Prevalence of diphtheria and tetanus antibodies and circulation of Corynebacterium diphtheriae in São Paulo, Brazil

Abstract

The introduction of routine vaccination against tetanus and diphtheria in Brazil has decreased the incidence and changed the epidemiology of both diseases. We then investigated the prevalence of Corynebacterium diphtheriae carrier status and diphtheria and tetanus immunity in São Paulo, Brazil. From November 2001 to March 2003, 374 individuals were tested for the presence of C. diphtheriae in the nasooropharynx and of serum diphtheria and tetanus antibodies. Participants were all healthy individuals without acute or chronic pathologies and they were stratified by age as follows: 0-12 months and 1-4, 5-9, 10-14, 15-24, 25-39, 40-59, and ≥60 years. Antibodies were assessed using a double-antigen ELISA. C. diphtheriae species were identified by biochemical analysis and toxigenicity was assessed by the Elek test. For diphtheria, full protection (antibodies ≥0.1 IU/mL) was present in 84% of the individuals, 15% had basic protection (antibodies ≥0.01 and <0.1 IU/mL) and 1% were susceptible (antibodies <0.01 IU/mL). Full tetanus protection (antibodies ≥0.1 IU/mL) was present in 79% of the participants, 18% had basic protection (antibodies ≥0.01 and <0.1 IU/mL) and 3% were susceptible (antibodies <0.01 IU/mL). The geometric mean of diphtheria and tetanus antibodies reached the highest values at 5-9 years and decreased until the 40-59-year age range, increasing again in individuals over 60 years. Three participants (0.8%) were carriers of C. diphtheriae, all non-toxigenic strains. The present results demonstrate the clear need of periodic booster for tetanus and diphtheria vaccine in adolescents and adults after primary immunization in childhood.

Perfil clínico-epidemiológico dos casos de tétano acidental ocorridos em Ribeirão Preto, Estado de São Paulo, no período de 1990 a 2009

“…Embora disponível na rede pública de saúde, a cobertura vacinal antitetânica ainda é bastante deficiente no Brasil, principalmente na população de idosos. Em estudo conduzido na Cidade de São Paulo observou-se que nos indivíduos maiores de 40 anos a prevalência de anticorpos protetores contra tétano é de apenas de 60% 11 .…”

“…O tétano acidental no Brasil apresenta uma tendência à senilização, visto a menor cobertura vacinal e a maior suscetibilidade aos acidentes na população geriátrica 11,12 . O coeficiente de mortalidade vem apresentando redução em todas as faixas etárias exceto nos maiores de 60 anos 13 .…”

Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil

“…A study investigating human immunity to DT in São Paulo (2001 to 2003) showed that 82% of individuals aged 40 to 59 years were susceptible to the disease (19). Overall, these data suggest that five years after the Brazilian Ministry of Health recommended additional booster doses to be provided every 10 years, the adult population in our country is not fully protected against diphtheria.…”

Üst Solunum Yolu Enfeksiyonu Bulguları ile Başvuran Çocukların Boğaz Sürüntü Örneklerinde Corynebacterium diphtheriae, Corynebacterium ulcerans ve Corynebacterium pseudotuberculosis Suşlarının Araştırılması

“…Taşıyıcılarda yeterli sayıda toksijenik suş ortaya çıktığında enfeksiyonun duyarlı kişilere yayılması artmaktadır. Avrupa'da yapılan çalışmalar, difteri epidemisini önlemek için gereken antikor düzeyinin popülasyonda koruyucu eşiğin altında olduğunu ve yaşla ters orantılı olarak azaldığını göstermektedir 9 .…”