Grover S S, Negi S S, Singh S, Ray K
National Centre for Disease Control-NCDC, 22-Sham Nath Marg, Delhi 54, India.
Biologicals. 2012 Jul;40(4):262-5. doi: 10.1016/j.biologicals.2012.03.001. Epub 2012 Mar 29.
The level of circulating tetanus toxin, antitoxin and their individual influence on the outcome of tetanus cases were determined in unimmunized 125 neonatal and 39 infant cases of tetanus. PHA (passive haemagglutination) test showed 40% positive cases for toxin while its absence in the remaining cases indicated of either toxin fixation to the central nervous system (CNS) or it got neutralized by antitoxin. TN (toxin neutralization) and PHA test carried out in 46 sera samples revealed a strong positive correlation (r = 0.9) showing that 35/46 (76%) and 38/46 (82.6%) samples were positive for antitoxin, respectively. 25.4% of the neonate and infant cases and 34% of the control group had a protective serum tetanus antitoxin level. 42.5% of the paired sera from unimmunized mothers and their neonates showing nonprotective antitoxin levels suggested that a high level of antitoxin is needed for transplacental transfer, although transfer may not play a decisive role in the resistance against the disease. The presence of toxin or antitoxin in the clinical cases did not affect the outcome of the disease, although in neonates, presence of toxin was found to be a bad prognostic sign. This study explicitly advocates for the need to improve the vaccination coverage strategy.
在125例未免疫的新生儿破伤风病例和39例婴儿破伤风病例中，测定了循环破伤风毒素、抗毒素水平及其对破伤风病例预后的个体影响。PHA（被动血凝）试验显示40%的病例毒素呈阳性，其余病例毒素阴性表明毒素要么固定于中枢神经系统（CNS），要么已被抗毒素中和。对46份血清样本进行的TN（毒素中和）和PHA试验显示出强正相关（r = 0.9），表明分别有35/46（76%）和38/46（82.6%）的样本抗毒素呈阳性。25.4%的新生儿和婴儿病例以及34%的对照组血清破伤风抗毒素水平具有保护性。42.5%未免疫母亲及其新生儿的配对血清显示抗毒素水平无保护性，这表明经胎盘转移需要高水平的抗毒素，尽管转移可能在抵抗该疾病中不发挥决定性作用。临床病例中毒素或抗毒素的存在并不影响疾病的预后，尽管在新生儿中，毒素的存在被发现是一个不良预后指标。本研究明确主张需要改进疫苗接种覆盖策略。
