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Neonatal tetanus despite protective serum antitoxin concentration.

S Y Maselle1, R Matre, R Mbise

  • 1Department of Microbiology and Immunology, Muhimbili Medical Centre, Tanzania.

FEMS Microbiology Immunology
|June 1, 1991
PubMed
Summary

Neonates with tetanus had high antibody levels, suggesting the toxin dose can overwhelm immunity. Even with high antibody levels from maternal vaccination, tetanus can still occur, indicating potential issues with immune response effectiveness.

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Area of Science:

  • Immunology
  • Neonatal Medicine
  • Vaccinology

Background:

  • Neonatal tetanus remains a significant health concern, particularly in regions with lower vaccination coverage.
  • Maternal vaccination with tetanus toxoid is a primary strategy to protect newborns against tetanus.
  • The immune response to tetanus toxoid during pregnancy can be complex and variable.

Purpose of the Study:

  • To investigate serum antibody levels against tetanus toxin in neonates diagnosed with clinical tetanus.
  • To evaluate the relationship between maternal tetanus toxoid vaccination status and antibody levels in affected neonates.
  • To explore potential mechanisms by which tetanus can occur despite presumed protective antibody titers.

Main Methods:

  • Enzyme-Linked Immunosorbent Assay (ELISA) was employed to quantify serum antibodies against tetanus toxin.

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  • Antibody levels in neonates with clinical tetanus were compared to the established minimum protective level (0.01 IU/ml).
  • Maternal vaccination history, including tetanus toxoid administration during pregnancy and booster doses, was recorded.

    • Main Results:

    • Seven neonates with clinical tetanus exhibited serum antibody levels 4-13 times higher than the protective threshold.
    • Mothers of these neonates, with one exception, had received tetanus toxoid vaccination during pregnancy.
    • Two neonates whose mothers received multiple booster doses showed exceptionally high antibody concentrations (100- and 400-fold above protective levels).

    Conclusions:

    • High pre-existing anti-tetanus toxin antibody levels do not always prevent neonatal tetanus, as the toxin dose may overwhelm the immune response.
    • Multiple booster injections of tetanus toxoid during pregnancy might lead to an ineffective immune response in some cases.
    • Further research is warranted to understand the nuances of immune response to tetanus toxoid in pregnancy and its implications for neonatal protection.