Tetanus Immunity Gaps in Children 5–14 Years and Men ≥ 15 Years of Age Revealed by Integrated Disease Serosurveillance in Kenya, Tanzania, and Mozambique

Scobie, Heather M.; Patel, Minal; Martin, Diana L.; Mkocha, Harran; Njenga, Sammy M.; Odiere, Maurice R.; Pelletreau, Sonia; Priest, Jeffrey W.; Thompson, Ricardo; Won, Kimberly Y.; Lammie, Patrick J.

doi:10.4269/ajtmh.16-0452

Cited by 26 publications

(29 citation statements)

References 18 publications

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“…We support recent calls to integrate tetanus vaccination with adult male circumcision, as a way of boosting immune status in men 13 – 15 . Formalization of tetanus vaccination programmes and establishment of tetanus as a notifiable disease have been associated with global declines in the incidence of tetanus since the 1940s 14 .…”

Section: Lessons Learntsupporting

confidence: 76%

“…The results of our research and another study based at the Bugando Medical Centre 13 indicate that such tetanus is being underreported. In studies conducted since 2000, only 28% (40/145) of Tanzanian males aged at least 15 years were found to be seroprotected against tetanus 15 and only 24% (24/102) of 102 tetanus patients at the Bugando Medical Centre reported previous immunization against the disease 13 . Implementation of a robust immunization programme against tetanus, ideally coupled with mandatory tetanus reporting, could be very beneficial in the United Republic of Tanzania and should be a priority.…”

Section: Lessons Learntmentioning

confidence: 99%

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Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Aziz

Peck

Kalluvya

et al. 2017

Bull. World Health Organ.

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ProblemIn the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported.ApproachWe analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016.Local settingBugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women.Relevant changesFrom our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme – e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11–55 years and five (83%) of them died in hospital – all of overwhelming sepsis.Lessons learntWithin the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.

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Section: Lessons Learntsupporting

confidence: 76%

Section: Lessons Learntmentioning

confidence: 99%

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Aziz

Peck

Kalluvya

et al. 2017

Bull. World Health Organ.

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“…Serological methods to directly measure immunity to one or several of the vaccines administered are increasingly used and are useful validation tools. There are relatively little-published data on the antibody response to TT and duration of protection in routine vaccination programmes in low-income countries where the accelerated WHO schedule is used [12]. As part of a study to evaluate the detection of anti-tetanus antibody using a non-invasive oral fluid sample, sera and vaccine histories were collected from a representative group of children aged 4 months to 6 years in Uganda.…”

Section: Introductionmentioning

confidence: 99%

Serum anti-tetanus and measles antibody titres in Ugandan children aged 4 months to 6 years: implications for vaccine programme

et al. 2018

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To study the antibody response to tetanus toxoid and measles by age following vaccination in children aged 4 months to 6 years in Entebbe, Uganda. Serum samples were obtained from 113 children aged 4-15 months, at the Mother-Child Health Clinic (MCHC), Entebbe Hospital and from 203 of the 206 children aged between 12 and 75 months recruited through the Outpatients Department (OPD). Antibodies to measles were quantified by plaque reduction neutralisation test (PRNT) and with Siemens IgG EIA. VaccZyme IgG EIA was used to quantify anti-tetanus antibodies. Sera from 96 of 113 (85.0%) children attending the MCHC contained Measles PRNT titres below the protective level (120 mIU/ml). Sera from 24 of 203 (11.8%) children attending the OPD contained PRNT titres 0.15 IU/ml by EIA, a level considered protective. The overall concentration of anti-tetanus antibody was sixfold higher in children under 12 months compared with the older children, with geometric mean concentrations of 3.15 IU/ml and 0.49 IU/ml, respectively. For each doubling in age between 4 and 64 months, the anti-tetanus antibody concentration declined by 50%. As time since the administration of the third DTP vaccination doubled, anti-tetanus antibody concentration declined by 39%. The low measles antibody prevalence in the children presenting at the MCHC is consistent with the current measles epidemiology in Uganda, where a significant number of measles cases occur in children under 1 year of age and earlier vaccination may be indicated. The consistent fall in anti-tetanus antibody titre over time following vaccination supports the need for further vaccine boosters at age 4-5 years as recommended by the WHO.

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“…Serological surveys (serosurveys) provide invaluable insight into the natural history and epidemiology of infection and can be used to: assess the effectiveness of vaccine campaigns, determine proximity to theoretical thresholds for disease elimination, estimate the burden of disease for immunising and/or chronic infections, and identify gaps in population immunity to inform interventions such as supplementary immunisation activities [1][2][3][4] . As a tool in seroepidemiology, serosurveys have been a significant component of disease control and elimination strategies for acute viral vaccine preventable disease (VPDs) like measles, rubella, and polio in high-income countries.…”

Section: Introductionmentioning

confidence: 99%

Serological Surveys for complementing assessments of vaccination coverage in sub-Saharan Africa: A systematic review

Wanjiku¹,

Adetifa²

2018

Wellcome Open Res

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Serosurveys of biomarkers of infection/vaccination are widely Background: used for evaluating vaccine-induced immunity and monitoring the effectiveness of immunisation programmes in developed countries. In sub-Saharan Africa (sSA) where vaccination coverage (VC) estimates are often incomplete, inaccurate and overestimate effective population immunity, the use of serosurveys is limited.We conducted a review of the use of serosurveys to Methods: assess/complement assessments of VC in sSA by searching electronic databases (PubMed, Embase, Web of Science, Popline, Ovid and Africa Wide Information) for English language articles published from 1 January 1940 to 31 January 2017. We also searched the references of retrieved articles. SSA was defined as all of Africa excluding the countries in North Africa. We included only articles that measured VC and assessed the quality of these studies using the Newcastle-Ottawa Scale.We found 1056 unique records, reviewed 20 eligible studies of which Results: just 12 met our inclusion criteria. These 12 studies were serosurveys of measles, tetanus, polio and yellow fever. Antibodies induced by natural infection confounded serological test results and there was significant discordance between vaccination history and the presence of antibodies in all except for tetanus vaccine. No study looked at Hepatitis B.Serosurveys for tetanus or tetanus containing vaccines may be Conclusions: directly useful for ascertainment of vaccination exposure or reliably complement current survey methods that measure VC. Given the limited experience in using serosurveys for this purpose in sSA, well-designed serosurveys of tetanus and possibly hepatitis B are required to further validate/evaluate their performance.

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Tetanus Immunity Gaps in Children 5–14 Years and Men ≥ 15 Years of Age Revealed by Integrated Disease Serosurveillance in Kenya, Tanzania, and Mozambique

Cited by 26 publications

References 18 publications

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Serum anti-tetanus and measles antibody titres in Ugandan children aged 4 months to 6 years: implications for vaccine programme

Serological Surveys for complementing assessments of vaccination coverage in sub-Saharan Africa: A systematic review

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