OBJECTIVE

This study aimed to determine whether adjunctive therapy with magnesium sulfate is more effective than diazepam alone in reducing mortality and morbidity rates among adult patients with tetanus admitted to Mariano Marcos Memorial Hospital and Medical Center (MMMH & MC) from January 1, 2012, to January 1, 2022.

Retrospective cohort study using chart review and descriptive statistics. included patients admitted at East Avenue Medical Center for DFU. The primary endpoint was major amputation of the lower extremities. Data were analyzed using Receiver Operating Characteristic (ROC) analysis and logistic regression.

A total of 51 patients were included in the study, with 17 patients in the adjunct magnesium sulfate group and 34 patients in the diazepam group. Based on the results of this study, at a 95% confidence interval, ICU stay was significantly longer in the magnesium sulfate group compared to the diazepam group, along with an increased average hospital stay. There was no significant difference in patient mortality in terms of treatment, age, severity, ICU stay, or duration of mechanical ventilation.

The use of magnesium sulfate as an adjunct treatment for tetanus is not superior to standard stand-alone diazepam, regardless of severity. Magnesium sulfate use is associated with a longer overall hospital stay. Lastly, hospital-acquired pneumonia and aspiration pneumonia significantly increase the risk of mortality among patients with tetanus, regardless of age, treatment, or severity.

Humans ; Retrospective Studies ; Tetanus/epidemiology* ; China/epidemiology*

HPV vaccination is the most effective way for preventing the cervical cancer. To respond the WHO calling for cervical cancer elimination, some Chinese provincial governments are launching the Free HPV Vaccination Programs for teenagers. Basing on the current stage of domestic utilization and the global immunization strategies of HPV vaccination, this paper provides a comprehensive review of the key aspects in the process of HPV vaccination, including subjects and priority vaccination population, vaccination dose and time interval, the principal of vaccination replacement, and the vaccination suggestion on special populations, etc. The article above contents and gives the advice on the immunization strategy of HPV vaccination in China.
AIDS Vaccines ; Adolescent ; BCG Vaccine ; China ; Diphtheria-Tetanus-Pertussis Vaccine ; Female ; Humans ; Immunization Programs ; Influenza Vaccines ; Measles-Mumps-Rubella Vaccine ; Papillomavirus Infections/prevention & control* ; Papillomavirus Vaccines ; Respiratory Syncytial Virus Vaccines ; SAIDS Vaccines ; Uterine Cervical Neoplasms ; Vaccination

Objective: To analyze the dropout of adsorbed diphtheria, tetanus and acellular pertussis combined vaccine (DTaP) routine immunization in China in 2019. Methods: DTaP vaccination data in all counties in China were collected through National Immunization Program Information Management System in 2019. Cumulative dropout rate and vaccination rate of DTaP in different provinces were calculated. According to the P₂₅, P₅₀ and P₇₅ values of DTaP dropout rate for all counties by province, counties in each province were divided into four groups (Q₁-Q₄). The DTaP average dropout rate of four groups and absolute difference (difference in DTaP average dropout rate between Q₄ and Q₁) were calculated. Spearman rank correlation was used to analyze the relationship between absolute difference and provincial DTaP dropout rate, DTaP₁ and DTaP₃ vaccination rate. Results: DTaP₁ vaccination rate ranged from 92.98% to 99.94% by province, with a median of 99.55%. Provincial DTaP dropout rate ranged from 0.36% to 28.66%, with a median of 3.54%. The provincial DTaP dropout rate was more than 10% in Gansu and Guizhou, about 28.66% and 17.19%. Absolute difference ranged from 4.02% to 39.22%, with a median of 10.16%. Provinces with the largest absolute difference were Gansu, Qinghai, Liaoning and Guizhou, about 39.22%, 34.48%, 23.31% and 21.33%, respectively. Correlation analysis indicated that the absolute difference was positively correlated with provincial DTaP dropout rate, with a correlation coefficient of 0.492 (P=0.004). It was negatively correlated with DTaP₁ and DTaP₃ vaccination rate. Correlation coefficients were -0.542 (P=0.001) and -0.562 (P=0.001), respectively. Conclusions: There are significant county-level differences in DTap dropout rate in most provinces, with relatively high difference in western provinces.
Humans ; Infant ; Whooping Cough/prevention & control* ; Diphtheria-Tetanus-Pertussis Vaccine ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Vaccination ; China ; Immunization, Secondary ; Immunization Schedule ; Antibodies, Bacterial

A fusion protein containing a tetanus toxin peptide, a tuftsin peptide and a SARS-CoV-2S protein receptor-binding domain (RBD) was prepared to investigate the effect of intramolecular adjuvant on humoral and cellular immunity of RBD protein. The tetanus toxin peptide, tuftsin peptide and S protein RBD region were connected by a flexible polypeptide, and a recombinant vector was constructed after codon optimization. The recombinant S-TT-tuftsin protein was prepared by prokaryotic expression and purification. BALB/c mice were immunized after mixed with aluminum adjuvant, and the humoral and cellular immune effects were evaluated. The recombinant S-TT-tuftsin protein was expressed as an inclusion body, and was purified by ion exchange chromatography and renaturated by gradient dialysis. The renaturated protein was identified by Dot blotting and reacted with serum of descendants immunized with SARS-CoV-2 subunit vaccine. The results showed that the antibody level reached a plateau after 35 days of immunization, and the serum antibody ELISA titer of mice immunized with recombinant protein containing intramolecular adjuvant was up to 1:66 240, which was significantly higher than that of mice immunized with S-RBD protein (P < 0.05). At the same time, the recombinant protein containing intramolecular adjuvant stimulated mice to produce a stronger lymphocyte proliferation ability. The stimulation index was 4.71±0.15, which was significantly different from that of the S-RBD protein (1.83±0.09) (P < 0.000 1). Intramolecular adjuvant tetanus toxin peptide and tuftsin peptide significantly enhanced the humoral and cellular immune effect of the SARS-CoV-2 S protein RBD domain, which provideda theoretical basis for the development of subunit vaccines for SARS-CoV-2 and other viruses.
Adjuvants, Immunologic ; Aluminum ; Animals ; Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19/prevention & control* ; COVID-19 Vaccines/genetics* ; Humans ; Mice ; Mice, Inbred BALB C ; Recombinant Proteins/genetics* ; SARS-CoV-2/genetics* ; Spike Glycoprotein, Coronavirus/genetics* ; Tetanus Toxin ; Tuftsin ; Vaccines, Subunit ; Viral Vaccines

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.
Artificial Intelligence ; Data Warehousing ; Humans ; Tetanus ; Tetanus Toxoid ; Whooping Cough/prevention & control*

Some countries with high coverage of diphtheria, tetanus and pertussis combined vaccines have experienced pertussis epidemics and/or local outbreaks since 1980s. This phenomenon is called "pertussis resurgence". In recent years, pertussis epidemics in several provinces of China have resurged dramatically, arousing great concern from all parties. By referring the working model of the Global Pertussis Initiative, the Chinese Preventive Medicine Association has organized and launched the China Pertussis Initiative. A group of experts in this field has analyzed data of current pertussis in China and identified problems posed by the disease. This expert consensus was completed based on the discussions of the latest national and international research progeress, epidemiological trends and immunization strategies of pertussis, with special aims to provide guidance for the surveillance, prevention and control of pertussis in China.
China/epidemiology* ; Consensus ; Humans ; Immunization, Secondary ; Tetanus ; Vaccination ; Whooping Cough/prevention & control*

OBJECTIVE: To describe the profile, management, and outcome of adult patients admitted for tetanus. METHODOLOGY: A search of the hospital and department database was conducted for patients with admitting or final diagnosis of tetanus. Patients below 19 years old, with alternative diagnosis, incomplete or unavailable records, transferred to another institution, and went home against medical advice were excluded. Data on patient demographics, source of infection, symptom severity, and management were obtained. Data was described using proportions and averages. RESULTS: Thirty-two patients were included in the study. Twenty-seven were male with a mean age of 45.63 ± 13.39. All cases had no history of tetanus vaccination. The most common focus of infection was acute injuries. More than half of patients would be diagnosed within 72 hours of symptom onset. The most common symptoms on presentation were trismus, rigidity, dysphagia, and spasms. On admission, Cole severity for 11 (34.4%) cases was mild, 17 (53.1%) moderate, and 4 (12.5%) severe. Prophylactic tracheostomy was performed in 31 patients and 19 (59.4%) were placed on assisted ventilation. All cases were treated with metronidazole. A benzodiazepine was started in all cases for spasm control. Baclofen, magnesium sulfate, and antiepileptic drugs such as carbamazepine were also used. Twenty (62.5%) patients suffered from complications, the most common of which was nosocomial pneumonia, which resulted in longer ICU and hospital stays. Eleven patients exhibited progression in Cole severity: 8.6% at stage 1, 57.1% at stage 2, and 34.3% cases were at stage 3. Mortality rate was 19% with the proportion increasing with Cole severity. CONCLUSION We describe the presentation and course of patients admitted for tetanus in our institution. Most cases were males and all cases had no vaccination history. Trismus was the most common presenting symptom. Metronidazole was the antibiotic of choice and benzodiazepines were the mainstay for spasm control. Majority of cases were mild to moderate in severity on presentation. Advanced disease stages were associated with higher fatality rates. Complications were associated with longer ICU and hospital stay. These findings suggest that prevention of progression of disease severity and complications must be the focus of tetanus protocols to shorten hospital stay and decrease mortality rate. Promoting vaccination of at-risk adults is recommended to lower the incidence of tetanus.
Tetanus ; Clostridium tetani ; Clostridium Infections

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.
Adolescent ; Adult ; Aged ; Chickenpox ; Chronic Disease ; Communicable Diseases ; Diphtheria ; Encephalitis, Japanese ; Hepatitis A Vaccines ; Herpes Zoster ; Humans ; Immunization Programs ; Immunization ; Infant ; Internationality ; Korea ; Measles ; Mumps ; Pneumococcal Vaccines ; Prevalence ; Rubella ; Streptococcus pneumoniae ; Tetanus ; Vaccination ; Whooping Cough

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity