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1.
BMC Infect Dis ; 20(1): 731, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028231

RESUMO

BACKGROUND: The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. CASE PRESENTATION: A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. CONCLUSION: This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.


Assuntos
Hematoma/diagnóstico , Tétano/patologia , Idoso , Anticoagulantes/uso terapêutico , Feminino , Hematoma/etiologia , Hematoma/terapia , Humanos , Imunoglobulinas/uso terapêutico , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Tétano/complicações , Tétano/tratamento farmacológico , Tomografia Computadorizada por Raios X
3.
Mol Immunol ; 127: 164-174, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33002728

RESUMO

BACKGROUND AND PURPOSE: Tetanus neurotoxin has many potential therapeutic applications, due to its ability to increase localised muscle tone when injected directly into a muscle. It is a closely related molecule to botulinum neurotoxin (most commonly known as Botox), which has been widely used to release muscle tension for therapeutic and cosmetic applications. However, tetanus toxin has been relegated to the "maybe pile" for protein therapeutics - as most of the population is vaccinated, leading to highly effective antibody-mediated protection against the toxin. The potential for tetanus-based therapeutics remains substantial if the problem of pre-existing immunity can be resolved. EXPERIMENTAL APPROACH: A well-established murine model of localised muscular contraction was utilised. We administered functional tetanus toxin combined with an immunogenic, but functionally inactive, decoy molecule. KEY RESULTS: Incorporation of the decoy molecule greatly reduces the dose of active toxin required to induce a localised increase in muscle tone in mice vaccinated with the human toxoid vaccine. CONCLUSION AND IMPLICATIONS: Our results clearly demonstrate that the barriers to developing a tetanus toxin therapeutic are not insurmountable and the technology presented here is the first major step towards realising the therapeutic potential of this powerful neurotoxin. Opening the therapeutic potential of tetanus toxin will have huge implications for the wide range of diseases caused by low-tone muscle.


Assuntos
Toxoide Tetânico/imunologia , Toxoide Tetânico/uso terapêutico , Animais , Humanos , Camundongos Endogâmicos C57BL , Proteínas Recombinantes/isolamento & purificação , Soluções , Tétano/imunologia , Toxoide Tetânico/administração & dosagem , Vacinação
4.
Acta Chir Orthop Traumatol Cech ; 87(4): 292-296, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32940226

RESUMO

Tetanus is a disease caused by tetanotoxin produced in necrotic wounds by Clostridium tetani. It is a very rare disease in Czechia due to successful and effective population-wide vaccination programme, despite the fact that spores of C. tetani are permanently present in the environment. Groups with the highest risk of clinical tetanus include elderly people, immunocompromised individuals, residents of foreign origin with unclear vaccination history, and unvaccinated children. We present four case studies of severe and mild form of tetanus, wound infection with the presence of C. tetani without the development of clinical tetanus in a fully vaccinated individual, and unexpected risk of tetanus in an unvaccinated child. Due to the rare occurrence of tetanus in Czechia, the clinical awareness of the risk of tetanus decreases as well as the clinical experience with diagnosis of early or mild forms of tetanus. Communication skills during the management of contaminated wounds play a critical role in the decision who should get tetanus anatoxin only and who should get antitetanus immunoglobulin along with the active immunization by tetanus anatoxin. Key words: etanus, Clostridium tetani, vaccination, postexposure prophylaxis, vaccine hesitancy, contaminated wounds.


Assuntos
Tétano , Idoso , Criança , Clostridium tetani , Humanos , Tétano/diagnóstico , Tétano/prevenção & controle , Toxoide Tetânico , Vacinação
5.
Toxicon ; 187: 75-81, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32889026

RESUMO

Tetanus is an acute, fatal disease caused by exotoxin produced by Clostridium tetani. The current vaccine against tetanus is based on inactivated tetanus toxin (TeNT). To develop a recombinant TeNT vaccine suitable for replacement of full-length tetanus toxoid (TT) vaccine for use in humans, a recombinant non-tagged isoform of the Hc domain of the tetanus toxin (THc) was expressed in Escherichia coli and purified by sequential chromatography steps. The immunogenicity and protective effect of the THc antigen were explored and compared with those of TT in Balb/c mice. The THc-based subunit vaccine provided complete protection against TeNT challenge following a high dosage as a toxoid vaccine. While the anti-THc and neutralising antibody titres were higher for the THc-based vaccine than the TT vaccine because protective epitopes are located on the THc domain. Frequency- and dose-dependent immunoprotection were also observed in THc-immunised mice. Mice immunised with one injection of 1 µg or 4 µg THc antigen were completely protected against 102 or 103 50% mouse lethal dose (LD50) of TeNT, respectively. Furthermore, the THc protein was found to recognise and bind to ganglioside GT1b in a dose-dependent manner, and anti-THc sera antibodies also inhibited binding between THc and GT1b. Antigen on the form of recombinant non-tagged THc domain expressed in E. coli achieved strong immunoprotective potency, suggesting that it could be developed into a candidate subunit vaccine against tetanus as an alternative to the current TT vaccine.


Assuntos
Toxina Tetânica , Vacinas Sintéticas , Animais , Anticorpos Neutralizantes , Gangliosídeos , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Tétano , Toxoide Tetânico , Vacinas de Subunidades
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(9): 953-957, 2020 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-32907284

RESUMO

Objective: To observe the adverse reactions of Diphtheria, Tetanus, Acellular Pertussis and Haemophilus Influenzae Type b Combined Vaccine conjugate vaccine at the anterolateral thigh muscle, upper arm deltoid muscle and upper gluteal region. Methods: A total of 12 241 infants who were voluntarily vaccinated DTaP-Hib from April 2015 to April 2019 in Beijing were selected for the study. DTaP-Hib vaccine is recommended for 3, 4, 5 months of age for basic immunization and 18 to 24 months of age to strengthen immunization. Subjects were divided into the groups of lateral thigh muscle, the upper arm deltoid and upper gluteal region according to the actual inoculation sites. Adverse reactions were collected within 30 minutes and 7 days after each does of vaccination at different sites and compared between three groups. The incidence of adverse reactions at the three different inoculation sites was compared by Chi-square test. Results: A total of 12 241 infants and toddlers received combined DTaP-Hib and 35 027 doses of DTaP-Hib were investigated. The number and of lateral thigh muscles, upper arm deltoids and gluteal muscles were 3 461 infants and 11 129 doses, 2 659 infants and 7 957 doses, 6 121 infants and 15 941 doses respectively. A total of 2 489 adverse reactions occurred. The incidence of adverse reactions was 7.11%. The incidence of adverse reactions in deltoid muscle of upper arm was 9.69%(771 doses), which was higher than that in gluteal muscle (7.58%, 1 211 doses) and anterolateral muscle of thigh (4.56%, 507 doses). The incidence of mild, moderate and severe adverse reactions in the upper arm deltoid group were higher than those in the other two groups. The incidence rates were 4.85% (386 doses), 3.77% (300 doses) and 1.07% (85 doses) respectively. The differences between groups were statistically significant(P<0.001). The total adverse reactions of the three doses of basic immunization and the fourth dose of enhanced immunization had the same trend in different parts. The incidence of adverse reactions was in the order of the upper arm deltoid injection, upper gluteal injection and lateral thigh muscle injection from high to low. The differences were statistically significant (P<0.001). Conclusion: The incidence of adverse reactions of DTaP-Hib vaccination in three different sites was low, which confirmed that the DTaP-Hib vaccination got expected safety regardless of the sites of inoculation. The lateral femoral muscle group had the lowest incidence of adverse reactions, hence it should be preferred as the inoculation site of DTaP-Hib vaccination.


Assuntos
Difteria , Vacinas Anti-Haemophilus , Haemophilus influenzae tipo b , Tétano , Coqueluche , Pequim , Pré-Escolar , Humanos , Lactente , Vacina Antipólio de Vírus Inativado , Vacinas Conjugadas
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(9): 958-962, 2020 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-32907285

RESUMO

Objective: To evaluate the safety of diphtheria, tetanus and acellular pertussis (DTaP) containing combination vaccines used in Chengdu. Methods: The AEFI reports data of DTaP vaccine, DTaP-Haemophilus influenza type b combined vaccine (DTaP-Hib) and DTaP-inactivated poliovirus-Hib combined vaccine (DTaP-IPV-Hib) in Chengdu from 2015 to 2019 were collected through the national immunization management system. Description epidemiological method was used to analyze the data. Results: From 2015 to 2019, a total of 8 234 cases of AEFI of DTaP containing combination vaccines were reported in Chengdu, with a reported incidence of 194.55/100 000 doses, including 7 897 cases of common adverse reaction (168.59 per 100 000) and 234 cases of rare adverse reaction (5.53 per 100 000). The DTaP vaccine reported 4 240 cases AEFI (140.63 per 100 000), the DTaP-Hib vaccine reported 2 490 cases AEFI (399.09 per 100 000) and the DTaP-IPV-Hib vaccine reported 1 504 cases AEFI (253.49 per 100 000). All the three vaccines had the highest incidence for the booster doses; the rare adverse reaction were mainly Anaphylactic Reaction (6.27 per 100 000). Conclusions: The AEFI monitor system had high sensitivity, and the rare adverse reaction rate was extremely low, all the vaccines had good safety profiles. The Thrombocytopenic purpura and Laryngeal Edema should be paid more attention to.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Difteria , Vacinas Anti-Haemophilus , Tétano , Coqueluche , Anticorpos Antibacterianos , Humanos , Lactente , Vacina Antipólio de Vírus Inativado/efeitos adversos , Vacinas Combinadas/efeitos adversos , Vacinas Conjugadas/efeitos adversos
9.
Medicine (Baltimore) ; 99(31): e21529, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756200

RESUMO

RATIONALE: Tetanus is usually caused by wound infection with Clostridium tetani after acute injuries. Skin cancer wound is a rarely reported cause of tetani infection. It is difficult to be diagnosed and mistaken for other brain lesions. PATIENT CONCERNS: A 49-year-old man presenting with the only symptom of repeated convulsions was admitted to our department. He had an ulcerated skin cancer on the right buttock that had been excised in another hospital 1 month before admission, leaving the wound unhealed. He was suspected of having a metastatic brain tumor early, but exhibited a negative cranial CT-scan. DIAGNOSIS: Tetanus was diagnosed when he was observed to have sudden convulsions after sensory stimulation such as noise, light, or touch. INTERVENTIONS: Despite administration of a high dose of diazepam and phenobarbitone, continuous generalized rigidity with laryngospasm still occurred. Instead, when propofol was intravenously infused, the spastic convulsion completely stopped. Tracheotomy and mechanical ventilation were performed. OUTCOMES: The patient gradually recovered in 2 weeks. LESSONS: Tetanus is rarely infected through the wound of an ulcerated skin cancer. Early diagnosis can only be based on accurate assessment of clinical manifestations, and propofol infusion appears to be more effective in anti-convulsion management for patients with tetanus. Routine vaccination to prevent tetanus in patients with ulcerated skin cancer should be considered in the future clinical work.


Assuntos
Neoplasias Cutâneas/complicações , Tétano/etiologia , Úlcera/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/complicações , Tétano/fisiopatologia
10.
Am J Trop Med Hyg ; 103(4): 1717-1725, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618256

RESUMO

In Haiti, measles, rubella, and maternal and neonatal tetanus have been eliminated, but a diphtheria outbreak is ongoing as of 2019. We conducted a nationally representative, household-based, two-stage cluster survey among children aged 5-7 years in 2017 to assess progress toward maintenance of control and elimination of selected vaccine-preventable diseases (VPDs). We stratified Haiti into West region (West department, including the capital city) and non-West region (all other departments). We obtained vaccination history and dried blood spots, and measured antibody concentrations to VPDs on a multiplex bead assay. Among 1,146 children, national seropositivity was 83% (95% CI: 80-86%) for tetanus, 83% (95% CI: 81-85%) for diphtheria, 87% (95% CI: 85-89%) for measles, and 84% (95% CI: 81-87%) for rubella. None of the children had long-term immunity to tetanus or diphtheria (IgG concentration ≥ 1 international unit/mL). Seropositivity in the West region was lower than that in the non-West region. Vaccination coverage was 68% (95% CI: 61-74%) for ≥ 3 doses of tetanus- and diphtheria-containing vaccine (DTP3), 84% (95% CI: 80-87%) for one dose of measles-rubella vaccine (MR1), and 20% (95% CI: 16-24%) for MR2. The seroprevalence of measles, rubella, and diphtheria antibodies is lower than population immunity levels needed to prevent disease transmission, particularly in the West region; reintroduction of these diseases could lead to an outbreak. To maintain VPD control and elimination, Haiti should achieve DTP3 and MR2 coverage ≥ 95%, and include tetanus and diphtheria booster doses in the routine immunization schedule.


Assuntos
Difteria/epidemiologia , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/epidemiologia , Tétano/epidemiologia , Vacinação , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Masculino , Estudos Soroepidemiológicos , Cobertura Vacinal
11.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-47562

RESUMO

É uma doença infecciosa grave, não contagiosa, causada por uma toxina produzida pela bactéria Clostridium tetani. Essa bactéria é encontrada nas fezes de animais e de seres humanos, na terra, nas plantas, em objetos e pode contaminar as pessoas que tenham lesões na pele (feridas, arranhaduras, cortes, mordidas de animais etc.), pelas quais o microrganismo possa penetrar, provocando o tétano acidental.


Assuntos
Tétano
12.
BMC Public Health ; 20(1): 855, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503478

RESUMO

BACKGROUND: Immunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone. METHODS: This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods. RESULTS: The overall prevalence of receiving TT immunization during women's last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639,2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well. CONCLUSION: Higher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.


Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Toxoide Tetânico/administração & dosagem , Tétano/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Pobreza/estatística & dados numéricos , Gravidez , Prevalência , Serra Leoa/epidemiologia , Inquéritos e Questionários , Tétano/mortalidade , Adulto Jovem
13.
Rev. bras. ortop ; 55(3): 284-292, May-June 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1138038

RESUMO

Abstract Objective To evaluate whether the conducts involving antimicrobial treatment and prophylaxis against tetanus have been performed according to the Clinical Protocol of the Institution. Methods Descriptive and retrospective study conducted in patients of both genders, > 18 years old admitted to a public hospital specialized in emergency and trauma, to treat primary open fracture. The data of interest were surveyed in medical records, drug prescriptions, report of patients admitted in the Surgical Block and tetanus prophylaxis requests. Results A total of 241 patients were selected, mostly male (81.7%), young adults (64.3%), victims of motorcycle accidents (53.5%). Infectious complications were present in 18.7% of the fractures, the mean time for the surgical approach was 4 hours and 12 minutes, and 91.7% of the patients had preoperative antimicrobial prescription. The main inadequacies identified were: period of prescription of antimicrobial treatment (63.5%); choice of the antimicrobial scheme (59.3%) and antimicrobial dose (58.0%). Only 14.1% of the patients were immunized against tetanus. Conclusion The greatest divergences with the Clinical Protocol were observed in the issues involving the antimicrobial regimen used, doses and time of prescription, as well as in tetanus prophylaxis.


Resumo Objetivo Avaliar se as condutas envolvendo o tratamento antimicrobiano e a profilaxia contra o tétano têm sido realizadas conforme o Protocolo Clínico da Instituição. Métodos Estudo descritivo e retrospectivo, realizado em pacientes de ambos os gêneros, > 18 anos, admitidos em um hospital público estadual especializado em urgência e trauma, para tratamento primário de fratura exposta. Os dados de interesse foram pesquisados em prontuários médicos, prescrições de medicamentos, relatórios de pacientes admitidos no Bloco Cirúrgico e solicitações de profilaxia antitetânica. Resultados Foram selecionados 241 pacientes, a maioria homens (81,7%), adultos jovens (64,3%), vítimas de acidentes motociclísticos (53,5%). As complicações infecciosas estiveram presentes em 18,7% das fraturas, o tempo médio para a abordagem cirúrgica foi de 4 horas e 12 minutos, e 91,7% dos pacientes tiveram prescrição do tratamento antimicrobiano no pré-operatório. As principais inadequações identificadas foram: período de prescrição do tratamento antimicrobiano (63,5%); escolha do esquema de antimicrobianos (59,3%) e dose dos antimicrobianos (58,0%). Apenas 14,1% dos pacientes foram imunizados contra o tétano. Conclusão As maiores divergências com o Protocolo Clínico foram observadas nas questões envolvendo o esquema de antimicrobianos utilizados, doses e tempo de prescrição, bem como na profilaxia antitetânica.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Tétano , Ferimentos e Lesões , Motocicletas , Acidentes , Tratamento Primário , Antibioticoprofilaxia , Emergências , Prevenção de Doenças , Fraturas Ósseas , Auditoria Clínica , Fraturas Expostas , Hospitais Públicos , Infecções , Anti-Infecciosos , Antibacterianos
15.
Int J Infect Dis ; 96: 422-430, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32387447

RESUMO

OBJECTIVE: To determine the seroprevalence of antibodies against of diphtheria, tetanus, and pertussis among Thai adolescents. METHODS: A cross-sectional study was conducted among Thai adolescents aged 11-20 years who had completed five doses of diphtheria, tetanus, and pertussis (DTP)-containing vaccine during childhood, either diphtheria toxoid, tetanus toxoid, whole-cell pertussis (DTwP) or diphtheria toxoid, tetanus toxoid, acellular pertussis (DTaP) vaccine. Protective antibodies against diphtheria, tetanus, and pertussis were defined as anti-diphtheria toxoid IgG ≥0.1 IU/ml, anti-tetanus toxoid IgG ≥0.1 IU/ml, and anti-Bordetella pertussis toxin IgG ≥5 IU/ml, respectively. RESULTS: Of 220 adolescents (median age 16 years), 45% had received a tetanus toxoid, reduced diphtheria toxoid (Td) booster vaccine during adolescence, and none (0%) had received a tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap) booster vaccine. Overall, 50%, 99%, and 57% of adolescents demonstrated protective antibodies against diphtheria, tetanus, and pertussis, respectively. The geometric mean concentrations (GMCs) of antibodies against diphtheria (p = 0.06) and tetanus (p < 0.001) were higher among adolescents who had received Td vaccine. Nevertheless, the antibody levels against both diseases waned over time, regardless of Td booster vaccination. Likewise, pertussis antibody levels gradually declined after the fifth childhood dose of DTwP/DTaP vaccine. CONCLUSIONS: Approximately half of these healthy Thai adolescents had not maintained protective antibodies against diphtheria and pertussis. A booster vaccination with diphtheria toxoid and/or acellular pertussis-containing vaccines is a crucial strategy to prevent such diseases in this population.


Assuntos
Anticorpos Antibacterianos/sangue , Difteria/sangue , Tétano/sangue , Coqueluche/sangue , Adolescente , Adulto , Criança , Estudos Transversais , Difteria/epidemiologia , Difteria/prevenção & controle , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Feminino , Humanos , Imunização Secundária , Masculino , Estudos Soroepidemiológicos , Tétano/epidemiologia , Tétano/prevenção & controle , Tailândia/epidemiologia , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adulto Jovem
17.
MMWR Morb Mortal Wkly Rep ; 69(17): 515-520, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352953

RESUMO

Maternal and neonatal tetanus* (MNT) remains a major public health problem, with an 80%-100% case-fatality rate among neonates, especially in areas with poor immunization coverage and limited access to clean deliveries (i.e., delivery in a health facility or assisted by medically trained attendants in sanitary conditions) and umbilical cord care (1). In 1989, the World Health Assembly endorsed the elimination† of neonatal tetanus (NT), and in 1999, the initiative was relaunched and renamed the MNT elimination§ initiative, targeting 59¶ priority countries (1). Elimination strategies include 1) achieving ≥80% coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV) among women of reproductive age through routine immunization of pregnant women and supplementary immunization activities (SIAs)** in high-risk areas and districts††; 2) achieving care at ≥70% of deliveries by a skilled birth attendant (SBA)§§; and 3) enhancing surveillance for NT cases (1). This report summarizes progress toward achieving MNT elimination during 2000-2018. Coverage with ≥2 doses of TTCV (2 doses of tetanus toxoid [TT2+] or 2 doses of tetanus-diphtheria toxoid [Td2+]) among women of reproductive age increased by 16%, from 62% in 2000 to 72% in 2018. By December 2018, 52 (88%) of 59 priority countries had conducted TTCV SIAs, vaccinating 154 million (77%) of 201 million targeted women of reproductive age with TT2+/Td2+. Globally, the percentage of deliveries assisted by SBAs increased from 62% during 2000-2005 to 81% during 2013-2018, and estimated neonatal tetanus deaths decreased by 85%, from 170,829 in 2000 to 25,000 in 2018. By December 2018, 45 (76%) of 59 priority countries were validated by WHO as having achieved MNT elimination. To achieve elimination in the remaining 14 countries and sustain elimination in countries that have achieved it, implementation of MNT elimination strategies needs to be maintained and strengthened, and TTCV booster doses need to be included in country immunization schedules as recommended by the World Health Organization (WHO) (2). In addition, integration of maternal, newborn, and child health services with vaccination services is needed, as well as innovative approaches to target hard-to-reach areas for tetanus vaccination and community engagement to strengthen surveillance.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Vigilância da População , Tétano/prevenção & controle , Feminino , Humanos , Programas de Imunização , Recém-Nascido , Gravidez , Tétano/epidemiologia , Toxoide Tetânico/administração & dosagem
18.
Artigo em Inglês | MEDLINE | ID: mdl-32326203

RESUMO

Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles-mumps-rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. Methods: A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. Results: The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche , Difteria , Vacinas contra Hepatite B , Jovens em Situação de Rua , Vacina contra Sarampo-Caxumba-Rubéola , Sarampo , Caxumba , Poliomielite , Rubéola (Sarampo Alemão) , Tétano , Cobertura Vacinal , Criança , Estudos Transversais , Vacina contra Difteria, Tétano e Coqueluche/uso terapêutico , Feminino , Vacinas contra Hepatite B/uso terapêutico , Humanos , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/uso terapêutico , Inquéritos e Questionários , Vacinação
19.
Artigo em Inglês | MEDLINE | ID: mdl-32305971

RESUMO

Immunization strategies for the elderly are frequently perceived as comprising only vaccines against influenza, Streptococcus pneumoniae, and herpes zoster. However, besides these vaccines, which are recommended specifically for the elderly, regular booster vaccinations against tetanus, diphtheria, and in some cases pertussis and polio, are recommended in many countries for adults including the elderly. Vaccination recommendations for adults differ greatly between individual countries and coverage data are scarce. A substantial proportion of adults, and particularly of the older age groups, do not have protective antibody concentrations against diphtheria, whereas tetanus-specific antibody concentrations are generally higher. Protection against pertussis is unsatisfactory in all adults, and development of improved vaccines is ongoing. Future vaccination strategies should include regular and well-documented booster shots throughout life, as post-booster antibody concentrations correlate with pre-booster antibody concentrations.


Assuntos
Difteria/prevenção & controle , Encefalite Transmitida por Carrapatos/prevenção & controle , Fatores Imunológicos/uso terapêutico , Tétano/prevenção & controle , Vacinas/uso terapêutico , Coqueluche/prevenção & controle , Anticorpos Antibacterianos , Vacina contra Difteria, Tétano e Coqueluche/uso terapêutico , Humanos , Imunização Secundária , Vacinação , Vacinas Combinadas , Vacinas Virais/uso terapêutico
20.
Artigo em Inglês | MEDLINE | ID: mdl-32305985

RESUMO

People who travel to countries where they are at risk of contracting specific infections often need specific vaccines. To make correct recommendations in this respect several points have to be considered. The state of health of the traveler should be known as well as his or her destination and travel style. Very important, however, is the age of the traveler. As advancing age leads to changes in the immune system, in older individuals many infections are more severe. On the other hand, most vaccines are less immunogenic in the elderly. In this chapter, we will discuss which vaccines are necessary for older travelers visiting (mainly) tropical and subtropical countries, how these vaccines have to be used, and if perhaps their use has to be altered in older individuals. First, standard vaccinations will be addressed. When the immunization state of the individual is incomplete because certain vaccinations are expired or missing, it has to be updated. Vaccinations against tetanus, diphtheria, influenza, pneumococcal diseases, measles, and poliomyelitis have to be considered in this respect, because the risk of getting infected with these diseases in tropical and subtropical regions or in regions with poor hygienic conditions is often higher or at least the same as in industrialized countries. The second and main part of this chapter contains the typical travel vaccines. We will deal with vaccinations against cholera, hepatitis A and B, Japanese encephalitis, invasive meningococcal diseases, rabies, typhoid fever, and yellow fever. Clinical courses and epidemiology of the different infections are presented. The respective vaccines are discussed in detail, especially their efficiency in older individuals as far as data are available in this respect. Finally, recommendations for their use in older travelers will be given.


Assuntos
Fatores Imunológicos/uso terapêutico , Viagem , Vacinas/uso terapêutico , Idoso , Cólera/prevenção & controle , Difteria/prevenção & controle , Encefalite Japonesa/prevenção & controle , Encefalite Transmitida por Carrapatos/prevenção & controle , Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Humanos , Influenza Humana/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Poliomielite/prevenção & controle , Raiva/prevenção & controle , Tétano/prevenção & controle , Febre Tifoide , Vacinação , Febre Amarela/prevenção & controle
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