM: To investigate if knowledge of risk factors for CHD, measured by a questionnaire, would show any relation to advice to compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. METHOD: Men and women <71 years who had had a cardiac event were screened consecutively (509) from the medical records. Responders (392) were interviewed, examined and received a questionnaire. Three hundred and forty-seven patients answered the questionnaire regarding their general knowledge of risk factors for CHD, compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. RESULTS: There were statistically significant correlations between general knowledge about risk factors for CHD and compliance to certain lifestyle changes: weight, physical activity, stress management, diet, attainment of lipid level goals and the likelihood of taking prescribed blood pressure-lowering drugs. General knowledge of risk factors had no correlation to blood glucose or blood pressure levels nor on smoking habits or treatment patterns for prescribed lipid- and blood glucose-lowering drugs. CONCLUSION: Knowledge correlates to patient behaviour with respect to some risk factors, which should be recognised in preventive programs.     

陕西省铜川市健康人群百日咳、白喉、破伤风抗体水平监测结果分析

目的 了解陕西省铜川市健康人群百日咳、白喉、破伤风(百白破)抗体水平,为有效控制百白破提供参考依据。 方法 采用分层多级抽样的方法,在铜川市4区(县)随机抽取1岁、1~2岁、3~4岁、5~6岁、7~14岁、15~19岁、20岁健康人群368人,用酶联免疫吸附试验测定百日咳、白喉、破伤风IgG抗体。 结果 2011年铜川市健康人群百日咳抗体阳性率为38.04%,抗体几何平均浓度(GMC)为54.56 U/ml;白喉抗体阳性率94.02%,安全保护率60.87%,GMC为1.61 IU/ml;破伤风抗体保护率55.71%,GMC为2.70 IU/ml。 结论 铜川市健康人群百日咳IgG抗体阳性率低,7岁以上人群白喉及破伤风抗体保护率较低。预测铜川市近年不会发生白喉及新生儿破伤风疫情,但存在百日咳流行的隐患。故今后应通过加强百日咳的诊断及时规范管理病例,避免传播,还应按免疫程序及时加强免疫,并建议对大年龄组人群接种低白喉、破伤风联合疫苗含量的疫苗。     

2009-2013年陕西省咸阳市肾综合征出血热疫苗免疫效果评价

目的评价2009 2013年陕西省咸阳市双价肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)疫苗的免疫效果,为以疫苗接种为主的防控对策的制定提供更可靠的依据。方法随机选取100名监测对象,评价接种疫苗前、基础免疫后、加强接种后、加强接种1年等不同时间点,监测对象的抗体水平变化。结果基础免疫后监测对象HFRS抗体水平明显升高,加强接种后抗体水平达到最高峰,随后开始下降;HFRS抗体水平与地区、年龄关系不明显;基础免疫前抗体阳性率仅为4.26%(4/94),接种疫苗后,抗体阳性率达41.49%(39/94);加强免疫后抗体阳性率达61.70%(58/94);加强接种1年后,抗体阳性率为47.87%(49/94);经Mc Nemar检验,基础免疫的阳转率为38.89%(35/90),加强接种的阳转率可达到61.11%(55/90)。结论疫苗接种后出血热抗体水平和抗体阳性率明显升高,强化接种后下降,表明咸阳市采取疫苗接种仍是见效最快、最安全、效果最显著的防病措施。