Tetanus vaccination

Adsorption. The adsorption of the components of a vaccine on to a mineral adjuvant. The mineral adjuvants, or carriers, most often used are aluminium lydroxide, aluminium phosphate and calcium phosphate and their effect is to increase the immunogenieity and decrease the toxicity, local and systemic, of a vaccine. Diphtheria vaccine, tetanus vaccine, diphtheria/tetanus vaccine and diphtheriaAetanus/pertussis vaccine are generally prepared as adsorbed vaccines. 

The single-component bacterial vaccines are listed in Table 15.1. For each vaccine, notes are provided of the basic material fkm which the vaccine is made, the salient production processes and tests for potency and for safety. The multicomponent vaccines that are made by blending together two or more of the single component vaccines are required to meet the potency and safety requirements for each of the single components that they contain. The best known of the combined bacterial vaccines is the adsorbed diphtheria, tetanus and pertussis vaccine (DTPerWac/Ads) that is used to immunize infants, and the adsorbed diphtheria and tetanus vaccine (DTWac/Ads) that is used to reinforce the immunity of school entrants. 

Notes Diphtheria and whooping cough vaccines are seldom used as single-component preparations but as components of diphtheria/tetanus vaccines and diphtheria/tetanus/pertussis vaccines. A combined diphtheria/tetanus/pertussis/Hib vaccine is available. 

The quality control of both diphtheria and tetanus vaccines requires that the products are tested for the presence of free toxin, that is for specific toxicity due to inadequate detoxification with formalin, at the final-product stage. By this stage, however, the toxoid concentrates used in the preparation of the vaccines have been much diluted and, as the volume ofvaccine that can be inoculated into the test animals (guinea-pigs)... 

The primary course of DTP protection consists of three doses of a combined vaccine, each dose separated by at least 1 month and commencing not earlier than 2 months of age. In such combinations the pertussis component ofthe vaccine acts as an additional adjuvant for the toxoid components. Monovalent pertussis and tetanus vaccines, and combined vaccines lacking the pertussis component (DT) are available. If pertussis vaccination is contraindicated or refused then DT vaccine alone should be offered. The primary course of pertussis vaccination is considered sufficient to confer life-long protection, especially since the mortality associated with disease declines markedly after infancy. The risks associated with tetanus and diphtheria infection persist... 

ELISA test for batch potency testing of tetanus vaccines for human use EU... 

Tetanus vaccines Toxoid formed by formaldehyde treatment... 

Diphtheria and tetanus vaccines are two commonly used toxoid-based vaccine preparations. The initial stages of diphtheria vaccine production entail the growth of Corynebacterium diphtheriae. 

The toxoid is then prepared by treating the active toxin produced with formaldehyde. The product is normally sold as a sterile aqueous preparation. Tetanus vaccine production follows a similar approach. Clostridium tetani is cultured in appropriate media. The toxin is recovered and inactivated by formaldehyde treatment. Again, it is usually marketed as a sterile aqueous-based product. 

Two strengths of diphtheria toxoid are available (pediatric [D] and adult, which contains less antigen). Primary immunization with D is indicated for children younger than 6 weeks of age. Generally, D is given along with acellular pertussis and tetanus vaccines (DTaP) at 2, 4, and 6 months of age, and then at 15 to 18 months and 4 to 6 years of age. 

The primary immunization series for pertussis vaccine consists of four doses given at ages 2, 4, 6, and 15 to 18 months. A booster dose is recommended at age 4 to 6 years. Adults up to age 64 should receive a pertussis-containing vaccine with their next tetanus vaccine. 

Tetanus vaccine, 25 488-490 Tetra(dimethylamino)ethylene, 22 720 1,1,2,2-Tetrachloroethane... 

Examples are diphtheria and tetanus vaccines. Diphtheria vaccine is produced by formaldehyde treatment of the toxin secreted by Corynebacterium diptheriae. Similarly, tetanus vaccine is obtained from toxins of cultured Clostridium tetani that has been treated with formaldehyde. 

The following instructions assume the use of a tetanus vaccine, here tetanus toxoid formulated with aluminum phosphate. These instructions can easily be adapted to other vaccines by following the standard formulation procedures and immunization protocols for these vaccines in mice. 

Well-rotted manures improve soil structure and water-holding capacity, and supply nitrogen, potassium, and other plant foods. Their nutrient content will vary with the proportion of manure and urine to straw or other bedding, and on whether they have been stored under cover or outdoors in the rain. However, they should be medium- to high-fertility soil improvers. Apply at a rate of one or two wheelbarrow loads (12-24 gal) per 50 sq ft (50-100 liters/5 sq m). When handling any animal-based product, keep cuts covered, wash your hands under running water before handling food, and be sure your tetanus vaccination is up to date. 

The polio vaccine is administered in three doses at 1-month intervals, starting from the age of 2 months. The pertussis vaccine is given in combination v/ith the diphtheria and tetanus vaccines as a 3-in-l vaccine, the DTP vaccine. The DTP vaccine follows the schedule of the polio vaccine, so at 2 months, the DTP and the polio vaccine are given. Both are repeated at 3 months of age and at 4 months of age. In areas where the incidence of tuberculosis is not greater than 40 per 100 000, the BCG vaccine is not usually recommended for infants of 0-6 months. 

Tetanus vaccines Toxoid formed by formaldehyde treatment of toxin produced by Clostridium tetani Active immunization against tetanus... 

Booster dose In previously immunized persons, a booster dose of 0.5 ml IM should be given every five years to maintain adequate level of immunity. The need for tetanus vaccine in wound management depends both on the condition of the wound and immunisation history of the patient. For tetanus prone wound, tetanus immunoglobulin may also be required. 

It is the physician s responsibility to inform the patient of the risk of immunization and to use vaccines and antisera in an appropriate manner. This may require skin testing to assess the risk of an untoward reaction. Some of the risks previously described are, however, currently unavoidable on the balance, the patient and society are clearly better off accepting the risks for routinely administered immunogens (eg, influenza and tetanus vaccines). 

Galazka A, Gasse F (1995) The present status of tetanus and tetanus vaccination. Curr Top Microbiol Immunol 195 31-53... 

TCDD in the workers was 217 pg/g blood lipid (range, 33.6-2,252) compared to 3.9 pg/g in the controls (range, 2.9-6.0). There was no significant correlation between the current 2,3,7,8-TCDD concentrations and alterations in any of the immune parameters among the entire exposed group. In addition, the results of the tetanus vaccination and the chromate resistance test were not correlated with... 

Composition and Methods of Manufacture. The diseases of diphtheria and tetanus are caused by toxins synthesized by the oiganisms Coynebacterium diphtheriae and Clostridium tetanic respectively. Diphtheria and tetanus vaccines contain purified toxins that have been inactivated by formaldehyde to form toxoids. 

Anti-tetanus immunoglobulin is an example of passive immunisation (refer to Immunoglobulins in BNF for other examples). It is designed to give immediate, short-term protection. It does not confer long-term immunity to tetanus and Ms.AR should be advised that her son should be immunised with the tetanus vaccine at an appropriate time. A full course of the tetanus vaccine should ensure protection for several years. 

As discussed previously, the immune theory of aging is based, to a considerable degree, on the fact that the immune system becomes less efficient with aging. Importantly, Zn also plays a role in the immune system. For example, Zn supplementation in the elderly (a) increases the number of circulating T-lymphocytes (b) improves delayed cutaneous hypersensitivity to various antigens and (c) increases the immunoglobulin G antibody response to tetanus vaccine (D13). This early study is supported by additional recent reports which also demonstrate that Zn supplementation improves the immune system in the elderly (F9, R6). 

Adverse events after diphtheria-tetanus vaccine in the USA in 1982-84 have been reviewed in detail (SEDA-13, 273). The usual types of local intolerance can be seen. For example, some 5% of schoolchildren develop redness and swelling, whilst some older children develop enlargement of the regional lymph nodes. Such reactions are much less common in young children, and much more common in children given combined vaccines. 

In a study of adverse events after immunization in New Zealand in 1990-95 (3), reactions at the injection site after adult tetanus-diphtheria vaccine (68 reports per 100 000 immunizations) were reported five times more often than with tetanus vaccine. 

Sidebotham PD, Lenton SW. Incidence of adverse reactions after administration of high dose diphtheria with tetanus vaccine to school leavers retrospective questionnaire study. BMJ 1996 313(7056) 533. ... 

Hurwitz EL, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipnlative Physiol Ther 2000 23(2) 81-90. 

Martin-Munoz MF, Pereira MJ, Posadas S, Sanchez-Sabate E, Blanca M, Alvarez J. Anaphylactic reaction to diphtheria-tetanus vaccine in a child specific IgE/IgG determinations and cross-reactivity studies. Vaccine 2002 20(27-28) 3409-12. 

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