East African immigrant children in Australia have poor immunisation coverage.

AIM: To provide data on the immunisation status of recently arrived East African children and adolescents in Australia. METHODS: A prospective audit was conducted at a hospital-based paediatric immigrant health clinic, in Melbourne, Australia, over the time period November 2000-January 2002. Study subjects were consecutive children and adolescents born in East Africa, arriving in Australia after January 1998. Vaccination status was ascertained by parent report and review of patient-held records where available, and by serological testing for immunity to hepatitis B, tetanus, diphtheria, rubella and measles. RESULTS: Among 136 participants, 132 (97%) had incomplete or unknown immunisation status based on parent report and vaccination records; written records were available for 5/136 (4%) of participants. Only 21/136 (15%) had serological immunity to all five of measles, rubella, tetanus, diphtheria and hepatitis B, despite a total of 395 visits to vaccine providers by participants since migration. A higher proportion of children had serological immunity to measles (90%) compared to the proportion with serological immunity to rubella (77%), tetanus (61%), diphtheria (45%) and hepatitis B (33%). The predictive value of parent-reported vaccination status for serological immunity was poor. CONCLUSIONS: Paediatric East African immigrants in Victoria are very likely to be inadequately immunised and parent-reported vaccination status does not predict serological immunity. Full catch-up immunisation is recommended where immunisation status is unknown and written records are unavailable. Consideration should be given to policy and program development to provide timely and complete immunisation coverage in this group after arrival in Australia.

Cross cultural communication of tetanus vaccinations in Bolivia.

Although neonatal tetanus (NNT) is common in developing countries, many people are unaware of its causes and prevention. A study analyzed cultural beliefs and practices to understand how people in three cultural areas in Bolivia (Aymara, Quechua and Tupi-Guarani) think about NNT and tetanus toxoid (TT) immunizations. In all three cultural areas NNT is perceived within a magical and biological framework that involves alternative healing systems and healers. Tetanus immunization programs could be more successful if tetanus were a clearly marked target for the Aymara, Quechua and Tupi-Guarani people, and vaccinators were sensitive to their cultural perceptions. Health workers need to communicate cross-culturally the relationship of TT vaccinations to how members of these ethnic groups perceive NNT.

The 1985 national immunisation survey: diphtheria, tetanus, and pertussis (whooping cough)

In April 1985 a national immunisation survey was conducted in which sera were collected from almost 3000 randomly selected children throughout New Zealand. The sera collected were from about 1000 new school entrants (mean age 5 years), 1000 standard 3 students (mean age 10 years), and 1000 form 4 students (mean age 15 years). The sera were tested for diphtheria and tetanus immunity and antibody to pertussis by enzyme-linked immunosorbent assay (ELISA) tests. The percentage of those immune to diphtheria decreased with age from 73.1% in the 5 year olds to 53.7% in the 15 year olds. The percentage of those immune to tetanus decreased with age from 66.9% in the 5 year olds to 54.6% in the 10 year olds but then increased to 64.0% in the 15 year olds. While more than 71.0% of the 10 and 15 year olds had measurable antibody to pertussis, only a low 54.4% of the 5 year olds did. The proportion immune to diphtheria and tetanus in both Maoris and Europeans was approximately similar in all three age groups. More Maoris (78.9%) than Europeans (66.1%) had antibody to pertussis. When the data had been standardised for age and ethnic group the percentage with antibody to pertussis and immunity to diphtheria was highest in the southern region, while for tetanus immunity the percentage immune was highest in the northern and southern regions. We conclude that a sizeable pool of new school entrants (mean age 5 years) without antibody to pertussis is accumulating at a time when pertussis still persists.(ABSTRACT TRUNCATED AT 250 WORDS)

A survey of neonatal tetanus and perinatal mortality in southern Muslim communities in Thailand.

The objective was to obtain the incidence rate of neonatal tetanus, perinatal mortality rate, and the coverage of health care utilization in the rural Muslim in the lower part of southern Thailand. In a retrospective field study, the rural populations of Narathiwat, Yala and Pattani provinces were studied by cluster sampling technique. The still birth rate and early neonatal mortality rate were 15.3 per 1,000 births and 11.2 per 1,000 live births, respectively. The maternal mortality rate was 1.7 per 1,000 live births. 55% of all pregnancies received 2 injections of tetanus toxoid, 80% of deliveries were performed by traditional birth attendants. The incidence rate of neonatal tetanus was 0.9 per 1,000 live births. The coverage of health service for prevention of perinatal mortality was low and these perinatal and maternal mortality rates were unacceptably high. In contrast, the incidence of neonatal tetanus was not particularly high for unknown reasons.

The use of magnesium sulphate in the intensive care management of an Asian patient with tetanus.

Tetanus, a potentially fatal but largely preventable disease through immunisation, is rare in Singapore. Timely diagnosis and appropriate intensive care management is essential to ensure survival. We aim to report the management of such a patient with magnesium sulphate. This has not been reported locally. By maintaining serum magnesium at 3 to 4 mmol/l we were able to control sympathetic overactivity by day 6, stop neuromuscular blockade by day 7 and wean off ventilator by day 11. Aminoglycoside-induced hypomagnesemia was also demonstrated, necessitating an increase in magnesium sulphate infusion rate to maintain serum magnesium at therapeutic level.

A population-based serologic survey of immunity to tetanus in the United States.

BACKGROUND: Vaccination rates are frequently considered a surrogate measure of protection. To provide more accurate estimates, serum levels of antibody against tetanus were measured as part of the third National Health and Nutrition Examination Survey (NHANES III), which studied a representative sample of the civilian, noninstitutionalized population of the United States. METHODS: We measured tetanus antitoxin using a solid-phase enzyme immunoassay in serum samples from 10,618 persons six years of age and older who were examined during phase 1 of NHANES III in 1988 to 1991. RESULTS: Overall, 69.7 percent of Americans six years of age and older had protective levels of tetanus antibodies (> 0.15 IU per milliliter). The rate decreased from 87.7 percent among those 6 to 11 years of age to 27.8 percent among those 70 years of age or older. Among children 6 to 16 years of age, 82.2 percent had protective levels of tetanus antibodies, with little variation according to race or ethnicity. More men than women were immune (79.0 percent vs. 62.4 percent). Mexican Americans had a significantly lower rate of immunity (57.9 percent, P < 0.05) than either non-Hispanic whites (72.7 percent) or non-Hispanic blacks (68.1 percent). Those with a history of military service, higher levels of education, or incomes above the poverty level were more likely to have protective antibody levels. Although the prevalence of immunity declined rapidly starting at the age of 40 years, most of the 107 cases of tetanus (with 20 deaths) reported in 1989 and 1990 occurred in persons 60 years of age or older. CONCLUSIONS: Despite the fact that effective vaccines against tetanus have been available since the 1940s, many Americans do not have immunity to tetanus, and the rates are lowest among the elderly. There is an excellent correlation between vaccination rates (96 percent) and immunity (96 percent) among six-year-olds. However, antibody levels decline over time, and one fifth of older children (10 to 16 years of age) do not have protective antibody levels.