29例新生儿破伤风患儿的护理

目的：探讨新生儿破伤风的护理特点.方法：回顾总结29例新生儿破伤风的护理经验.结果：29例患儿均治愈.结论：及早准确使用破伤风抗毒素血清（TAT）,交替使用安定和氯丙嗪等药物控制抽搐,严密观察病情和精心护理是该病治愈的关键.     

Have you had a tetanus booster in the last 10 years? Sensitivity and specificity of the question

OBJECTIVE: To evaluate the accuracy of patients' recall of their last Tetanus/Diphtheria (Td) booster in the setting of employee health clinics known for high immunization rates and good documentation of vaccine status. METHODS: Five hundred and seventy-two patients of an employee health clinic answered a written questionnaire about whether they have had a Td booster in the last 10 years. Answers were compared with patients' charts as the gold standard. RESULTS: The sensitivity of the question is 92.4% (95% CI 89.0-95.0) and specificity is 26.5% (95% CI 12.9-44.4). Positive predictive value is 92.6% (95% CI 89.3-95.2) and negative predictive value is 25.7% (95% CI 12.5-43.3). Age and gender do not affect the accuracy of recall. CONCLUSION: A positive answer to this question is highly reliable whereas a negative answer is unreliable. PRACTICE IMPLICATIONS: In the setting of employee health clinics, when patients affirm the receipt of a Td booster within the previous 10 years, it is quite likely that they are up to date and do not require re-administration of the vaccine. Any other answer to this question (No, I do not know) is unreliable and a booster should be recommended if not contraindicated.     

Influences on formation of tetanus antibody after simultaneous injection of tetanus immunoglobulin with tetanus vaccine

The goal of this study was to determine how much the formation of tetanus antibody is influenced after a single injection of tetanus vaccine (Td) and the simultaneous injection of tetanus vaccine with tetanus immunoglobulin (TIG). All of the healthy adult volunteers were divided into two groups: group 1 (Td only) and group 2 (Td plus TIG). Two hundred thirty seven volunteers were enrolled. When the baseline antibody titer, gender and age were adjusted, the geometric mean titers (GMTs) of the tetanus antibody (group 1 vs group 2) was 0.8438 IU/mL vs 0.5684 IU/mL at 4 weeks (P = 0.002), 0.4074 IU/mL vs 0.3217 IU/mL at 6 months (P = 0.072) and 0.3398 IU/mL vs 0.2761 IU/mL at 12 months (P = 0.140) after injection, respectively. The formation of tetanus antibody after tetanus vaccination is not influenced by TIG at the late period and in adults below the age of 50 yr, but there are significant differences between the two groups at the early period of 4 weeks after vaccination and for the patients over 60 yr.     

Antibody levels against tetanus and diphtheria after polychemotherapy for childhood sarcoma: a report from the Late Effects Surveillance System

Background

It is known that antineoplastic treatment may induce secondary immunodeficiency, but studies after childhood sarcoma are rare. Since 1998, the Late Effects Surveillance System (LESS) of the German Society for Paediatric Oncology and Haematology (GPOH) prospectively registers late effects in soft tissue-, osteo- and Ewing's sarcoma patients treated within the therapy trials EICESS-92/EURO-E.W.I.N.G.-99, CWS-96/CWS-2002P, COSS-96 in Austria, Germany and Switzerland.

Patients and methods

Antibody levels (AL) against diphtheria and tetanus were used as markers for immunity and classified according to established guidelines for protective AL values. There were 47 eligible relapse-free patients < 21 years of age (31 males; 10 osteosarcoma, 12 Ewing's and 25 soft tissue sarcoma patients). Median age at diagnosis was 9.6 (interquartile range: 4.4-14.7) years.

Results

A median 7.2 (3.7-12.2) months after end of antineoplastic therapy, in 28% (13/47; 95% CI 16-43%) of patients there were no protective AL (<0.1 IU/ml) against diphtheria and/or tetanus. Diphtheria and tetanus AL were positively correlated (r = 0.39; p = 0.007). In multivariable analysis, the type of treatment had no effect on AL, similar to tumour type and time of examination after treatment end. Younger patients had significantly lower AL against tetanus (p = 0.009) and girls had significantly lower AL against diphtheria than boys (p = 0.015).

Conclusion

Lack of protective AL against tetanus and/or diphtheria is frequent after childhood sarcoma treatment. Prospective surveillance of immunity and, if indicated, re-immunization is warranted in patients treated for childhood cancer.     

Physico-chemical properties of Salmonella typhi Vi polysaccharide-diphtheria toxoid conjugate vaccines affect immunogenicity

In this study it was demonstrated that the immunogenicity of Vi polysaccharide-diphtheria toxoid conjugates was related to the physical and chemical structure of the conjugate. Conjugates were prepared in two steps, firstly binding adipic acid dihydrazide (ADH) spacer molecules to diphtheria toxoid (DT) carrier protein then secondly binding varying amounts of this derivatized DT to a fixed amount of Vi capsular polysaccharide purified from Salmonella enterica Serovar Typhi. As the amount of DT bound to the Vi increased the size of the conjugate increased but also the degree of cross-linking increased. The immunogenicity of the conjugates was tested in mice and measured by ELISA for anti Vi and anti DT IgG responses, and the results revealed a trend that as the amount of DT bound to the Vi increased the anti Vi responses increased. This study establishes a correlation between physico-chemical characteristics of the conjugate and the magnitude of the anti Vi and anti DT responses.     

An investigational tetravalent meningococcal serogroups A, C, W-135 and Y-tetanus toxoid conjugate vaccine co-administered with Infanrix™ hexa is immunogenic, with an acceptable safety profile in 12-23-month-old children

Tetravalent meningococcal serogroups ACWY conjugate vaccines will provide an advantage to those at most risk of invasive meningococcal disease; namely young children. Co-administration of ACWY-TT with DTaP-HBV-IPV/Hib was assessed in a randomized trial in 793 children aged 12-23 months. Pre-specified criteria for non-inferiority of immunogenicity following co-administration versus separate ACWY-TT and DTaP-HBV-IPV/Hib administration were reached. One month post-vaccination, ≥97.3% of ACWY-TT vaccinees had rSBA titres ≥1:8 (all serogroups). Seroprotection/seropositivity rates against DTaP-HBV-IPV/Hib antigens were ≥98.2%. The safety profile of co-administration was similar to that of DTaP-HBV-IPV/Hib alone. ACWY-TT and DTaP-HBV-IPV/Hib co-administration during the second year would facilitate introduction of ACWY-TT into routine toddler vaccination schedules.     

Immunogenicity and reactogenicity of co-administered tetanus-diphtheria-acellular pertussis (Tdap) and tetravalent meningococcal conjugate (MCV4) vaccines compared to their separate administration

In the United States, co-administration of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine and tetravalent meningococcal conjugate vaccine (MCV4) is recommended in adolescents. In this clinical study, 1341 adolescents received Tdap (Boostrix® GlaxoSmithKline) and MCV4 (Menactra®, Sanofi-Pasteur) simultaneously or sequentially one month apart. Co-administration of Tdap + MCV4 was well tolerated and immunogenic, resulting in high levels of antibodies against diphtheria, tetanus, pertussis and meningococcal serogroup A,C,W-135 and Y antigens. The data provide support for current recommendations for co-administration of Tdap and MCV4 vaccines at the same office visit.     

Higher mass meningococcal group C-tetanus toxoid vaccines conjugated with carbodiimide correlate with greater immunogenicity

To examine the link between meningococcal C (MenC) vaccine size and immunogenic response, a panel of MenC glycoconjugate vaccines were prepared differing in chain length, molar mass and hydrodynamic volume. The preparations consisted of different lengths of MenC polysaccharide (PS) covalently linked to monomeric purified tetanus toxoid (TT) carrier protein using the coupling reagent ethylcarbodiimide hydrochloride (EDC). Size exclusion chromatography with multi-angle light scattering (SEC-MALS) and viscometry analysis confirmed that the panel of MenC-TT conjugates spanned masses of 191,500 to 2,348,000 g/mol, and hydrodynamic radii ranging from 12.1 to 47.9 nm. The two largest conjugates were elliptical in shape, whereas the two smallest conjugates were more spherical. The larger conjugates appeared to fit a model described by multiple TTs with cross-linked PS, typical of lattice-like networks described previously for TT conjugates, while the smaller conjugates were found to fit a monomeric or dimeric TT configuration. The effect of vaccine conjugate size on immune responses was determined using a two-dose murine immunization. The two larger panel vaccine conjugates produced higher anti-MenC IgG1 and IgG2b titres after the second dose. Larger vaccine conjugate size also stimulated greater T-cell proliferative responses in an in vitro recall assay, although cytokines indicative of a T-helper response were not measurable. In conclusion, larger MenC-TT conjugates up to 2,348,000 g/mol produced by EDC chemistry correlate with greater humoral and cellular murine immune responses. These observations suggest that conjugate size can be an important modulator of immune response.     

表达LTB乳酸杆菌提高艰难梭菌类毒素疫苗黏膜免疫效应的研究

目的 通过构建大肠埃希菌热敏性肠毒素B亚单位 (heat labile enterotoxin B subunit, LTB) 乳酸杆菌表达载体,研究其对艰难梭菌类毒素疫苗的黏膜免疫保护效应。方法 克隆LTB基因,制备pSIP411-LTB重组质粒,电转化到乳酸杆菌中,制备乳酸杆菌表达LTB载体;通过透析和层析等技术纯化艰难梭菌A毒素和B毒素,经甲醛处理获得的艰难梭菌A毒素和B毒素的类毒素作为疫苗候选抗原;在第0 d、第14 d和第28 d皮下接种小鼠艰难梭菌类毒素和口服乳酸杆菌表达LTB载体;在初次接种后第0 d、10 d、24 d和38 d检测抗A毒素和B毒素的血清IgG和粪便IgA;第34 d,小鼠经口感染艰难梭菌,观察疫苗保护效果。结果 成功构建了LTB乳酸杆菌佐剂表达载体和制备了艰难梭菌A毒素和B毒素的内毒素;各疫苗组和疫苗+LTB佐剂组小鼠在感染艰难梭菌后,均无腹泻、体重减轻和死亡现象,而对照组老鼠腹泻发病率为100%,死亡率42.86%,5 d体重下降0.83 g;在初次接种后的10 d、24 d和38 d,与空白组比较,各疫苗组抗A毒素或B毒素的血清IgG及粪便IgA显著升高(F=284.93,1 037.05,696.82,74,184.07,166.95,P<0.01);与疫苗组比较,接种疫苗+LTB佐剂组的血清IgG及粪便IgA显著升高(F=21.88,27.22,8.31,56.49,63.76,101.78,P<0.05)。结论 艰难梭菌A毒素和B毒素的类毒素作为疫苗的候选抗原对艰难梭菌的感染具有很好的保护效应,LTB乳酸杆菌载体表达佐剂能够提高免疫动物的抗体效价,增强黏膜免疫效应。