OBJECTIVETo investigate the immunity level of diphtheria antibody among children living in the areas where different coverage rates of 4-vaccines stratified by results of national immunization program (NIP) reviewed in 2004.

METHODSAccording to data from 4-vaccine coverage rates of NIP reviewed in 2004, 3 levels could be set. We randomly selected 2 counties at each level and then 10 villages from each county with 42 children involved who were born between 1992 and 2003. ELISA quantitative method was used to test IgG of diphtheria antitoxin.

RESULTS(1) The positive rate of diphtheria antitoxin was only 49.6% with the highest as 78.1% and lowest as 33.0%. There was a significant decreasing trend of this positive rate with the increase of age. The highest (61.2%) fell in the group that were born in 2003 and the lowest (37.6%) was seen among children born in 1992 to 1995. (2) Geometric mean concentrations (GMCs) was only 0.48 IU/ml with a trend of decrease when age was increasing. There was no GMCs peak seen in children who were at the age of boosting, as expected. (3) Positive rates of children born between 2001 and 2003 were lower than 62% while the diphtheria-pertussis-tetanus (DPT) vaccine coverage rates were all higher than 90%. (4) There was no significant difference of diphtheria antitoxin positive rates between children with eligible routine immunization (58.1%) and those were ineligible (59.6%).

CONCLUSIONOther than some specific ones, children from most of the investigated counties had a low level of antibody against diphtheria. The coverage rate of DPT vaccine did not necessarily reflect the immunity against diphtheria, suggesting the increase of immunity against diphtheria an urgent task to be taken care of.

Adolescent ; Age Distribution ; Antibodies, Bacterial ; immunology ; Child ; Child, Preschool ; China ; Diphtheria ; immunology ; prevention & control ; Diphtheria Antitoxin ; immunology ; Diphtheria-Tetanus-Pertussis Vaccine ; immunology ; Female ; Humans ; Male

The diagram of immune system with antigene was the toxic extract from the repeating stage, making the rough serum up to the lowest of 150 Lf/ml (or 210IU/ml) and applied the method of taking horse’s blood and giving back red blood cells to increase the the rough serum two times. The new process did reduce the level fN-protein, time and increase the quantity and productivity of the purified serum. The purified serum was of high quality: clear color, low level of N-protein to 30% compared with registered standard (150mg/ml).
Tetanus Antitoxin ; Serum

Accelerated stability test has been applied for predicting self-life of national standard serum tetanus anti-toxin (SAT). Samples of the tetanus antitoxin were kept at - 20°C, 4°C, 22°C, 37°C and 45°C for 6 months and their potency was estimated by using the toxin neutralization method on mice. There was relationship between the potency change and the self- life of serum tetanus antitoxin by using Arrhenius equation. The results demonstrated that the self-life of the national standard serum tetanus antitoxin was 9 years and 6 months when stored at -20°C.
Tetanus Antitoxin ; Diagnosis

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diph-theria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.
Adult ; Aged ; Aged, 80 and over ; Agricultural Workers' Diseases/epidemiology ; Diagnostic Errors ; Diphtheria-Tetanus-Pertussis Vaccine ; Emergency Service, Hospital ; Health Education ; Health Knowledge, Attitudes, Practice* ; Human ; Immunization, Secondary/psychology ; Immunization, Secondary/utilization* ; Korea/epidemiology ; Middle Aged ; Tetanus/diagnosis ; Tetanus/epidemiology* ; Tetanus/prevention & control ; Tetanus/therapy ; Tetanus Antitoxin/therapeutic use ; Tetanus Toxoid ; Treatment Outcome ; Vaccination/utilization* ; Wounds, Penetrating/complications

The Institute of Vaccine and Biologicals has recently released on market a purified tetanus antitoxin. The average potency of the product reached  3.000 IU/ml. The N-protein content is  70mg/ml
Tetanus Antitoxin ; Diseases ; Tetanus

The decoloration of purified sera was achieved by using 0.1% caprylic acid solution with pH 4.2 at 56oC. The technique can shorten the duration of purification processes
tetanus antitoxin

59 batches of purified tetanus antitoxin and 20 batches of anti-rabies serum (1997-2001) produced at IVAC Nha Trang were tested for: pH, total nitrogen, merthiolate content, sodium chloride content. In general, all the batches met the minimum requirements of the manufacture. However in order to improve the quality of the sera additional requirements should be set up
Tetanus Antitoxin ; Serum

BACKGROUND: The incidence of diphtheria has been markedly reduced and almostly eradicated by widespread use of DTP vaccines in developed countries. However, outbreaks of this disease may be occurred under some circumstances of ineffective immunization. In recent time, some studies reported persistent outbreaks of diphtheria in developed countries and indicated the existence of a large pool of susceptible individuals with potential for epidemic infection. In Korea, diphtheria vaccination has been well maintained since 1956 with high acceptant vaccination rates. So, there has been no reported diphtheria patient since 1987. But, there has been few study to diphtheria serosuvey, and no assessment of diphtheria immunization. Also, we do not use Td vaccine in adults for maintenance of diphtheria immunity. In this aspect, we conducted age related seroepidemiology of diphtheria and indirectly assessed the immunity of diphtheria vaccines, used in Korea. METHODS: For the evaluation of age related serosurvey of diphtheria immunity in Korean populations, study subjects below 10 years old aged children were classified into 10 groups (A~J) with one year interval, and beyond this age to 60 years old aged adults were classified into 5 group (K~O) with 10 years interval. And the adults over 60 years old age was classified into the last group (P). The numbers of each group were 100, and sex distributions of each group were almostly equal. And for the indirect assessment of diphtheria immunization in Korean children, children under 15 years old were classified into 6 groups (I~ VI) according to the status of DTaP vaccination. The numbers of this each group were 30, and sex ratio was almostly equal. Detection of specific IgG antibody to diphtheria toxin were determined by ELISA (contained fragment A & B toxin; IBL, Germany). RESULTS: In age related groups, the antibody titers to diphtheria toxin were well maintained until 10 years old age group, thereafter the titers abruptly decreased below 0.1 IU/mL and then slightly elevated after 30 years old age group and then maintained with low levels. In the groups related DTaP vaccine status, the antibody titers were very low (below 0.07 IU/mL) in prevaccination status, but the titers after primary vaccinations were markedly increased and maintained (above 0.6 IU/mL) until 15 years. And diphtheria antitoxin levels in the groups (L, M, N) showed no significant differences between males and females. CONCLUSION: The results of our study showed that the antibody titers to diphtheria toxin in the 20~50 years old aged groups dramatically decreased. This result indicated that vaccine induced diphtheria immunity did not last throughout life, and Td vaccination program in adults should be considered for maintenance of diphtheria immunity. And the immunity to diphtheria in Korean children indicated that 3 timesprimary and 2 times booster diphtheria immunizations were optimal.
Adolescent ; Adult ; Child ; Developed Countries ; Diphtheria Antitoxin ; Diphtheria Toxin ; Diphtheria* ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Disease Outbreaks ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunization ; Immunoglobulin G ; Incidence ; Korea ; Male ; Middle Aged ; Seroepidemiologic Studies* ; Sex Distribution ; Sex Ratio ; Vaccination ; Vaccines

Authors reviewed clinical records of 92 patients with tetanus from January 1974 to December 1983 at Severance Hospital and the following results wre obtained. 1) There were about 2.2 times more cases of neonatal tetanus than that of nonneonatal. The admitted cases of tetanus decreased in 1980's compared to those of 1970's. 2) The male versus female ratio was 3 : 1 not only in nonneonatal but also in neonatal teanus. 3) There was a tendency of higher mortality when the site of injury was on the central part of the body than on the distal. 4) Most cases of tetanus developed after the injury with bactrial contamination as expected, but a few cases are due to only trivial injury such as acupuncture or injection without overt contamination. 5) There was a close relationship between the incubation period and mortality in neonatal tetaus but no such definite relationship in nonneonatal tetaus. 6) The duraton of admission was about 3 weeks and the majority of deaths occureed in less than one week of admission. 7) There was no statistically significant difference in mortality between the group who used tetanus antitoxin from animal and that who used human tetanus immuneglobulin.
Acupuncture ; Animals ; Female ; Humans ; Male ; Mortality ; Tetanus Antitoxin ; Tetanus*

An attempt has been made to evaluate diphtheria and tetanus antitoxin response to diphtheria and tetanus toxoid as pressently marketed in Korea. A total of 80 infants divided in two groups according to doses of vaccine, were studied One group of 30 infants (group I ) received 1, 2 or 3 doses of D. P. T. vaccine (0.3ml, each) at approximately monthly interval. 1) In control group of 19 infants not immunized, the protective level of diphtheria antitoxin was found in 36.8% of infants, and the protective level of tetanus antitoxin was found in 5.3% of infants. These finding suggested the antitoxin level which was passively transmitted from the mother. 2) The frequency of diphtheria and tetanus vaccination correlates with antitoxin level, but there was no difference in antitoxin response between group I or group 11. 3) The antitoxin response were more excellant in infants given same dose of vaccine divided into multiple dose. 4) In both group I and 11, 100% of infants achieved protective level of diphtheria (0.03u/ml) and tetanus antitoxin (0.1u/ml) after 3 primary vaccination.
Diphtheria Antitoxin ; Diphtheria* ; Humans ; Infant ; Korea ; Mothers ; Tetanus ; Tetanus Antitoxin ; Tetanus Toxoid ; Vaccination