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Effect of tetanus toxoid vaccine on neonatal tetanus

Our review evaluated the existing evidence on immunisation with tetanus toxoid in women of reproductive age for the prevention of tetanus and death in newborn babies and to determine whether serious harms are associated with tetanus toxoid exposure.

Tetanus in newborn babies is an infection causing rigidity, muscle spasm and often death. The evidence is current to January 2015, the review includes three trials.

Tetanus toxoid immunization to reduce mortality from neonatal tetanus

Two assessed the effectiveness of vaccinating women of reproductive age 9823 infants: The third trial 48 women and their newborns assessed the safety of tetanus toxoid diphtheria acellular pertussis vaccine Tdap administration during pregnancy in comparison with placebo. Key results and quality of the evidence: A protective effect against deaths caused by tetanus was observed among the newborns from mothers who received at least two doses of the tetanus toxoid vaccine when compared with newborns from mothers who were immunised with influenza vaccine.

A similar protective effect was seen with at least two doses of the tetanus vaccine against newborn deaths. Cases of tetanus were less frequent among newborns from women who received at least one dose of tetanus toxoid.

Vaccines for women to prevent tetanus in newborn babies

This evidence was of moderate quality. In the second trial immunisation of women of reproductive age with tetanus diphtheria toxoid had a greater protective effect against newborn deaths than did cholera vaccine. The quality of the evidence was low for this outcome.

In the third study no serious adverse events during pregnancy or in babies were related to the receiving of Tdap vaccine. The women experienced more pain with the vaccine injection than with the placebo. The available evidence supports the implementation of immunisation programs for women of reproductive age or pregnant women in communities with similar, or higher, levels of risk of effect of tetanus toxoid vaccine on neonatal tetanus in newborn babies as at the two study sites.

Available evidence supports the implementation of immunisation practices on women of reproductive age or pregnant women in communities with similar, or higher, levels of risk of neonatal tetanus, to the two study sites. Read the full abstract. Tetanus is an acuteoften fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer.

Prevention may be possible by the vaccination of pregnant or non-pregnant women, or both, with tetanus toxoid, and the provision of clean delivery services. Tetanus toxoid consists of a formaldehyde-treated toxin that stimulates the production of antitoxin. To assess the effectiveness of tetanus toxoid, administered to women of reproductive age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus.

Randomised or quasi-randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of reproductive age on numbers of neonatal tetanus cases and deaths.

WHO recommendation on tetanus toxoid vaccination for pregnant women

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of biasextracted data and checked them for accuracy. Two effectiveness trials 9823 infants and one safety trial 48 mothers were included. The main outcomes were measured on infants born to a subset of those randomised women who became pregnant during the course of the studies.

One study 1182 infants assessed the effectiveness of tetanus toxoid in comparison with influenza vaccine in preventing neonatal tetanus deaths. A single dose did not provide significant protection against neonatal tetanus deaths, risk ratio RR 0. However, a two- or three-dose course did provide protection against neonatal deaths, RR 0. Administration of a two- or effect of tetanus toxoid vaccine on neonatal tetanus course resulted in significant protection when all causes of death are considered as an outcome RR 0.

No effect was detected on causes of death other than tetanus. Cases of neonatal tetanus after at least one dose of tetanus toxoid were reduced in the tetanus toxoid group, RR 0. Another studyinvolving 8641 children, assessed the effectiveness of tetanus-diphtheria toxoid in comparison with cholera toxoid in preventing neonatal mortality after one or two doses.

Neonatal mortality was reduced in the tetanus-diphtheria toxoid group RR 0. In preventing deaths at four to 14 days, neonatal mortality was reduced again in the tetanus-diphtheria toxoid group RR 0. The third small trial assessed that pain at injection site was reported more frequently among pregnant women who received tetanus diphtheria acellular pertussis than placebo RR 5. You may also be interested in: