Maternal HIV Infection and Placental Malaria Reduce Transplacental Antibody Transfer and Tetanus Antibody Levels in Newborns in Kenya

Abstract

Background. In clinical trials, maternal tetanus toxoid (TT) vaccination is effective in protecting newborns against tetanus infection, but inadequate placental transfer of tetanus antibodies may contribute to lower-thanexpected rates of protection in routine practice. We studied the effect of placental malaria and maternal human immunodeficiency virus (HIV) infection on placental transfer of antibodies to tetanus.Methods. A total of 704 maternal-cord paired serum samples were tested by ELISA for antibodies to tetanus. The HIV status of all women was determined by an immunoglobulin G antibody-capture particle-adherence test, and placental malaria was determined by placental biopsy. Maternal history of TT vaccination was recorded.Results. Tetanus antibody levels were reduced by 52% (95% confidence interval [CI], 30%-67%) in newborns of HIV-infected women and by 48% (95% CI, 26%-62%) in newborns whose mothers had active-chronic or past placental malaria. Thirty-seven mothers (5.3%) and 55 newborns (7.8%) had tetanus antibody levels !0.1 IU/mL (i.e., were seronegative). Mothers' self-reported history of lack of tetanus immunization was the strongest predictor of seronegativity and of tetanus antibody levels in maternal and cord serum.Conclusion. Malarial and HIV infections may hinder efforts to eliminate maternal and neonatal tetanus, making implementation of the current policy for mass vaccination of women of childbearing age an urgent priority.

Tetanus in developing countries: a case series and review

“…In developed countries, mortality among high-risk groups, such as the elderly, is still as high as 52%. 1,7 Myocardial infarction may be a consequence of autonomic dysfunction and likely contributes to the increased mortality in the elderly population. 6 Effective immunization requires five encounters with the health care system by the age of 15 years, followed by booster immunizations every 10 years.…”

“…Indeed, 70% of tetanus cases and 80% of deaths in these countries occur in people over 50 years of age. 4,7 Recently, 24 cases of tetanus in the United Kingdom were reported among injection drug users, with intramuscular and subcutaneous injections leading to an especially high risk for developing the disease. 1 Most of these patients had either no record or an incomplete record of immunization.…”

“…Generalized tetanus is the most common form and represents 80% of cases. 7 Neonatal tetanus is a form of generalized tetanus that usually occurs within 28 days of birth. It also carries a very high mortality and accounts for 50% of deaths from tetanus.…”

“…Puncture injuries are the most common method of entry, but tetanus has been reported after fractures, burns, animal scratches, otitis media, contaminated surgical wounds involving the gastrointestinal tract or abortions, as well as umbilical cord contamination. 3,4,7 In approximately 20% of cases, no entry site can be found. 3,7 The incubation period, defined as the time from injury to first symptom, can range from one to 60 days.…”

“…3,4,7 In approximately 20% of cases, no entry site can be found. 3,7 The incubation period, defined as the time from injury to first symptom, can range from one to 60 days. This is followed by the onset period (time to first spasm), which ranges from 1 to 7 days.…”