Epidemiological and Clinical Characteristics of Non-neonatal Tetanus Patients in Guangxi,China:An 11-year Retrospective Study(2011–2021)

Tetanus is the only non-communicable disease among vaccine-preventable infectious diseases.It is caused by an infection with Clostridium tetanus bacterium and is characterized by continuous tonic contraction and paroxysmal spasms of skeletal muscles throughout the body[1].

Characteristics, Management, and Outcomes of Tetanus Cases in a Referral Center in Senegal, between 2010 and 2017

Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.

A scoping review of studies on women's knowledge regarding Tdap vaccination during Pregnancy

This review aimed to determine and identify the knowledge and attitude of the mothers or pregnant women toward the Tdap vaccine during pregnancy.Whooping cough,Diphtheria disease and tetanus are infectious and pathogenic bacterial diseases that mainly affect children too young to complete basic vaccinations,and deaths associated with infectious diseases are frequent among them.Therefore,it is advisable for pregnant women to take the triple bacterial vaccine(tetanus,diphtheria and pertussis).This scoping review was conducted,and various electronic databases were searched,including Medline and PubMed.Moreover,Google Scholar,CDC,and immunization research group websites were searched to investigate the literature on the Tdap vaccine.As a result,13 studies were included in this review.Based on the findings of this review,the level of knowledge of ladies and pregnant women about the importance of the vaccine depended upon several factors,including education level,occupation,age,sources of vaccine information,maternal desire,being born outside the country,lower household income,religious misconception,residing in a province or area where the pertussis vaccine was not free,having given birth to live children in the past,and receiving maternity care from a midwife.Therefore,it can be concluded that the increase in the level of knowledge about the importance of Tdap vaccine increased the percentage of women who supported and accepted the vaccine.Studies have also shown that some mothers refused vaccination due to reservations about vaccine safety and efficacy since they did not have sufficient knowledge or experience.

临床药师防治新生儿破伤风及撤药综合征的循证用药实践

目的:探讨临床药师参与新生儿破伤风及撤药综合征的循证用药思路及监护要点。方法:临床药师参与1例新生儿破伤风及撤药综合征的药物治疗过程,对在家分娩的新生儿是否需预防破伤风和新生儿撤药综合征药物治疗进行证据检索。结果:临床药师建议预防用1500~3000 U破伤风抗毒素,并在确诊新生儿撤药综合征后给予苯巴比妥5 mg/(kg·d)维持治疗。临床医师采纳用药建议,患儿惊厥控制后停用苯巴比妥。患儿生命体征平稳出院,出院后3个月随访未再发生惊厥。结论:临床药师在针对临床治疗经验少和治疗方案有争议的用药问题上,充分结合最佳证据给予临床治疗依据,在促进新生儿临床安全、合理用药中发挥了一定作用。

咪达唑仑+机械通气治疗重症破伤风的疗效分析

目的探讨重症破伤风患者采用咪达唑仑+机械通气治疗的临床效果。方法随机选取2018年7月—2023年7月济南市第三人民医院收治的50例重症破伤风患者为研究对象,按照不同治疗方法分为参照组和研究组,每组25例。参照组采用硫酸镁等常规治疗,研究组在参照组基础上采用咪达唑仑+机械通气治疗。对比两组治疗总有效率、疼痛情况和并发症。结果研究组治疗总有效率[96.00%(24/25)]高于参照组[68.00%(17/25)],差异有统计学意义(χ^(2)=4.878,P<0.05)。治疗后,研究组疼痛评分(1.25±0.33)分低于参照组的(3.19±0.38)分,差异有统计学意义(t=19.273,P<0.05)。研究组并发症总发生率低于参照组,差异有统计学意义(P<0.05)。结论临床治疗重症破伤风患者,实施咪达唑仑药物联合机械通气疗法可提升重症破伤风患者的临床疗效,并有效缓解患者的疼痛程度,安全性较高。

吸附破伤风疫苗加强免疫后7天抗体水平变化

目的 明确吸附破伤风疫苗加强免疫后早期破伤风抗体(tetanus antibody, TAB)水平变化情况。方法 对2019—2021年在晋江市罗山街道社区卫生服务中心就诊的1978年以后出生的已完成含破伤风类毒素疫苗(tetanus toxoid-containing vaccine, TTCV)免疫规划5年以上的269例受试者加强免疫1剂破伤风类毒素(tetanus toxoid, TT),观察免疫后7 d TAB水平变化。结果 269例受试者中,加强免疫前TAB<0.01 IU/mL和0.01~0.09 IU/mL的受试者分别占29.4%和70.6%;加强免疫后7 d, TAB≥0.01 IU/mL的受试者达82.9%,TAB≥0.10 IU/mL的受试者达37.2%;加强免疫前后,不同TAB水平的受试者比例差异有统计学意义(χ2=123.05,P<0.001)。加强免疫后7 d,男、女性受试者中TAB≥0.10 IU/mL的受试者分别占35.6%和38.7%;12~<21岁、21~<31岁和31~42岁组受试者中TAB≥0.10 IU/mL的受试者分别占55.3%、36.8%和20.3%。结论 已完成全程TTCV免疫规划5年以上人群TT加强免疫后7 d约1/3的受试者可以获得有效免疫保护。

两种不同成分吸附破伤风疫苗预防接种安全性评价

目的 评价两种市售不同成分吸附破伤风疫苗(adsorbed tetanus vaccine)预防接种的安全性。方法 2021年4月—10月在晋江市罗山街道社区卫生服务中心动物致伤科招募接种吸附破伤风疫苗的11周岁以上就诊患者741例。患者自主选择接种两种不同成分吸附破伤风疫苗中的一种,A组293例接种吸附破伤风疫苗A(不含硫柳汞),B组448例接种吸附破伤风疫苗B(含硫柳汞)。比较两组预防接种后的不良事件(AEs)情况。结果 A组、B组中分别有29例、22例发生AEs,AEs发生率分别为9.90%(29/293)、4.91%(22/448),两组之间差异有统计学意义(χ^(2)=6.87, P=0.009)。不同年龄人群中,≥61岁人群在A组、B组的AEs发生率分别为6.67%(3/45)、0.00%(0/64),差异具有统计学意义(χ^(2)=12.43, P=0.036)。不同AEs类型中,疼痛在A组、B组的发生率分别为7.85%(23/293)、3.57%(16/448),差异具有统计学意义(χ^(2)=6.50, P=0.011)。在AEs持续时间方面,症状出现时间<24 h的患者在A组、B组AEs发生者中分别占44.83%(13/29)、72.72%(16/22),差异具有统计学意义(χ^(2)=3.98, P=0.046)。结论 不同成分的吸附破伤风疫苗均具有良好的预防接种安全性,但是AEs表现存在差异,A组人群的AEs发生率高于B组,但症状持续时间少于B组。

贵州省医疗机构外伤后破伤风预防处置现状调查

目的了解贵州省外伤后破伤风预防处置现状和医务人员破伤风防病知识知晓情况,为制定破伤风预防处置规范提供依据。方法实地调查全省所有三级甲等医院28家、所有县(区)人民医院87家;从贵州省免疫规划信息管理系统获取破伤风疫苗接种剂次;设计问卷随机抽取部分医院开展医务人员破伤风防病知识知晓情况调查。结果外伤后破伤风预防处置,5.21%的医疗机构只开展外伤处置,仅13.04%的医疗机构同时开展疫苗接种服务和被动免疫制剂注射,其余81.74%的医疗机构只开展破伤风被动免疫制剂注射服务。近5年,全省共接种破伤风疫苗24862剂次,年均仅4972剂次。与同期狂犬疫苗比,使用量极少。医务人员破伤风防病知识知晓率为30.60%,其中,含破伤风类毒素成分疫苗种类知晓率最低,仅11.72%,儿童含破伤风类毒素成分疫苗免疫规划程序知晓率最高,为62.76%。2021年1月1日至2023年6月30日,115家医疗机构诊断破伤风93例,其中28家三级甲等医院诊断62例,占66.67%。结论贵州省破伤风暴露后预防处置服务的可及性和规范性亟待提高,存在仅单纯使用破伤风被动免疫制剂、忽视除儿童常规免疫以外含破伤风类毒素成分疫苗的现象。医务人员对相关知识认知不足,有待进一步培训提高。

无典型外伤史破伤风1例

破伤风是由于破伤风芽孢梭菌侵入人体伤口后,出现的以肌肉强直性痉挛为特点的感染性疾病。近年来,随着卫生条件的改善,破伤风疫苗接种的普及,破伤风的发病率已明显降低。尽管如此,破伤风仍然是发展中国家,特别是在经济欠发达的农村地区重要的死亡原因。由于该病缺乏实验室确诊依据,临床上容易误诊、延误治疗。本文报道了1例无典型外伤史的破伤风患者诊治病例,通过对病情的分析,并结合文献复习,为临床医师对该类疾病的诊治提供参考。

BCS联合TDAP组织瓣转移IPBR治疗原发性乳腺癌的效果与安全性分析

目的比较保留乳房手术(BCS)联合胸背动脉穿支(TDAP)组织瓣转移乳房成形术与BCS联合背阔肌皮瓣乳房再造术在原发性乳腺癌中的治疗效果与安全性。方法选择该院收治的原发性乳腺癌患者,其中拟行BCS联合TDAP组织瓣转移乳房成形术患者42例为研究组,拟行BCS联合背阔肌皮瓣乳房再造术患者42例为对照组,观察患者围术期情况、术后效果及并发症等。结果84例患者均成功完成手术,研究组手术时间显著长于对照组(P<0.05),但两组拔管时间、引流时间及住院时间差异均无统计学意义(P>0.05);术后3个月,研究组重建乳房优良率为92.86%,高于对照组的76.19%,差异有统计学意义(P<0.05);研究组的满意度显著高于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论BCS联合TDAP组织瓣转移乳房成形术治疗原发性乳腺癌术后乳房美观性好,并发症少,安全可靠,是原发性乳腺癌治疗的较佳选择。

10岁及以下儿童破伤风抗毒素注射的规范化培训效果

目的 探讨10岁及以下儿童破伤风抗毒素注射的现况及实施规范化培训的效果。方法 2019年7月根据《中国破伤风免疫预防专家共识》对儿童外伤注射破伤风实施1个月规范化培训;将2018年1月—2019年6月收治的10岁及以下外伤(眼科、口腔科、耳鼻喉科、急诊外科)儿童为对照组,2019年8月—2021年6月收治的10岁及以下儿童为观察组;观察两组破伤风抗毒素使用情况和不良反应。结果 对照组275例儿童均使用破伤风抗毒素或破伤风免疫球蛋白注射,实施脱敏疗法46例(16.70%);观察组188例外伤儿童使用破伤风抗毒素或破伤风免疫球蛋白注射51例(27.13%),实施脱敏疗法3例(5.90%),两组比较差异有统计学意义(χ^(2)=284.616、3.962,P<0.05)。两组均未发生过敏反应,未出现破伤风病例。结论 儿童破伤风抗毒素注射的使用存在不合理性,可能增加注射破伤风抗毒素发生过敏的危险,增加患儿实施脱敏疗法增加的痛苦;通过规范化培训能明显较少破伤风抗毒素不合理的使用。

破伤风人免疫球蛋白抗-HBs效价测定(ELISA法)方法验证

目的:对ELISA法测定破伤风人免疫球蛋白抗-HBs效价进行方法学验证。方法:根据《中国药典》(2020年版)“9401生物制品生物活性/效价测定方法验证指导原则”,对破伤风人免疫球蛋白抗-HBs效价测定(ELISA法)方法进行专属性、相对准确度、中间精密度、线性及线性范围的验证,并与放射免疫方法(RIA法)测定结果进行比对。结果:专属性验证中,回收率在88%~110%,实测与理论结果等效,样品、混合样品均与标准回归曲线平行;相对准确度验证中,相对偏倚在-6.9%~5.0%,回归曲线斜率0.9981;中间精密度验证中,几何变异系数<10%;线性验证中,相关系数为0.9970;方法范围为10~120 mIU/mL。ELISA法测得的每1 g蛋白质中抗-HBs结果平均值比RIA法低0.5 IU。结论:经验证,ELISA法可替代RIA法用于破伤风人免疫球蛋白中抗-HBs效价的测定。

现代分析技术在破伤风类毒素的结构表征中的应用

目的采用现代分析技术对破伤风类毒素(TT)的结构进行表征。方法采用圆二色谱法(CD)对TT的二级结构进行考察,差示扫描量热法(DSC)对TT的变性温度进行考察,并对不同批次样品的测定结果进行比较。结果9批次TT的α-螺旋比例为25.4%~26.2%,反向平行为12.3%~14.9%,平行为6.4%~7.0%,β-转角为21.7%~24.0%,无规卷曲为31.8%~33.9%,熔解温度为89.19℃~90.47℃,结果重复性、批间一致性均良好。结论圆二色谱法和差示扫描量热法可用于破伤风类毒素的结构表征,为该类产品在生产过程中的稳定性和一致性提供技术支持。

羊破伤风的诊断与防治

破伤风病是由破伤风梭菌引起的中毒性传染病,羊群的整体发病率虽然不高但也时有发生,主要是细菌经伤口侵入机体后引起发病。主要症状表现为哺乳困难,四肢僵硬,咬肌强直,肌肉痉挛,口角外牵,若未及时诊治,极易发生死亡。结合工作实践,分析了羊破伤风病的流行病学、临床症状,探讨了羊破伤风病的诊断方法,并提出了针对性的防控措施,以期为广大羊养殖人员提供参考。

Intraoperative Diagnosis and Use of Glidescope^t^mVideo Laryngoscope for Cephalic Tetanus

This case report describes the clinical characteristics and management of a 38-year-old man with cephalic tetanus. He presented with a massive facial infection after a dental procedure. After induction of anesthesia, cephalic tetanus was clinically diagnosed during induction based on the presence of a new facial nerve palsy and nuchal rigidity even after the administration of succinylcholine. The first attempt at intubation was unsuccessful with a Macintosh laryngoscope due to persistent nuchal rigidity and lockjaw despite the use of succinylcholine. Consistent with other reports, intubation was remarkably uncomplicated when the video laryngoscope was used. Postoperatively, the Clostridium tetani infection progressed to generalized tetanus and responded to supportive care. This case highlights the difficulties of diagnosis, and supports the utility of the Glidescopetm video laryngoscope in this unusual pathological condition.

Maternal Tetanus at the University College Hospital in Ibadan Nigeria: A 15-Year Retrospective Analysis

Objective To determine the characteristics of women with maternal tetanus, pattern of presentation and outcome of management. Methods A total of 19 women were managed with maternal tetanus between 1990 and 2005 from the University College Hospital in Ibadan Nigeria. A retrospective study was performed. The medical records of all women managed as a case of maternal tetanus were retrieved from the central record department of the hospital. The pattern of presentation, characteristics of women, the duration of hospital admission, tetanus toxoid immunization, and outcome of care were measured. Results The records of 18 women managed were analyzed. The mean age at presentation was 25.2 ±5.3 years. The patients were mostly single, nulliparous and had primary school education. The maternal tetanus cases seen mainly complicated induced abortion while 5 and 2 other cases were due to childbirth complication and leg wound respectively. The portal of entry of the remaining 3 cases could not be ascertained. None of the patient managed had complete immunization schedule. The average duration of admission was 11.2 ± 6. 7 d. Five women had intensive care with 3 of them requiring ventilatory support. The case fatality rate was 66. 7%. The only factor that significantly improved survival was presence of generalized spasm at presentation （P=0.006） Conclusion The occurrence of maternal tetanus is a reflection of low quality of health care delivery and lack or inefficient routine immunization coverage in any community.

Tetanus of the Child after Extraction of <i>Tunga penetrans</i>in Brazzaville: One Case

Tetanus has become rare even exceptional in the West. On the contrary, it is common in developing countries such as Congo because of low immunization coverage. Its diagnosis, which is essentially clinical, is easy but necessitates a fine semeiological analysis under certain circumstances. We are reporting here a case of tetanus involving an 8-year-old unvaccinated, indigenous aboriginal boy that was caused by the extraction of a Tunga penetrans. The symptomatology of abdominal contractures led to an exploratory laparotomy. The evolution was favorable.

Influence of Age on the Clinical and Prognostic Features of Tetanus in Mali

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.

Neonatal Tetanus at Pediatric Teaching Hospital in Bangui

Background: Despite the Maternal and Neonatal Tetanus (MNT) elimination initiative, neonatal tetanus still persists in some parts of the world. Objectives: To determine hospital prevalence and describe epidemiological, clinical, therapeutic and outcome aspects of neonatal tetanus at the Pediatric Teaching Hospital in Bangui. Methodology: It was the review of hospitalized newborns’ files in the neonatal unit at Pediatric Teaching Hospital in Bangui between January 2016 and December 2019. Newborns discharged with tetanus diagnosis, and whose files were usable were included. The variables studied were: for the newborn: age, sex, birth weight, the reason for transfer, diagnosis, cause and time of death, place and method of delivery;for the mother: age, antenatal care, tetanus vaccine status, parity and geographical provenance. Epi Info 7 software, version 7.1.3.3 was used for data analysis. The chi2 test with the significance level set at p < 0.05 and the odds ratio were used. Résultats: Forty-eight (48) out of 5796 newborns had neonatal tetanus (0.8%). They were newborns to mothers with an average age of 18.8 years of which 68.8% (n = 33) were primipara and 87.5% (n = 42) not vaccinated against tetanus. Childbirth happened at home in 91.7% (n = 44), and the blade was used for sectioning the umbilical cord in 39.6% (n = 19). Newborns were referred from rural area in 47.9% (n = 23). A single antenatal care contact was done in 68.7% (n = 33). Tetanus was classified as severe according to the Dakar prognosis score between 4 and 6 in 89.6% of cases (n = 43). The death occurred in 58.3% (n = 28). Conclusion: The high frequency of neonatal tetanus as well as its severity requires pregnancy follow-up strengthening and childbirth monitoring in order to its elimination. But primary prevention relies on improving individual and general hygiene conditions.

Diphtheria and Tetanus Antibody Persistence in Indian Pre-school Children and Response to a Booster Dose of DT Vaccine.

Despite effective vaccines, diphtheria (D) resurged recently in the former socialistic block, and tetanus (T) still occurs in less privileged countries. We studied the antibody persistence for D and T in Indian pre-school children who had received four doses of DTP vaccine and subsequently, the response to a booster dose. Anti-D and anti-T IgG antibodies prior to and one month after a DT vaccine were measured by ELISA in 223 healthy children of 4-6 years who had previously received four doses of the triple vaccine. Adverse reactions were monitored for one month. While 30% and 14% of subjects were susceptible to D and T, respectively, 98% and 100% of them attained seroprotection post-vaccination. Both responses were significant. Local, but not systemic reactions except fever were rather common. A high proportion of the Indian pre-school population is susceptible to D and T, despite of receiving four doses. The current policy of giving the fifth dose at this age is appropriate.