破伤风抗毒素脱敏注射致敏1例报告

破伤风抗毒素系破伤风类毒素免疫马血浆经胃酶消化提纯制得的球蛋白制剂,主要用于预防和治疗破伤风.开放性外伤,特别是有感染破伤风危险的损伤后,临床常规用药.临床上注射治疗的病人很多,只有极少数过敏,与遗传,体质等因素有关.因此,在使用TAT时,①不但要在皮试前详细询问既往有无过敏史,而且在皮试注射后要严密观察患者病情变化,并向患者及家属交代注意事项,一旦发生过敏反应,要根据病情立即采取积极的抢救措施,防止过敏性休克的发生.②本例患者于皮试后50分钟出现过敏反应,故应延长对过敏体质患者的观察时间,③对条件简陋的门诊部,应加强完善抢救措施,以免贻误抢救时机.     

破伤风137例的发病原因分析及防治

目的:探讨破伤风的发病原因及防治对策。方法:回顾性分析137例破伤风病人的临床资料。结果:破伤风发病率最高的职业是农民(占64％);发病原因仍以外伤和感染占首位,而自行注射毒品引发破伤风者近来不断出现。绝大多数破伤风病人受伤后未及时做正确处理。结论:在广大农村加强破伤风防治和切断其感染途径是降低破伤风发病率的关键,一些新的感染途径如注射吸毒和医源性因素等应引起高度重视。     

新生儿破伤风七例临床分析

目的总结新生儿破伤风的临床治疗经验及预防措施.方法对7例新生儿破伤风的治疗做回顾性分析.结果 5例患儿治愈,1例转院,1例死亡.结论大剂量应用破伤风抗毒素（TAT）及地西泮,积极防治感染,保证热量供应,保持环境安静是治疗的主要措施,小剂量TAT治疗可能会延误或加重病情.推广新法接生可预防新生儿破伤风.     

Adherence of botulinum and tetanus neurotoxins to synaptosomal proteins

The ability of 125I-labeled botulinum type A and tetanus neurotoxins to adhere to blots of synaptosomal proteins separated by SDS-polyacrylamide gel electrophoresis was studied. Both neurotoxins appeared to adhere preferentially to an approximately 80 kDa and to a lesser extent to an approximately 116 kDa protein(s). Adherence of the neurotoxins to these proteins was enhanced by preincubation of the neurotoxins with GT 1b. The approximately 100 kDa heavy chain segment of BTxA adhered to the same proteins. The carboxy terminal half of the heavy chain adhered primarily to the approximately 80 kDa protein(s) while the amino terminal portion bound most intensely to the approximately 116 kDa protein(s). The ability of the approximately 80 and approximately 116 kDa proteins to stain positively with the periodic acid-Schiff reagent and to bind 125I-labeled wheat germ lectin suggests that they are glycosylated. Both neurotoxins appear to adhere to the same approximately 80 and approximately 116 kDa proteins because tetanus neurotoxin preincubated with GT 1b was able to reduce binding of radiolabeled botulinum type A neurotoxin to both proteins. Neither neurotoxin adhered to blots of proteins from liver, spleen, or kidney, suggesting that the proteins adhered to are neural components.     

A Status Report from 1996–2004: Are More Effective Immunization Interventions Being used in the Women,Infants, and Children (WIC) Program?

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) enrolls almost 50% of the US birth cohort and these children have significantly lower immunization coverage rates than their counterparts not eligible for WIC. In 1994, the Centers for Disease Control and Prevention (CDC) and USDA began a national initiative to increase immunization coverage in low-income children by incorporating immunization-promoting activities into WIC visits (WIC/Immunization linkages). Since 1998, CDC has monitored the WIC/Immunization linkages assessment and referral (with and without the more aggressive strategy of monthly voucher pick-up, client outreach and tracking and parental incentives) and three other immunization supporting activities (computerized systems to assess immunization status, collocation of WIC and immunization services, coordination of WIC and immunization services). METHODS: Through an annual survey of state Immunization and WIC programs, a trend analysis was conducted for years 1998 through 2004 to determine changes in the use and frequency of WIC/Immunization linkage activities. RESULTS: During the 7-year study period, the use of assessment and referral increased from 71% to 94%, monthly voucher pick-up from 24% to 35%, and coordination of WIC and immunization services from 61% to 78% (p<0.0001 for all comparisons) in WIC sites nationwide. The frequency of assessment and referral (at each visit [four or more times/ year] versus certification visits [two times/year]) was reported to decrease during the study period (p<0.0001). Outreach and tracking and collocation of services did not change significantly while the use of parental incentives decreased (p<0.0001). The availability of computers and their use immunization assessment increased during the period. From 2002-2004, the number of states reporting that they base assessment and referral on a single vaccine (diphtheria-tetanus-acellular pertussis) instead of counting multiple vaccines increased from 5 to 10. CONCLUSIONS: Immunization promoting activities, especially those known to be most effective in improving coverage such as monthly voucher pickup, are increasing in WIC. Focusing on effective interventions including supporting activities such as computerized assessment will be essential in meeting Healthy People 2010 infant and childhood immunization coverage goals. In addition, the use of WIC resources can be minimized by encouraging evaluation of diphtheria-tetanus-acellular pertussis coverage as a marker for up to date status, instead of counting all vaccine doses.     

Intranasal immunization with tetanus toxoid and CNF1 as a new mucosal adjuvant protects BALB/c mice against lethal challenge

Although often requiring the development of efficient adjuvants, needle-free mucosal delivery of vaccine is of major interest as a strategy of mass immunization against infectious diseases. We report that mucosal immunization against tetanus toxoid through nasal route, together with active cytotoxic necrotizing factor 1 (CNF1), elicits a specific and long lasting anti-tetanus toxin response, comprising seric IgG and IgA, as well as mucosal IgA. Immunized mice were protected against a challenge with lethal doses of tetanus toxin (10 × LD₅₀). The Rho GTPase activating toxin CNF1 is thus an attractive mucosal adjuvant candidate for nasal vaccines.     

Functional characterization of specific IgE antibodies for tetanus toxoid

Summary The specific IgE response that appears in subjects immunized with tetanus toxoid does not induce hypersensitivity reactions at subsequent immunizations. The type I immune response, therefore, was studied bothin vivo andin vitro, in 11 subjects who had specific IgE antibodies for tetanus toxoid. The results showed that: 1. the specific IgE antibodies are heterogeneous regarding their affinity for the mast cell and basophil receptors; 2. the specific IgG antibodies for tetanus toxoid, at serum concentrations, are not able to interfere with thein vitro specific basophil degranulation; 3. in the PEG precipitare there are aggregates of specific IgE antibodies for tetanus toxoid.In vitro, these molecular aggregates are not able to sensitize the basophil cells.     

韶关市健康人群百日咳、白喉和破伤风抗体水平监测

目的　了解韶关市健康人群百日咳、白喉和破伤风免疫状况,及时为免疫策略提供科学依据。方法　随机抽查部分0～4 0岁健康人群进行了百日咳、白喉和破伤风抗体水平监测。结果　百日咳抗体几何平均滴度GeimetricMeanTiter(GMT)和抗体保护率分别为1∶374 2、67.74% ;白喉、破伤风抗毒素GMT分别为0.1699IU/ml、0.1804IU/ml,阳性率分别为88.94 %、91.83%。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,应大力推广应用吸附无细胞百日咳、白喉、破伤风联合疫苗.     

α‐Galactosylceramide stimulates splenic lymphocyte proliferation in vitro and increases antibody production in vivo in late neonatal‐age mice

The neonatal stage is characterized by weak responses to various infections and vaccines, thus the development of efficient formulas to improve vaccine effectiveness is of high priority. The glycolipid alpha galactosylceramide (αGalCer) is known as a potent immune modulator due mainly to natural killer (NK) T cell activation. Using a mouse tetanus toxoid (TT) immunization model, we observed that neonatal mice given αGalCer at the time of primary immunization on postnatal day (pnd) 17 had a significantly higher TT‐specific immunoglobulin (Ig)M response as well as a memory IgG response, while αGalCer given on pnd 7 resulted in only marginal boosting. Consistently, immunostaining of the spleen sections from αGalCer‐treated pnd 17 immunized neonates showed a higher number of Ki67⁺ cells in the splenic germinal centre area, suggesting a stronger response after immunization. In‐vitro kinetic studies revealed that spleen cells from newborn to pnd 7 neonates did not respond to αGalCer stimulation, whereas cell proliferation was increased markedly by αGalCer after pnd 7, and became dramatic around neonatal pnd 17–18, which was accompanied by increased B, T and NK T cell populations in the spleen. In addition, in pnd 17 spleen cells, αGalCer significantly stimulated the production of NK T cytokines, interleukin (IL)‐4 and interferon (IFN)‐γ, and promoted the proliferation of CD23⁺ B cells, a subset of B cells enriched in germinal centres. These data suggest that αGalCer is an effective immune stimulus in the late neonatal stage, and thus may be useful in translational studies to test as a potential adjuvant to achieve a more efficient response to immunization.     

Tetanus in patients with chronic wounds – are we aware?

The incidence of tetanus in patients with wounds is unknown; however, recently concern has been raised over the proportion of tetanus cases in which a chronic wound is the portal of entry for Clostridium tetani. Varicose ulcers, dermatosis and necrosed tumours are estimated to be the point of entry for C. tetani spores in 11-14% of three cases. Of diabetic patients in the USA who contracted tetanus, a diabetic foot ulcer was responsible in 25% of cases despite this chronic wounds have yet to be considered as a risk factor for tetanus. An audit was undertaken and a survey devised to form the basis of the data collection to assess if patients with chronic wounds are up-to-date in accordance with the tetanus immunisation programme. Over a 5-day period, the data were prospectively collected and the tetanus status of a 100 patients retrospectively analysed. The status was then compared with general practitioner (GP) records via telephone follow-up. One hundred patients (n = 100) were available in the audit period, with the majority being male (n = 51). The age range was 22-91 years old (median 70 years). Nearly half of the samples (n = 48) were diabetic, with the majority of patients (n = 35) having venous leg ulcers. Only 15% had a biopsy of their wound. The duration of wounds varied from 1 to 480 months. Patients were asked to confirm their tetanus status. Almost half of the patients were unsure of their tetanus status 48% (n = 48), almost a third 30% (n = 30) thought they were not covered and 22% (n = 22) thought they were up-to-date. After confirming with the GP records, the results were as follows: almost half of the patients, 43% (n = 43) were not covered, 33% (n = 33) were up-to-date, 13% had no immunisation records available at the GPs, 10% had no GP contact details and 1% no contact was possible. Currently, tetanus prophylaxis is given based on the vaccination history of the patient but as identified that this can prove to be unreliable. With the burden of chronic wound and ageing population set to increase, levels of protection amplify the risk of tetanus faced by those suffering from chronic wounds. Strict caution should be taken in those patients who were born before the national childhood vaccination programme, implemented in 1961. Moreover, every effort should be made to ensure that such individuals complete their primary course. By ensuring each patient is actively immunised, protection against tetanus, a potential killer, is provided.