Prognostic factors in neonatal tetanus

objective Neonatal tetanus (NNT) is the leading cause of neonatal deaths in developing countries. The objective of this study was to determine prognostic indicators in NNT.methods We reviewed the clinical records of all neonates (n= 174) admitted to Ife State Hospital with the diagnosis of NNT from 1991 through 1995.results Delivery had occurred at home in 73.3% of cases. Only 37/164 of the mothers had had adequate immunization with tetanus toxoid. The umbilical cord appeared to be the portal of entry in 58.6% of cases. Mean age of infants at presentation was 7.2 days. Mortality was 57.5%; non-survivors succumbed after mean stay in the hospital of 5.0 days. Mortality was significantly associated with an incubation period of 6 days or less (P= 0.0026), infant's weight of less than 2.5 kg (P= 0.0113), lack of antenatal care in a health facility (P= 0.0279), birth at home (P= 0.0455), but not with lack of adequate maternal immunization (P = 0.2081; not significant). Multivariable analysis showed that a short (6 d) incubation period was the strongest predictor of mortality (OR = 3.11, P= 0.0030) while low infant weight (< 2.5 kg) was also a significant predictor (OR = 2.46, P= 0.0408).conclusions Hygienic deliveries and adequate cord care are very important for the prevention of neonatal tetanus deaths, and universal prenatal care, including education programmes on appropriate perinatal and cord care, can significantly reduce NNT incidence and mortality in developing countries.     

Misuse of tetanus immunoprophylaxis in wound care

We prospectively studied medical personnel compliance with antitetanus prophylaxis in 211 patients with wounds in three emergency departments. The guidelines were incorrectly followed in 13.4% of the patients, with 88.9% of the mistakes resulting from overimmunization. The most common mistake was the practice of giving tetanus and diphtheria toxoid (Td) to a patient with a clean wound who had complete primary immunization and a booster within ten years. This mistake accounted for 63% of the mistakes. The next most common, accounting for 18.5%, was the practice of giving Td and tetanus immune globulin to the never-immunized patient who had sustained a clean wound. Overimmunization increases the possibility of adverse reactions, and undertreatment places the patient at risk for tetanus.     

老年重症破伤风患者的临床特点及救治经验

目的分析12例老年重症破伤风患者的临床表现、治疗及转归,总结老年重症破伤风患者的患病特点及救治经验。方法回顾性分析我科2013年6月24日—2017年5月6日救治的12例老年重症破伤风患者资料。结果总体救治成功9例(75.00%),死亡3例(25.00%)。气管切开者11例,气管切开后存活率81.82%;11例发生院内感染者,以呼吸道及泌尿道感染最多见,主要病原体为鲍曼不动杆菌及嗜麦芽窄食单胞菌,最常见的真菌感染是酵母菌。抗生素治疗时间平均为(11.29±7.50)d,抗感染治疗有效率100%。12例患者平均住院时间(27.50±15.21)d。结论老年重症破伤风患者潜伏期长,病初症状不典型。及早识别重症患者,尽早气管切开、合理抗感染及营养支持是老年重症破伤风救治成功的关键。     

Hay fever and a single intramuscular injection of corticosteroid: a systematic review.

OBJECTIVES: In severe hay fever, some patients are strongly affected despite the use of first-line therapy and are therefore treated with an intramuscular injection of systemic corticosteroid (i.m. SCS) in some countries. The aim of this paper was to explore the efficacy and side effects of a single i.m. SCS injection in hay fever in adults. DATA SOURCES: PubMed, EMBASE, Cochrane Library. METHODS: Systematic review. Criteria for inclusion: hay fever or seasonal allergic rhinitis, adults, injectable steroids, clinical trials, English language. None of the clinical trials were excluded, since an important aim of the review was to identify any possible side-effects. Outcome measures: clinical effects, and clinical and physiological side-effects. RESULTS: 18 clinical trials met the inclusion criteria: nine double-blind RCTs (five placebo-controlled and four comparative RCTs), two single-blinded RCTs, and seven open trials. All studies were conducted before 1988. The efficacy of a single intramuscular injection of SCS was statistically significant in all five placebo-controlled trials and demonstrated considerable clinical benefit, lasting approximately from within the first day to four weeks. In the only two studies comparing i.m. SCS to nasal steroids a superior effect with i.m. SCS was demonstrated. The side-effects were few, both clinically and physiologically, with retained ability to respond to stress with hypothalamic-pituitary-adrenal activation. CONCLUSIONS: The studies in this review were sound and their findings consistent: i.m. SCS therapy was shown to be efficient and safe for the treatment of hayfever in adults. This review shows no support for any concerns regarding serious tissue atrophy or other serious side-effects, any long-lasting suppression of plasma-cortisol, or any influence on stress reaction, following a single intramuscular injection of SCS.     

Low seroprotection against diphtheria and tetanus in Lao adolescents

Objectives

There is currently no booster diphtheria or tetanus vaccine for Lao children before adolescence, despite international recommendations. We investigated seroprotection against diphtheria and tetanus among Lao adolescents.

Methods

Seven hundred seventy-nine serum samples were tested for anti-diphtheria and anti-tetanus antibodies.

Results

Overall, 25.8% of the adolescents had antibody titers corresponding to protection against diphtheria and 30.9% to sufficient immunity against tetanus. Female participants >16 years were more likely to be protected against diphtheria (p < 0.001) and tetanus (p < 0.029).

Conclusion

Low protection against diphtheria and tetanus, possibly due to low vaccination coverage or antibody waning, suggests booster doses are warranted before adolescence.     

超大剂量地西泮为主救治中重型破伤风探讨

目的 探讨持续微量泵入超大剂量地西泮[6-10 mg/(kg.d)]治疗中重型破伤风的临床疗效及安全性.方法　回顾性总结我院21例中重型破伤风患者的临床资料,并结合文献进行分析.结果　入院2 h内有2例(9.52%)极危重患者因喉肌痉挛窒息死亡,其余19例(90.48%)均治愈出院.超大剂量地西泮主要不良反应为嗜睡,未...     

Predicting the clinical outcome of tetanus: the tetanus severity score

OBJECTIVES: To create a new tetanus score and compare it with the Phillips and Dakar scores. METHODS: We used prospectively acquired data from consecutive patients admitted to the Hospital for Tropical Diseases, Ho Chi Minh City, to create the Tetanus Severity Score (TSS) with multivariate logistic regression. We compared the new score with Phillips and Dakar scores by means of resubstituted and prospective data, assessing performance in terms of sensitivity, specificity and area under receiver operator characteristic curves. RESULTS: Resubstitution testing yielded a sensitivity of 77% (298/385) and a specificity of 82% (1,183/1,437) for the TSS; 89% (342/385) and 20% (281/1,437) for the Phillips score; and 13% (49/385) and 98% (1,415/1,437) for the Dakar score. The TSS showed greatest discrimination with 0.89 area under the receiver operator characteristic curve (95% CI 0.88-0.90); this was 0.74 for the Dakar score and (95% CI 0.71-0.77) and 0.66 for the Phillips score (95% CI 0.63-0.70; P values <0.001). Prospective testing showed 65% (13/20) sensitivity and 91% (210/230) specificity for the TSS; 80% (16/20) and 51% (118/230) for the Phillips score; and 25% (5/20) and 96% (221/230) for the Dakar score. The TSS achieved the greatest area under TSS of 0.89 (95% CI 0.82-0.96), significantly greater than the Phillips score [0.74 (0.6-0.88), P = 0.049] but not the Dakar score [0.80, (0.71-0.90), P = 0.090]. CONCLUSIONS: The TSS is the first prospectively developed classification scheme for tetanus and should be adopted to aid clinical triage and management and as a basis for clinical research.     

10天序贯疗法与标准三联疗法治疗幽门螺杆菌感染荟萃分析

目的系统地评价10天序贯疗法能否获得比标准三联疗法更高的H．pylori根除率，以及两种方案之间发生副反应的差异。方法利用中英文检索词检索相关电子数据库，根据纳入标准入选了比较10天序贯疗法与标准三联疗法的幽门螺杆菌根除率的随机临床试验。提取患者基本资料、研究质量、H．pylori根除率和副作用的发生率等相关数据。针对于10天序贯疗法和7天或10天标准三联疗法的H．pylori根除率和副作用的发生率，计算相应的RR和95％可信区间。运用漏斗图评价出版偏倚。结果Meta分析纳入了10项随机对照研究，共2855例患者。10天序贯疗法明显优于7天或10天标准三联疗法，总的H．pylori根除率分别为93．5％、75．9％和79．4％，RR为1．23（95％CI=1．19—1．28）和1．16（95％CI：1．10—1．23）。无论是溃疡性消化不良患者还是非溃疡性消化不良患者，10天序贯疗法都能获得更高的H．pylori根除率，RR分别为1．16（95％CI=1．10—1．23）和1．26（95％CI=1．19—1．33）；针对克拉霉素耐药患者，10天序贯疗法的有效H．pylori根除率也高于标准三联疗法（75．9％vs32．7％），RR为2．18（95％CI=1．43—3．34）。然而两种方案副作用的发生率无明显差别（RR=1．00，95％CI=0．97—1．03）。结论10天序贯疗法明显优于7天或10天标准三联疗法,副作用无明显增加。     

Dysphagia in tetanus: Evaluation and outcome

A 72-year-old man who contracted tetanus after a puncture wound presented with severe dysphagia in association with trismus, risus sardonicus, and nuchal rigidity. We describe his medical course and outcome, including repeated videofluoroscopic barium swallow examinations. We emphasize the value of videofluoroscopy for examining and managing dysphagia in patients with tetanus, in both the acute and chronic stages of this rare illness.     

Tetanus immunity in long-term care facilities

OBJECTIVES: To investigate the correlates of tetanus immunity in the elderly residing in a long-term care facility in Hawaii. DESIGN: Cross-sectional. SETTING: A nursing home in Honolulu, Hawaii. PARTICIPANTS: Sixty subjects aged 65 and older: 30 men and 30 women. MEASUREMENTS: The interview included demographic information, immunization history, military service information, and other potential risk factors for tetanus. Serum tetanus antibody titers were measured. RESULTS: The data showed that 76.7% (46/60) had adequate tetanus titers. This is in stark contrast to previous studies, which have reported immunity rates of 27% to 46% in similar populations. There were significant associations between immunity and prior history of military service. There were no significant associations between immunity and past history of immunization, education, socioeconomic status, or sex. CONCLUSION: History of immunization from patients, families, or medical charts may be unreliable indicators of tetanus immunity. Recognizing patterns of and barriers to immunization could have important consequences for public health policy in long-term care institutions.     

Effectiveness of statin therapy in adults with coronary heart disease

BACKGROUND: We conducted a meta-analysis of patients with coronary heart disease (CHD) to determine the effectiveness of statin therapy; whether effectiveness varied according to patient characteristics, outcomes, or pretreatment low-density lipoprotein cholesterol (LDL-C) levels; and the optimal LDL-C goal and the level at which to initiate statin therapy. METHODS: Randomized trials or systematic reviews for secondary prevention of CHD with statin therapy published between January 1966 and December 2002 were identified through MEDLINE and the Cochrane Library. Studies were included if they randomly assigned adults with CHD to statin therapy or control, enrolled at least 100 individuals per arm, reported clinical outcomes and LDL-C levels, and were published as full studies in English. Two reviewers abstracted data using a prospectively designed protocol. RESULTS: Twenty-five studies enrolling 69 511 individuals were included. Participants in 19 placebo-controlled trials had a mean age of 63 years and a mean pretreatment LDL-C level of 149 mg/dL (3.85 mmol/L); 23% were women. Statin therapy reduced CHD mortality or nonfatal myocardial infarction 25% (relative risk [RR], 0.75; 95% confidence interval [CI], 0.71-0.79), all-cause mortality 16% (RR, 0.84; 95% CI, 0.79-0.89), and CHD mortality 23% (RR, 0.77; 95% CI, 0.71-0.83). Beneficial effects were seen in women and the elderly. There were no data to determine whether lowering the LDL-C level to less than 100 mg/dL (<2.59 mmol/L) was superior to lowering it to 100 to 130 mg/dL (2.59-3.36 mmol/L). Meta-regression analyses revealed risk reductions for CHD mortality or nonfatal myocardial infarction and major vascular events across available pretreatment LDL-C levels. CONCLUSION: Statin therapy reduces mortality and morbidity in adults with CHD, even at pretreatment LDL-C levels as low as 100 mg/dL (2.59 mmol/L).     

益生菌预防成人抗生素相关性腹泻的荟萃分析

目的:探讨益生菌的使用与成人抗生素相关性腹泻(AAD)的关联,分析益生菌预防AAD的有效性及安全性.方法:系统检索PubMed,Embase,CINAHL,AMED,the Cochrane database of SystematicReviews,the Cochrane Controlled TrialsRegister和中国期刊全文数据库(CNKI),检索时间跨度从1966-01/2012-04.我们只纳入随机对照试验,研究对象>18周岁,研究内容为服用抗生素的同时服用益生菌预防AAD.结果:本研究结果表明,RR=0.45,95%CI:0.29-0.69,P<0.001,益生菌可以显著降低服用抗生素后发生腹泻的机率.基于益生菌种类的亚组分析的结果(RR=0.42,95%CI:0.20-0.85,P=0.003)同样证明了益生菌预防AAD的有效性.结论:益生菌可以显著降低服用抗生素后发生成人AAD的机率.     

Tetanus immunization status and immunologic response to a booster in an emergency department geriatric population

STUDY OBJECTIVES: Although effective procedures for the prevention of tetanus have long been available, serosurveys done since 1977 demonstrate that 49% to 66% of the elderly population lacks a protective antitoxin level (more than 0.01 IU/mL). This study was undertaken to assess the tetanus immunization status of patients presenting to an emergency department and to evaluate their immunologic response to a tetanus booster. SETTING: The study was conducted in a tertiary care ED. TYPE OF PARTICIPANTS: The patients enrolled were 65 or more years old and had breaks in their skin barriers. DESIGN: At each patient's initial presentation, pertinent demographic data and tetanus immunization history were recorded. The patient was then followed for 21 days. INTERVENTIONS: Each patient's antitoxin titer was determined on a serum sample by ELISA, and, if required by the Advisory Committee on Immunization Practices criteria, a booster was administered at the first visit. MEASUREMENTS AND MAIN RESULTS: Serum antitoxin assays were repeated on days 7, 14, and 21 after the initial visit until seroconversion (titer more than 0.01 IU/mL). Forty-four patients (55%) had protective levels at initial presentation, and in 36 (45%) the levels were not protective. Age and sex were not predictive of protection. Past military service and a definite history of three or more previous immunizations were good predictors of protection. Of 34 patients who were followed serially for inadequate initial titers, only 19 (56%) seroconverted by day 14. Patients who did not seroconvert were more likely to be older (P less than .05). CONCLUSIONS: This study demonstrated that a significant number of elderly patients lacked an initial protective level of tetanus antitoxin. Of these, 44% failed to seroconvert within 14 days and carried a potential risk of developing tetanus.     

Efficacy of statin therapy in chronic systolic cardiac insufficiency: a meta-analysis

Background

Conflicting results currently exist on the clinical use of statins in patients with chronic systolic heart failure (CHF). This study aimed to investigate the effect of statins on clinical outcomes of CHF by a meta-analysis based on randomized controlled trials (RCTs).

Methods

We searched PubMed, MEDLINE, EMBASE, and Cochrane databases through 2010 and renewed in February 2011. We included RCTs of subjects who underwent statin or placebo treatment for established CHF, and provided data on clinical outcomes. Risk ratios (RR) were calculated using a random effects model.

Results

Thirteen trials involving 10,447 CHF patients were included in the meta-analysis. The pooling analysis showed that statin treatment did not significantly reduce the risk of all-cause death (RR = 0.93, 95% CI: 0.81–1.07, p = 0.31), death for cardiovascular cause or pump failure (p > 0.10), and rehospitalization for heart failure (RR = 0.90, 95% CI: 0.78–1.04, p = 0.15). In addition, statin therapy had a non-significant trend towards reduced risk of nonfatal myocardial infarction (RR = 0.84, 95% CI: 0.68–1.02, p = 0.08). When restricted to various statins and patients' age, the analysis demonstrated that atorvastatin was associated with reduced all-cause mortality (p = 0.009) and readmission rate for heart failure (p = 0.005), and the superiority of statin therapy was significant in CHF patients less than 65 years (both p < 0.01).

Conclusions

Although statin has little impact on clinical outcomes in overall CHF patients, statin administration if needed is feasible to CHF patients, and the treatment might be effective when restricted to specific statins or populations.     

Should adult tetanus immunization be given as a single vaccination at age 65?

Objective: To compare three vaccination strategies for the prevention of adult tetanus. Each strategy includes childhood primary immunization and wound prophylaxis, and one of the following: 1) the currently recommended booster every ten years; 2) a single booster at 65 years of age; or 3) no intervention after age 6 except for wound prophylaxis. Methods: Cost-effectiveness analysis was used to compare the three different strategies. A Markov model, cycled annually from age 5 through age 85, was applied to each strategy to predict the incidence and costs of tetanus for the U.S. adult population.Results: The three strategies have very similar effects on life expectancy but different costs. Expressed incremental to no intervention after childhood primary immunization, the decennial booster strategy is least cost-effective, with a discounted incremental cost-effectiveness ratio of $143,138 per year of life saved compared with $4,527 for the single-booster strategy. Sensitivity analysis demonstrates that the decennial strategy is more effective but more costly over a wide range of model assumptions. Conclusions: The current policy of recommending tetanus booster vaccinations every ten years is effective but much more costly than a more easily implemented policy that also provides considerable protection against tetanus. The authors recommend forsaking decennial boosters in favor of a policy of including a single booster at age 65 along with other recommended health maintenance maneuvers reserved for that age. Presented in part at the annual meeting of the Society of General Internal Medicine, Seattle, Washington, May 2, 1991. Dr. Littenberg is an American College of Physicians George Morris Piersol Teaching and Research Scholar.     

Influence of deviation from guidelines on the outcome of community-acquired pneumonia

STUDY OBJECTIVE:s: Consensus guidelines for the empirical treatment of community-acquired pneumonia (CAP) have been published. We investigated the following factors: (1) the degree of adherence to American Thoracic Society (ATS) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) guidelines; and (2) the influence of adhering to these guidelines on mortality and length of hospitalization. DESIGN: Prospective, observational study. SETTING: Tertiary-care teaching hospital. PATIENTS: Two hundred ninety-five patients with CAP who were consecutively admitted to the hospital and treated empirically. INTERVENTIONS: Patients were stratified according to the prognostic rule of Fine, and the antibiotic regimen prescribed in the first 24 h was evaluated as to whether or not it adhered to treatment guidelines. RESULTS: Adherence to SEPAR and ATS guidelines was 66% and 88%, respectively. There were no significant differences in mortality or duration of hospitalization between adherent and nonadherent regimens. However, mortality in severe CAP (Fine risk class V) was significantly higher in patients with nonadherent treatments (SEPAR: relative risk [RR], 2.6; 95% confidence interval [CI], 1.1 to 5.6; ATS: RR, 2.5; 95% CI, 1.1 to 5.8). In a multivariate analysis, adherence to ATS guidelines was independently associated with decreased mortality (RR, 0.3; 95% CI, 0.14 to 0.9) after adjusting for the Fine score. CONCLUSIONS: Adherence was higher to ATS guidelines than to SEPAR guidelines. Severe CAP had a significantly higher mortality when the guidelines (both ATS and SEPAR) were not followed. Length of hospitalization was similar irrespective of adherence to either set of guidelines.     

Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial

Penicillin, the drug of choice in tetanus, may potentiate the effect of tetanus toxin by inhibiting the type-A (GABAA) receptor for gamma-amino-n-butyric acid. Metronidazole has therefore been suggested as an alternative. Intramuscular benzathine penicillin (1.2 million units as a single dose; N=56), enteral metronidazole (600 mg every 6 h for 10 days; N=55) and intravenous benzyl penicillin (2 million units every 4 h for 10 days; N=50) were therefore compared, in a randomized, controlled trial, among patients with all grades of tetanus. On presentation, the three treatment groups were similar in terms of age and sex distributions, immune statuses, durations of illness, and their APACHE-II scores and Ablett's grades of tetanus. Of the patients given benzathine penicillin, 36 required tracheostomy, 10 neuromuscular blockade, and 23 mechanical ventilation; the corresponding numbers for the metronidazole (34, 12 and 18, respectively) and benzyl-penicillin groups (39, 12 and 25, respectively) were similar (P>0.10). The incidences of dysautonomia and nosocomial pneumonia and the numbers of in-hospital deaths (26 with benzathine penicillin, 19 with metronidazole and 22 with benzyl penicillin; P=0.392) were also similar in each treatment arm. The length of the hospital stay was longer in the patients receiving benzyl penicillin than in the benzathine-penicillin or metronidazole groups, with means (S.D.) of 21.9 (15), 16.9 (11) and 19.9 (15) days, respectively, but the difference was not statistically significant (P=0.09). Although the three antibiotic regimens investigated appear equally effective, benzathine penicillin offers the convenience of a single, intramuscular injection instead of the 10 days of therapy needed with the other two drugs.     

Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta‐Analysis

OBJECTIVES: To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults. DESIGN: Systematic review and meta‐analysis. SETTING: MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies. PARTICIPANTS: Older adults (aged ≥60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition. MEASUREMENTS: Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I² statistic was used to assess heterogeneity in a random‐effects model. RESULTS: Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200–1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79–0.93; I²=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community‐dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta‐regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87–0.98) and more heterogeneity (I²=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001). CONCLUSION: Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.     

Entwicklung einer numerisch-additiven Kombinationsvaccine gegen tetanus und Pocken: Development of a combination vaccine against tetanus and smallpox

Mandatory vaccination against smallpox was abolished on the account of smallpoxeradication proclaimed by the WHO and the postvaccinal complications detected after smallpox vaccination. At the same time vaccine banks with the vaccinia virus strain “Elstree” were organized. Should mass vaccinations with this vaccinia virus strain be carried out in a case of emergency, severe postvaccinal diseases and complications can arise in overaged and immunosuppressed vaccinees after primovaccination. Therefore attenuated vaccinia virus strains should be used for vaccine banks, which cannot be activated, or increase in virulence in impaired vaccinees after primovaccination. For these individuals the vaccinia virus strain “MVA”, among other attenuated vaccinia strains, is recommended. The MVA virus strain can be applied parenterally without complications. From the scientific and field-relevant point of view it was tried to combine the vaccinia virus strain “MVA” with tetanus toxoid and to develop a combination vaccine “tetanus-smallpox”.In immunization experiments using mice, piglets and monkeys, safety and efficacy of the vaccine were investigated. Efficacy was demonstrated by means of postvaccinal antibody determination and by the mouse protection test. Tetanus antitoxin was measured by ELISA and indirect hemagglutination test, antibody levels to vaccinia virus were investigated employing the neutralization test and hemagglutination inhibition test.No significant differences in potency could be demonstrated between the combination vaccine and the corresponding monovalent vaccines in mice, piglets and monkeys. The combination vaccine consisted of 12 Lf tetanus toxoid and 10^8,25 TCID₅₀ vaccinia virus “MVA” preserved with gelatine and glucosamine.The double intramuscular immunization of monkeys stimulated average tetanus antitoxin titers of 1:310 and average vaccinia virus titers of 1:195 2 weeks p. revacc. Similar results were obtained in mice and piglets.Side reactions were not observed in mice and piglets. Except for occasional local reactions of short duration at the injection site of the monkeys, similarly no adverse reactions were observed after intramuscular vaccination with the combination vaccine.     

Immunologic response to a single dose of tetanus toxoid in older people

OBJECTIVES: Several studies have demonstrated that a large percentage of older people are inadequately immunized against tetanus. The aim of this study was to assess the immunity against tetanus in a group of individuals aged 69 and older and to examine the immune response to a single dose of tetanus toxoid. DESIGN: A convenience sample of 115 residents of a large retirement home, aged 69 and older, was studied. After a blood sample for anti-tetanus antibody titer, a single dose of tetanus toxoid vaccine was administered. Repeat titers were obtained 6 weeks after the vaccination and analyzed by ELISA assay. Antibody levels equal to or greater than 0.1 IU/mL were considered protective. RESULTS: Sixty-seven of 115 (58.3%) individuals had adequate antibody titers. Those individuals who reported having been vaccinated with tetanus toxoid in the past were more likely to be immunized adequately compared with those who reported having never been vaccinated (66.7% vs 39.3%, P = .02). After vaccination, 34 of 46 (73.9%) individuals with inadequate antibody titers became seropositive. Those who remained seronegative had mean prevaccination antibody titers significantly lower than those who seroconverted. Sixteen of 17 (94.1%) persons who reported having been vaccinated in the past and were found to be seronegative developed adequate antibody titers following vaccination, compared with only nine of 16 (56.2%) who reported never having been vaccinated (P = .04). There was no association between seroconversion rate and age, sex, underlying diseases, and army service. CONCLUSIONS: Most individuals will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine. A history of past immunization is a good predictor of becoming adequately immunized. It is important that physicians follow the current recommendations for adult immunization and initiate campaigns to ensure that the older population is protected against tetanus.