Relationship Between Tetanus Antitoxin Titration Level and Vaccination History

Abstract

Objectives: We aimed to determine tetanus antitoxin levels and to evaluate their relationship with history of vaccination among patients applying to the outpatient clinics of a University hospital.

Methods: A questionnaire including socio-demographic characteristics and tetanus vaccination status was applied and blood samples taken from 218 subjects between 1 and 30 June 2015. Participants were classified into five groups according to their vaccination timing.

Results: The mean age of participants was 46.7±15.4 years and 134 (61.5%) were women. Tetanus antitoxin levels were found weak positive in 54 (24.8%) patients, positive in 44 (20.2%) and strong positive in 120 (55.0%). Tetanus antitoxin level positivity was significantly associated with vaccination timing according to history. Among 105 participants who did not remember being vaccinated or who knew they were vaccinated but did not remember the date, 16 (15.2%) remembered the vaccination time when their injury, military service and pregnancy were questioned specifically. Antitoxin levels decreased with increasing age independent of gender (0.9-fold increase/year).

Conclusion: We found that the booster dose recommended every 10 years was not applied sufficiently. Tetanus vaccination history must be questioned in more detail among people who do not remember/know their vaccination history, with specific questions regarding pregnancy, military service and injury histories. 

Keywords

• C.tetani,tetanus,vaccine,immunization history

Kaynakça

1. 1. Taeusch W, Ballard A. Avery’s disease of the newborn. Edition 1998; 7: 516-517.
2. 2. American Academy of Pediatrics. Report of the committee on infectious diseases. 1997 Red Book. 24th ed. 1997:518-23.
3. 3. CDC Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook - 13th Edition, 2015.
4. 4. Adult Immunization Guide, 2nd Review. May 2016, İstanbul.
5. 5. Collins S, Amirthalingam G, Beeching NJ, et al. Current epidemiology of tetanus in England, 2001-2014. Epidemiol Infect. 2016;18:1-11.
6. 6. Ünal S, Tanrıöver DM, Taş E, Güner İ, Çetin Ö, Sayar İ. The effects of educating family physicians and getting targets for vaccination on pneumococcal vaccination coverage rates. Flora 2015;20(1):10-15.
7. 7. Kader Ç, Balci, Erbay. Evaluation of tetanus antibody levels in adults in Yozgat, Turkey. Turk J Med Sci. 2016;46:646-50. 8. Centralized information system for infectious diseases (CISID) data.euro. who.int/cisid
8. 9. Atabey N, Gökoğlu M. Antitoxin levels detected against tetanus in different age groups. Microbiology Bull. 1990;24:133-40.

9. 10. Aggerbeck H, Pederson B, Heron I. Simultaneous quantitation of diphteria and tetanus antibodies by double antigen, time resolved fluorescence immunoassay. J Immunol Methods. 1996;190:171-83.
10. 11. Ramshorst V. Titration of diphtheria and tetanus antitoxins in sera of low titer. Bull World Health Org. 1971;45:213-8.
11. 12. Sönmez C, Çöplü N, Esen B. Improvement of home-made ELISA technique for detection of anti-tetanus antibodies. Turkish Microbiol Commun Bull. 2010;40:259-66.
12. 13. William P. Fundamental Immunology. 2nd ed. London: Raven Pres,1998:331-4.
13. 14. Duman N, Yılmazel G, Başcı A, Koçak D. Frequency of vaccination against tetanus in pregnancies participating in the birth preparation class and factors affecting them. Turk Family Physicians Bull. 2015;19:84-9.
14. 15. Bayas JM, Vilella A, Bertran MJ, et al. Immunogenicity and reactogenicity of the adult tetanus-diphtheria vaccine. How many doses are necessary? Epidemiol Infect. 2001;127:451-60.
15. 16. Filia A, Bella A, von Hunolstein C, et al. Tetanus in Italy 2001-2010: a continuing threat in older adults. Vaccine. 2014;32:639-44.
16. 17. Weinberger B. Adult vaccination against tetanus and diphtheria: the European perspective. Clin Exp Immunol. 2017;187:93-9.
17. 18. Quinn HE, McIntyre PB. Tetanus in the elderly--An important preventable disease in Australia. Vaccine. 2007;25:1304-9.
18. 19. Öner S, Buğdaycı R, Kurt A, Öztürk C, Şaşmaz T. Tetanus seroprevalence –among women 15-49 years old, in Mersin, Turkey. Turkiye Klinikleri J Med Sci-2008;28:839-46.
19. 20. Tosun S, Deveci S, Yücetürk M, Dönmez A, Kaplan Y. Investigation of tetanus antitoxin titer levels in people over forty years of age. Turkiye Klinikleri J Med Sci 2012;32:301-7.
20. 21. Hainza U, Jeneweina B, Ascha E, et al. Insufficient protection for healthy elderly adults by tetanus and TBE vaccines. Vaccine 2005;23:3232–5.
21. 22. Infectious Diseases International Research Initiative (ID-IRI). Tetanus in adults: Results of multicenter ID-IRI study. Eur J Clin Microbiol Infect Dis 2017;25:12-6.
22. 23. Kaml M, Weiskirchner I, Keller M. Booster vaccination in the elderly: Their success depends on the vaccine type applied earlier in life as well as on pre-vaccination antibody titers. Vaccine. 2006;24:6808–11.