Search

Introduction: Standard emergency medicine practice includes tetanus vaccine administration as part of wound care management for patients who are not fully immunized. Since there have been no available studies in the United States reaffirming the prevalence of Clostridium tetani (C tetani) since 1926, we sought to identify its prevalence in a major urban county in the US.Methods: We sampled soil, rusted metal, concrete, and dog feces to determine the prevalence of C tetani in a single metropolitan county in the United States. Soil samples and swabs were collected from four locations: the soil of a public park and an elementary school; dog feces from a single public dog park; and rusted surfaces (metal and concrete) in common student areas of a university campus. The presence of C tetani in each sample was determined using a quantitative polymerase chain reaction.Results: In total, 200 samples were collected, of which 37 (18.5%) tested positive for C tetani DNA. Among the 140 samples taken from the soil, just one (0.7%) tested positive for C tetani DNA. Of the 40 samples of rusted metal and concrete surfaces, 30 (75%) tested positive for C tetani, and six (30%) of the 20 samples from dog feces tested positive for C tetani.Conclusion: We found that C tetani is frequently present on rusted metal and concrete surfaces but rarely in soil samples. Minor wounds contaminated with soil may be considered low risk for tetanus. However, future studies should assess the burden of C tetani in other similar urban, suburban, and rural environments to help determine the threat of C tetani more exactly.

Introduction: This study assesses the effectiveness of AI tools, ChatGPT and Google Gemini, in educating the public about neurological conditions such as Bell's palsy, Tetanus, and Headaches, and assess chatbot-generated patient guides based on readability and ease of understanding. Methodology: In March 2024, the authors conducted a cross-sectional study to develop patient education brochures for Bell's palsy, Tetanus vaccination, and Persistent Headache, leveraging AI models ChatGPT and Google Gemini. The brochures' quality was assessed through readability, similarity, and a modified DISCERN score for reliability. Statistical analysis, performed in R software, compared responses from both AI models using unpaired T-tests. The correlation between ease score and reliability was explored using Pearson's Coefficient of Correlation. Results: The study revealed no significant variances in word count, sentence count, or average words per sentence between the two AI tools. However, materials generated by ChatGPT exhibited significantly higher ease scores, highlighting its proficiency in creating more understandable content (p < 0.05). Conclusions: This study finds ChatGPT outperforms Google Gemini in readability despite similar metrics. This suggests ChatGPT's potential superiority in creating more understandable patient education materials. As AI advances, it's essential to research more tools and medical conditions to ensure they meet diverse patient education needs. [ABSTRACT FROM AUTHOR]

Background: Tetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive. Case summary: A 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home. Conclusion: First contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease. [ABSTRACT FROM AUTHOR]

Simple Summary: Clostridial infections in cattle are a major veterinary concern in Brazil, significantly impacting the country's livestock industry. These infections are caused by various Clostridium species, which are anaerobic, spore-forming bacteria capable of producing powerful toxins. The main clostridial diseases affecting cattle in Brazil include botulism, tetanus, blackleg, malignant edema and enterotoxemia. Prevention and control measures of regular vaccination programs are crucial in preventing clostridial diseases. Ensuring proper hygiene, especially during surgical procedures, and minimizing injuries can help reduce the risk of infection. Surveillance and research are essential for understanding the epidemiology of these diseases and improving control strategies. Monitoring outbreaks and investigating new cases help in adapting vaccination protocols and management practices. The economic impact of clostridial infections causes significant economic losses in Brazil's cattle industry due to high mortality rates, decreased productivity, and the costs associated with vaccination and treatment. Effective prevention and control strategies are crucial to mitigate these losses and ensure the health and productivity of cattle herds. Clostridial infections in cattle are a significant concern for Brazilian livestock. These diseases are caused by various species of Clostridium, which are known for their ability to produce potent toxins. Botulism in cattle is a serious and often fatal condition caused by the ingestion of neurotoxins produced by C. botulinum. This bacterium thrives in decomposing organic matter, such as spoiled feed, carcasses, and contaminated water. Tetanus is less common, but it is a serious disease that follows the contamination of wounds with Clostridium tetani spores. It results in muscle stiffness, spasms, and often death due to respiratory failure. Blackleg (C. chauvoei) is a disease that primarily affects young cattle, leading to acute lameness, swelling, and high fever. Malignant edema (C. septicum and others) is characterized by rapid onset of swelling at wound sites, and it can occur after injuries or surgical procedures. Enterotoxemia is triggered by the rapid growth of C. perfringens in the gut following excessive carbohydrate intake. This leads to toxin production that causes sudden death. In conclusion, clostridial bovine infections remain a persistent challenge for Brazilian cattle farmers. With continued focus on vaccination, good management practices, and research, the impact of these diseases can be minimized, safeguarding the livestock industry's economic viability. [ABSTRACT FROM AUTHOR]

Neuropeptides and neurotrophins are stored in and released from dense core vesicles (DCVs). While DCVs and synaptic vesicles (SVs) share fundamental SNARE/SM proteins for exocytosis, a detailed understanding of DCV exocytosis remains elusive. We recently identified the RAB3-RIM1 pathway to be essential for DCV, but not SV exocytosis, highlighting a significant distinction between the SV and DCV secretory pathways. Whether RIM1 is the only RAB3 effector that is essential for DCV exocytosis is currently unknown. In this study, we show that rabphilin-3A (RPH3A), a known downstream effector of RAB3A, is a negative regulator of DCV exocytosis. Using live-cell imaging at single-vesicle resolution with RPH3A deficient hippocampal mouse neurons, we show that DCV exocytosis increased threefold in the absence of RPH3A. RAB3A-binding deficient RPH3A lost its punctate distribution, but still restored DCV exocytosis to WT levels when re-expressed. SNAP25-binding deficient RPH3A did not rescue DCV exocytosis. In addition, we show that RPH3A did not travel with DCVs, but remained stationary at presynapses. RPH3A null neurons also had longer neurites, which was partly restored when ablating all regulated secretion with tetanus neurotoxin. Taken together, these results show that RPH3A negatively regulates DCV exocytosis, potentially also affecting neuron size. Furthermore, RAB3A interaction is required for the synaptic enrichment of RPH3A, but not for limiting DCV exocytosis. Instead, the interaction of RPH3A with SNAP25 is relevant for inhibiting DCV exocytosis. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionCTRI Registration number\nSUMMARYWHO and other health agencies recommend that tetanus toxoid (TT) should be replaced by tetanus-diphtheria (Td) vaccine taking into consideration the low coverage and waning immunity, especially for diphtheria. In this randomised, multicentre, non-inferiority study, the immunogenicity and safety of TeddyVac™ vaccine of Human Biologicals Institute were compared with an existing brand.The study involved 444 eligible subjects in two age groups at four centres across India. Group A included subjects of 18–60 years and Group B subjects of 10–18 years of age. All subjects received single dose of either TeddyVac™ or the comparator vaccine as per randomisation. Blood samples for antibody titre estimation were collected before vaccination and 4–6 weeks after vaccination. Immunogenicity was assessed by estimating seroconversion rate, seroprotection rate, and geometric mean titres of antibodies. Safety was evaluated by collection and analysis of data on solicited and unsolicited adverse events.Overall, 441 subjects completed the study. Both the vaccine arms showed comparable seroconversion after a single dose for both the components. Both arms showed increase in seroprotection and geometric mean titres after a single dose of vaccination for both vaccine components, being significantly better for the diphtheria component in the test vaccine arm. Only few minor local and systemic adverse events were observed in both the vaccine arms. No serious adverse event was reported.The study results indicate that the TeddyVac™ vaccine is immunogenic, safe and non-inferior to the comparator Vaccine when administered to healthy subjects of 10 to 60 years of age.CTRI/2021/07/035112In a randomised, multicentre study, TeddyVac™ vaccine of Human Biologicals Institute was found to be immunogenic, safe and non-inferior to an existing commercial brand when administered to healthy subjects of 10 to 60 years of age. [ABSTRACT FROM AUTHOR]

Background: Dried blood spots (DBSs) enable the study of serological markers of various pathogens without the need to obtain serum/plasma through venipuncture. Methods: Sixty-four blood samples were prepared on Whatman™ 903 cards using specimens obtained by venipuncture to study the detection of serological markers of diphtheria, tetanus, and pertussis in DBSs, and their stability 4 months post-collection. An automated chemiluminescent immunoassay was used to investigate diphtheria, tetanus, and pertussis IgG levels from both DBSs and plasma samples. Results: An optimal cut-off value for DBSs was calculated to improve the performance of diphtheria and tetanus serological markers in DBSs, achieving high sensitivity (95% and 98%, respectively) and specificity (91.7% and 92.3%, respectively). No protection against pertussis was found in the population studied. The correlation observed between the plasma and the DBSs processed after sample collection was high (0.967–0.970) for all antibodies studied except pertussis (0.753), both considering hematocrit before sample elution or not. The correlation between DBSs and plasma for diphtheria and tetanus remained strong following a 4-month delay in DBS processing at 4 °C (0.925–0.964) and −20 °C (0.924–0.966), with only a minor decrease observed for diphtheria at room temperature (0.889), while maintaining a strong correlation for tetanus (0.960). For pertussis, the correlation between DBSs and plasma was drastically reduced after delaying its processing for 4 months at any temperature. Conclusions: To summarize, hematocrit levels within the normal range do not affect the processing of DBSs in the study of serological markers of diphtheria, tetanus, and pertussis. The DBS stability for serological diagnosis of diphtheria and tetanus is adequate when samples are stored at −20 °C for a period of 4 months. The pertussis serological marker does not appear to remain stable after 4 months, even when the DBS is stored frozen at −20 °C. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Certain infectious diseases are caused by specific bacterial pathogens, including syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, leprosy, and tuberculosis. These diseases significantly impact global health, contributing heavily to the disease burden. The study aims to thoroughly evaluate the global burden of syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, and leprosy. Methods: Leveraging the Global Burden of Disease (GBD) study 2021, age-specific and Socio-demographic Index (SDI)-specific incidence, disability-adjusted life-years (DALYs), and death for eight specific bacterial infections across 204 countries and territories from 1990 to 2021 were analyzed. Percentage changes in age-standardized incidence rate (ASIR), DALY rate, and mortality rate (ASMR) were also examined, with a focus on disease distribution across different regions, age groups, genders, and SDI. Results: By 2021, among the eight diseases, gonococcal infection had the highest global ASIR [1096.58 per 100,000 population, 95% uncertainty interval (UI): 838.70, 1385.47 per 100,000 population], and syphilis had the highest global age-standardized DALY rate (107.13 per 100,000 population, 95% UI: 41.77, 212.12 per 100,000 population). Except for syphilis and gonococcal infection, the age-standardized DALY rate of the remaining diseases decreased by at least 55% compared to 1990, with tetanus showing the largest decrease by at least 90%. Globally, significant declines in the ASIR, age-standardized DALY rate, and ASMR for these eight bacterial infections have been observed in association with increases in the SDI. Regions with lower SDI, such as sub-Saharan Africa, experienced a relatively higher burden of these eight bacterial infections. Conclusions: Although there has been an overall decline in these eight diseases, they continue to pose significant public health challenges, particularly in low SDI regions. To further reduce this burden in these areas, targeted intervention strategies are essential, including multi-sectoral collaboration, policy support, improved WASH management, and enhanced research efforts. [ABSTRACT FROM AUTHOR]

The compatibility of mandatory vaccinations with human rights has become a very current issue with the COVID-19 pandemic and the Vavřička ruling by the European Court of Human Rights. This ruling has faced criticism for not conducting examinations related to disease and vaccines based on direct scientific evidence. In this analysis, an assessment will be made based on direct scientific evidence about tetanus and its vaccine. The prevailing reason for mandatory tetanus vaccination is to protect the health of the vaccinated individual. Competent adults have the right to refuse treatment. This rule also applies to preventive medical interventions, including tetanus vaccination. As a rule, parents are entitled to give consent for medical interventions on their children. If an immediate and serious threat permanently endangers the minor’s life, medical intervention can be carried out against the parents’ will. The limitation of parental autonomy is more disputed when the minor’s life is not immediately threatened. With respect to tetanus vaccination as a preventive medical intervention, it does not eliminate an immediate and serious risk of harm. As a result, interference with the parent’s discretion on tetanus vaccination as a preventive medical intervention should be evaluated for its compatibility with the current legal approach to medical interventions on minors and patient rights. [ABSTRACT FROM AUTHOR]

Patients undergoing immune effector cell therapy (IECT) are at high risk for infections. We assessed seropositivity against pneumococcus, tetanus, and diphtheria in patients before and after IECT and the patients' response to vaccination. We enrolled patients who underwent IECT from January 2020 to March 2022. Antibody levels for diphtheria, tetanus, and pneumococcus were measured before IECT, at 1 month, and 3–6 months after. Eligible patients were vaccinated after IECT. In non-seroprotected patients, we discontinued testing. Before IECT, most patients had seroprotective antibody levels against tetanus (68/69, 99%) and diphtheria (65/69, 94%), but fewer did against pneumococcus (24/67, 36%). After IECT, all patients had seroprotective antibody levels for tetanus at 1 month (68/68) and 3–6 months (56/56). For diphtheria, 65/65 patients (100%) had seroprotective antibody levels at 1 month, and 48/53 (91%) did at 3–6 months. For pneumococcus, seroprotective antibody levels were identified in 91% (21/23) of patients at 1 month and 79% (15/19) at 3–6 months following IECT. Fifteen patients received a pneumococcal vaccine after IECT, but none achieved seroprotective response. One patient received the tetanus-diphtheria vaccine and had a seroprotective antibody response. Because some patients experience loss of immunity after IECT, studies evaluating vaccination strategies post-IECT are needed. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Jiangtao Yu,1,&ast; Benfeng Zheng,2,&ast; Na Liu,2,3 Yiheng Zhu,4 Fen Hui,5 Jin Zhang,5 Lin Luan1,2 1Department of Epidemiology, School of Public Health, National Vaccine Innovation Platform, Nanjing Medical University, Nanjing, 210000, People’s Republic of China; 2Department of Immunization Program, Suzhou Center for Disease Control and Prevention, Suzhou, 215000, People’s Republic of China; 3Center for Immunization Planning, Chinese Center for Disease Control and Prevention, Beijing, 100050, People’s Republic of China; 4Suzhou Municipal Health Commission, Suzhou, 215000, People’s Republic of China; 5The Fifth People’s Hospital of Suzhou, Suzhou, 215000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lin Luan, Email szluanlin@163.comObjective: To investigate the epidemiology, and hospitalization of tetanus in Suzhou, Jiangsu Province, China, focusing on the severity of the disease, treatment, outcomes and hospitalization costs, and to explore the risk factors for severe tetanus.Methods: This retrospective, multicenter observational study analyzed tetanus patients admitted to various medical institutions between 2013 and 2023. Patients were classified into two groups as severe or non-severe, using the Ablett classification. Differences between the two groups were compared using the Chi-squared test, Fisher’s exact test and Mann–Whitney U-test. Binary logistic regression analysis was used to evaluate potential risk factors for severe disease.Results: A total of 63 patients with tetanus were included in this study. The median age of the patients was 57.0 (48.0– 74.0) years, with a predominance of males (65.1%). There was an overall increasing trend in the rate of severe illness in tetanus patients from 2013– 2023 (P< 0.001). The proportion of patients admitted to the hospital was highest (39.7%) in summer (June–August) (P=0.001). The rate of severe tetanus was significantly higher in patients aged ≥ 65 years than in those aged 0– 40 years and 41– 64 years (P=0.019). The incubation period was 8.0(5.0– 11.0) days for severe tetanus patients and 11.0 (8.0– 18.0) days for non-severe patients (P=0.005). Compared to the non-severe group, the severe group shouldered a higher hospitalization cost, with total costs amounting to US &dollar;19062.8(4675.4– 29,385.4) and US &dollar;4291.1(1356.6– 19,635.4), respectively. Binary logistic regression analysis revealed that patients aged 65 years and above significantly increased the risk of developing severe disease (OR = 3.345, 95% CI: 1.039– 10.770).Conclusion: Tetanus occurs primarily in the summer in Suzhou City, Jiangsu Province, China. The incubation period is shorter in patients with severe tetanus. The elderly are the main affected population, with the risk of developing severe disease escalating with advancing age. Knowledge of tetanus immunoprophylaxis should be strengthened to further reduce morbidity and mortality.Keywords: tetanus, severe, hospitalization, risk factors

Abstract Background Tetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive. Case summary A 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home. Conclusion First contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

Kaz&inodot;m K&inodot;ratl&inodot;,1 Ibrahim Mohamed Hirsi,2 Burak Çelik,3 Murat Aysin,4 Ahmed Mohamed Ali,1 Selim Turfan,5 Hakan Zeybek6 1Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia; 2Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Pediatrics, Mogadishu, Somalia; 3Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey; 4Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey; 5Giresun Training and Research Hospital, Department of Emergency Medicine, Giresun, Turkey; 6Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Orthopedics and Traumatology, Mogadishu, SomaliaCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia, Tel +252 611 522 947, Email drkazimkiratli@gmail.comIntroduction: Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities.Methods: This study includes tetanus patients who were admitted to the Recep Tayyip Erdo&gbreve;an Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients’ sociodemographic details.Results: The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1– 38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p< 0.001), generalized/neonatal tetanus (p< 0.001), high non-vaccination rate (p:0.011), antibiotic usage (p< 0.001), and a positive blood culture (p< 0.001). Almost all of the complications (p< 0.001) and all of the deaths (p< 0.001) were in the severe group.Conclusion: In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine’s low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.Keywords: immunization, Somalia, Sub-Saharan Africa, tetanus, vaccination

Tetanus, once prevalent worldwide, has become rare in developed nations since the advent of active immunization. However, in India, where population density and healthcare challenges persist, the burden of adult tetanus remains largely unexplored. Here, authors present a suspected case of adult tetanus in an 18-year-old male from suburban Mumbai, highlighting the ongoing public health concern. The patient, a daily-wage worker, presented with chest pain, back spasms, and progressive muscle rigidity following trauma to his foot Despite aggressive medical intervention, including immunoglobulin therapy and intensive care, the patient succumbed to cardiac arrest ten days’ post-admission. This case underscores the persistent threat of tetanus in India, even after the successful elimination of maternal and neonatal tetanus. Delayed diagnosis due to ambiguous symptoms and neglect of basic hygiene practices contribute to severe complications and mortality. Efforts to combat tetanus should focus on enhancing public awareness, promoting vaccination, and ensuring prompt wound care.

Abstract Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus.

Copyright of Remedia is the property of Medical Tribune CZ, s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Government of India, in collaboration with the World Health Organization (WHO), established the National Polio Surveillance Project (NPSP) in 1997 and initiated acute flaccid paralysis (AFP) surveillance to achieve the goal of polio eradication. The WHO South-East Asia Region, comprising of 11 countries, including India, was certified as polio-free in March 2014. India was also validated to have eliminated maternal and neonatal tetanus in May 2015. Over the years, the surveillance of other vaccine-preventable diseases (VPDs) was integrated with AFP surveillance in the country. Outbreak-based measles–rubella (MR) surveillance was initiated in 2005 using AFP surveillance as a platform, case-based fever–rash (FR) surveillance started in 2021 as one of the strategies to achieve measles and rubella elimination in the country. The surveillance of diphtheria, pertussis, and neonatal tetanus was integrated with AFP surveillance in a phased manner during 2015–2022. The surveillance system for VPDs in India, supported by a laboratory network of 10 polio laboratories, 28 measles–rubella laboratories, and 20 diphtheria–pertussis laboratories, has enhanced the national health capacity and security. The setting up and expansion of the surveillance system in the country involved the important component of capacity building of personnel on various components of surveillance, including case identification, case investigation, sample collection and shipment, data analysis and public health response. These capacities have been used effectively during other emergencies, such as the recent COVID-19 pandemic, as well as during outbreaks of other diseases and natural calamities. [ABSTRACT FROM AUTHOR]

Tetanus is a toxigenic illness caused by the action of Clostridium tetani neurotoxin (TeNT), which results in partial or generalized muscle stiffness in infected mammals and birds. The disease is rarely reported in cats due to their innate resistance to the toxin. This multicentric retrospective study aimed to describe a significant population of cats with a diagnosis of tetanus and report their signalment, clinical and neurological signs, diagnostic findings, treatment, and outcome. A retrospective search through medical records from 11 referral centers in Europe resulted in the identification of 27 cases of feline tetanus from July 2005 to April 2023. These cases were further compared with previously reported cases in the veterinary literature. Young cats were more commonly represented than older cats, with a median age of 4 years. Clinical signs were initially characterized by a lame and/or stiff limb, near the primary injury site, in 17/26 (65%) cats. Signs were focal or multifocal in 21/27 (78%) cats of this study and one typical sign was the inability to flex the most severely affected limbs. Electrodiagnostic studies revealed characteristic changes, such as continuous spontaneous motor unit discharges in both agonist and antagonist muscles. Such studies are particularly useful in focal and multifocal cases and should be performed to further support the diagnosis. The toxin was successfully identified in one case using the mouse bioassay. Treatment included antibiotherapy (metronidazole) in most cases, muscle relaxants, appropriate nursing cares and handling of potential complications. Overall, the outcome appeared to be positive, with only 1/27 (3.7%) cats being euthanized due to financial restrains. 23/25 (92%) cats returned to an independent ambulatory capacity on all limbs within a median delay of 25 days. Mild to moderate longterm sequelae were reported in eight (30%) cats. This multicentric study is the first to bring together such a large number of cats affected with tetanus. Presentation of the disease in cats differs from that observed in humans and dogs, with most cats being locally affected. Compared to previous reports of tetanus, this series of cats had a better outcome overall, especially for cats affected with generalized tetanus. [ABSTRACT FROM AUTHOR]

Tetanus is a non-communicable disease, preventable with vaccination. Despite the implemented vaccination strategy, a certain number of tetanus cases per year continue to occur. The aim of the study was to evaluate the seroprevalence of anti-tetanus antibodies in the Italian population by age, sex and geographical area. To determine the level of tetanus-specific antibodies, an immunoenzymatic assay was used. A total of 3,821 serum samples were collected in the years 2019–20 from healthy subjects aged 6–90 years residing in 13 Italian regions. Overall, 85 % of the tested subjects resulted positive. The rate of subjects protected against tetanus showed a gradual decrease from the younger age groups to the older ones (6–12 years: 93.6 %, 13–24 years: 91.8 %, 25–39 years: 91.0 %, 40–64 years: 78.2 %, ≥ 65 years: 45.3 %); this is particularly evident in the Southern regions and Islands. Moreover, the prevalence of subjects with low protection (<0.1 IU/ml) was significantly higher in the ≥ 65 age group (10.3 %). Males and females' prevalence showed a significant difference only in the oldest age group (M: 60.8 %, F: 30.4 %). In general, a higher prevalence was observed for Northern (90.8 %) and Central regions (87.3 %) than Southern regions and Islands (80.0 %). These data, compared with epidemiological ones which showed a high number of cases in the elderly, confirmed that the population with lower protection has a greater risk of contracting the disease, demonstrating the need for adequate immunization through both primary vaccination and boosters for all ages and both sexes, in order to provide lifelong protection. [ABSTRACT FROM AUTHOR]

Tetanus is a life-threatening bacterial disease in humans and many animal species caused by the neurotoxin tetanospasmin produced by Clostridium tetani. Antitoxins obtained from horses and humans are primarily used to treat this disease. However, there are several clinical side effects and disadvantages associated with the use of these antitoxins. Current techniques for diagnosing tetanus use monoclonal antibodies produced in mice. These antibodies have several advantages, such as their homogeneity and specificity. In contrast, a notable feature of polyclonal antibodies, especially egg yolk antibodies, i.e. immunoglobulin-Y (IgY), extracted from poultry, is that they can be generated in greater quantities than mammalian antibodies (IgG). In this study, 22-week-old chickens were immunized with C. tetani toxoid and adjuvant (Freund's complete and incomplete adjuvants) via injection into the chest muscle. The immunization process was completed by administering two booster injections at 4-week intervals. Total antibody titers were observed to reach their highest level in the serum of blood samples taken 14 days after the last immunization. IgY antibodies were isolated noninvasively from the eggs of immunized and nonimmunized chickens using the polyethylene glycol (6000) extraction protocol. Immunological analyses confirmed that the purified IgY antibodies were produced specifically for the C. tetani toxoid. The specific tetanus antibodies obtained in this study may be valuable therapeutic tools as alternatives to current treatments for tetanus in humans and domestic animals. [ABSTRACT FROM AUTHOR]

Objective. To estimate the proportion of vaccinated subjects and associated factors in adults and older adults in Mexico. Materials and methods. Analysis of data obtained from the Ensanut Continua 2021-2023 and comparison with the proportion of vaccinated subjects in Ensanut 2012. Results. Given that only 6.8% of adults and older adults in Ensanut Continua 2021-2023 and 17.7% in Ensanut 2012 could accredit their vaccination status, the analysis is based on self-report. When comparing Ensanut Continua 2021-2023 with Ensanut 2012, the proportion of vaccinated subjects according to age group and biologic was as follows: adults aged 20-59 years, tetanus: 66.87 vs. 78.08%; women of childbearing age, tetanus: 71.1 vs. 82.0%; measles/rubella: 36.8 vs. 48.5%; older adults, tetanus: 59.5 vs. 65.86%; influenza: 58.7 vs. 51.9%; pneumococcus: 34.8 vs. 45.9%. Covid-19 vaccine coverage in younger and older adults was 86.6 and 89.2%, respectively. Incomplete schedules were more prevalent in men and in people without health insurance, among adults aged 20 to 59; and in people without health insurance, among adults aged 60 years or older. Discussion. A considerable proportion of adults and older adults are not protected against vaccinepreventable diseases in 2021-2023. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Any patient presenting with trismus should have tetanus considered as a differential diagnosis. Early recognition, timely treatment and supportive care can improve patient outcomes. Treatment with tetanus immunoglobulin to neutralize the toxin, antimicrobials to treat the infection and sedation in the intensive care unit are key therapeutic options. [ABSTRACT FROM AUTHOR]

Background Sub-Saharan Africa (SSA) and South Asia account for most new cases of tetanus. Despite efforts by the World Health Organization to eradicate tetanus, it still causes many maternal mortalities. We examined the prevalence and risk factors associated with tetanus protection among rural mothers in 33 SSA countries. Methods Data were extracted from the most recent Demographic and Health Surveys of 33 SSA countries. A sample of 162 601 women from rural areas was drawn. Both descriptive and binary logistic regression analyses were conducted. Results Overall, approximately half (49.3%) of rural mothers were protected against tetanus. The association between maternal age, education, marital status, working status, distance to the health facility and number of antenatal visits were statistically significant with rural mothers' protection from tetanus. Also, relationship to the household head, household size and frequency of listening to radio, reading a newspaper and watching television were statistically significant in predicting rural mothers' protection from tetanus. Conclusions Policies and interventions by stakeholders must target high-risk populations, including adult women, those of poorer wealth status, those without media exposure and mothers with low educational attainment. [ABSTRACT FROM AUTHOR]

Tetanus is a life-threatening, vaccine-preventable disease caused by an endotoxin produced by Clostridium tetani. We report a case of severe tetanus in an adult male with a history of intravenous drug use. The patient presented with a 1-day history of inability to open his jaw and a right lower extremity necrotic wound. Initial management consisted of tetanus toxoid, human tetanus immunoglobulin, antimicrobials and intermittent lorazepam. Due to progressive symptoms, wound debridement and placement of an advanced airway in the operating room ensued. Episodes of tetany were associated with fever, autonomic instability, acute desaturations and preemptive ventilator triggering despite maximum doses of continuous propofol and midazolam. Neuromuscular blockade with cisatracurium was added, resulting in control of tetany. Despite initial control, NMB could not be weaned due to recurrent spasms. Intravenous dantrolene was therefore sought as an alternative antispasmodic. Following an initial load, patient was successfully liberated from cisatracurium. Dantrolene was therefore converted to enteral to facilitate gradual down-titration of intravenous sedatives with subsequent conversion to oral benzodiazepines. After a prolonged hospital course, the patient was able to be discharged home. Dantrolene was thus effectively utilized as an adjunctive antispasmodic agent to facilitate liberation from cisatracurium and continuous sedation. [ABSTRACT FROM AUTHOR]

Background: Central poststroke pain (CPSP) is one of the primary sequelae following stroke, yet its underlying mechanisms are poorly understood. Methods: By lesioning the lateral thalamic nuclei, we first established a CPSP model that exhibits mechanical and thermal hypersensitivity. Innocuous mechanical stimuli following the thalamic lesion evoked robust neural activation in somatosensory corticospinal neurons (CSNs), as well as in the deep dorsal horn, where low threshold mechanosensory afferents terminate. In this study, we used viral‐based mapping and intersectional functional manipulations to decipher the role of somatosensory CSNs and their spinal targets in the CPSP pathophysiology. Results: We first mapped the post‐synaptic spinal targets of lumbar innervating CSNs using an anterograde trans‐synaptic AAV1‐based strategy and showed these spinal interneurons were activated by innocuous tactile stimuli post‐thalamic lesion. Functionally, tetanus toxin‐based chronic inactivation of spinal neurons targeted by CSNs prevented the development of CPSP. Consistently, transient chemogenetic silencing of these neurons alleviated established mechanical pain hypersensitivity and innocuous tactile stimuli evoked aversion linked to the CPSP. In contrast, chemogenetic activation of these neurons was insufficient to induce robust mechanical allodynia typically observed in the CPSP. Conclusion: The CSNs and their spinal targets are required but insufficient for the establishment of CPSP hypersensitivity. Our study provided novel insights into the neural mechanisms underlying CPSP and potential therapeutic interventions to treat refractory central neuropathic pain conditions. [ABSTRACT FROM AUTHOR]

Study reports a rare case of puerperal ewe suspected for uterine tetanus. The ewe was presented with increased respiration and stiff hind limbs and became recumbent on the tenth day of her lambing. The ewe died despite being treated symptomatically, with the discharge of thick creamy pus from external genitalia. Grams-staining of the impression smears didn’t reveal the Clostridium tetani organisms. [ABSTRACT FROM AUTHOR]

Introducing new recombinant protein antigens to existing pediatric combination vaccines is important in improving coverage and affordability, especially in low- and middle-income countries (LMICs). This case-study highlights the analytical and formulation challenges encountered with three recombinant non-replicating rotavirus vaccine (NRRV) antigens (t-NRRV formulated with Alhydrogel® adjuvant, AH) combined with a mock multidose formulation of a pediatric pentavalent vaccine used in LMICs. This complex formulation contained (1) vaccine antigens (i.e., whole-cell pertussis (wP), diphtheria (D), tetanus (T), Haemophilus influenza (Hib), and hepatitis B (HepB), (2) a mixture of aluminum-salt adjuvants (AH and Adju-Phos®, AP), and (3) a preservative (thimerosal, TH). Selective, stability-indicating competitive immunoassays were developed to monitor binding of specific mAbs to each antigen, except wP which required the setup of a mouse immunogenicity assay. Simple mixing led to the desorption of t-NRRV antigens from AH and increased degradation during storage. These deleterious effects were caused by specific antigens, AP, and TH. An AH-only pentavalent formulation mitigated t-NRRV antigen desorption; however, the Hib antigen displayed previously reported AH-induced instability. The same rank-ordering of t-NRRV antigen stability (P[8] > P[4] > P[6]) was observed in mock pentavalent formulations and with various preservatives. The lessons learned are discussed to enable future multidose, combination vaccine formulation development with new vaccine candidates. [ABSTRACT FROM AUTHOR]

Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards. Methods: We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. Results: The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4-6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10-11 h for tuberculosis among the insured households. Conclusions: While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention. [ABSTRACT FROM AUTHOR]

Background: Limited data exists regarding population immunity against diphtheria, tetanus, and pertussis in Thailand during the post-COVID-19 pandemic period. This study aimed to evaluate the age-specific seroprevalence of anti-diphtheria toxoid (anti-DT) IgG, anti-tetanus toxoid (anti-TT) IgG, and anti-pertussis toxin (anti-PT) IgG in individuals across diverse age groups in Chonburi province, Thailand following the COVID-19 pandemic. Methods: Between October 2022 and January 2023, a total of 657 participants from Chonburi Province, Thailand, were included in this study. The participants were categorized into 9 age groups: 70 years. Analysis of anti-DT, anti-TT, and anti-PT IgG levels was conducted using commercial ELISA kits (EUROIMMUN, Lübeck, Germany). Results: Overall, 65.4 % of the population had seroprotection against diphtheria (antibody level ≥0.1 IU/mL), while 95.1 % had seroprotection against tetanus (antibody level ≥0.1 IU/mL). The 31–40 years age group exhibited the lowest seroprotection for diphtheria (48.9 %), and the >70 years age group had the lowest seroprotection for tetanus (73.3 %). The