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Vaccinations
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Joshua H. Barash, Edward M. Buchanan
Td (tetanus toxoid, reduced inactivated diphtheria toxoid) is a tetanus vaccine containing diphtheria toxoid as well (Table 40.1). Tetanus in newborn infants, once common, is prevented if the mother has been immunized, because the immune mother passes antibodies to the fetus across the placenta. Maternal tetanus toxoid vaccination has been shown to be up to 98% effective in preventing neonatal tetanus [25]. Td effectiveness in preventing neonatal deaths was 62% [26]. The WHO estimates that 1.5 million cases of neonatal tetanus have been prevented since a 1989 initiative to eliminate maternal and neonatal tetanus.
Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Vaccination is the only means of inducing immunity to tetanus toxin, and some of the cases of affected neonates have been in babies whose mothers reported they had been vaccinated. It is therefore important to confirm the vaccination history and repeat the doses if unclear. The WHO recommends vaccinating the pregnant mother to prevent neonatal tetanus, as antitoxins cross the placental barrier. Pregnant women who have not been vaccinated in childhood or adolescence should receive at least two doses of tetanus vaccine before giving birth:The first dose should be administered at the first consultation.The second dose should be administered at least four weeks after the first dose and ideally at least two weeks before the due date to maximise the maternal antibody response and passive antibody transfer to the infant.After the birth, continue to a total of five doses. Once administered, these five doses confer lifelong protection.
Animal Bites
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Tetanus has four presentations: Generalized tetanus: Most common. Usually starts with trismus (lockjaw), with progression to the rest of the muscles of the body leading to tonic contractions, spasms, dysphagia, opisthotonus and a rigid abdomen.Localized tetanus: Sometimes toxin only tracks up the nerves of an affected limb, and in these cases, only that limb may be affected. Localized tetanus may progress to generalized tetanus.Cephalic tetanus: A form of local tetanus affecting the head, face or neck.Neonatal tetanus: Caused by contamination of the umbilical stump of a child born to a mother with no immunity to tetanus. Initially manifests as inability to feed, but classical generalized tetanus soon sets in.
Antenatal vaccination for influenza and pertussis: a call to action
Published in Journal of Obstetrics and Gynaecology, 2021
Despoina Gkentzi, Maria Zorba, Markos Marangos, Ageliki Vervenioti, Ageliki Karatza, Gabriel Dimitriou
According to the World Health Organisation (WHO), in the last two decades, the global mortality of children < 5 years of age has declined. However, neonatal mortality has decreased at a much slower pace. (http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2015). Neonates and infants in the first few months of life have an immature and relatively ineffective immune system. Therefore, there is need for the global health community to identify and implement effective strategies in the field. Maternal vaccination has been recognised as an important public health intervention to protect both pregnant women and their offspring from various infectious diseases. The combination of improved hygienic practices during delivery as well as the universally recommended maternal tetanus toxoid vaccine administration have resulted in a 92% reduction of neonatal tetanus mortality (Healy 2012).
Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention
Published in Expert Review of Anti-infective Therapy, 2020
Constantin Radu Popescu, Miranda M. M. Cavanagh, Bentry Tembo, Msandeni Chiume, Norman Lufesi, David M. Goldfarb, Niranjan Kissoon, Pascal M. Lavoie
Maternal immunizations provide a first window of opportunity to protect neonates against deadly pathogens such as tetanus, diphtheria, pertussis, and influenza through the transfer of antibodies from the mother to the fetus via the placenta [50]. Neonatal tetanus has been nearly eliminated in LMICs that have widely implemented maternal tetanus vaccination programs [51]. Vaccines against influenza and pertussis are similarly routinely administered in pregnant women in many HICs, but these interventions have yet to be routinely adopted in LMIC [52]. The uptake of maternal vaccines remains an ongoing challenge in LMIC, despite proven benefits, in part due to limited access of these women to antenatal care [53]. Increasing consideration should also be given for developing safe, effective vaccines against RSV and GBS, since these infections remain a major source of morbidity and mortality in LMIC [54–56].
Maternal immunization: where are we now and how to move forward?
Published in Annals of Medicine, 2018
Ivo Vojtek, Ilse Dieussaert, T. Mark Doherty, Valentine Franck, Linda Hanssens, Jacqueline Miller, Rafik Bekkat-Berkani, Walid Kandeil, David Prado-Cohrs, Andrew Vyse
In 1989, the WHO, the United Nations Children’s Fund and the United Nations Population Fund launched an initiative to eliminate neonatal tetanus by 1995. Guidelines were later expanded to include maternal tetanus because tetanus also threatens women during pregnancy and delivery [29]. This initiative relied on specifically-designed local programs to increase immunization rates in pregnant women and improve birth hygiene and disease surveillance in high-risk regions [29]. As of 2015, approximately 148 million women of childbearing age (including pregnant women) have received at least two doses of tetanus toxoid vaccine through this initiative [29]. Although this approach has decreased neonatal tetanus by 96% compared to the late 1980s, the WHO estimated that 34,000 new-borns still died from the disease in 2015 [29]. As of June 2017, 16 countries were yet to eliminate maternal and neonatal tetanus (i.e. reach a level of <1 case of neonatal tetanus per 1000 live births) [29].