Tetanus vaccine

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Schematic structure of the tetanus toxin

A tetanus vaccine or tetanus toxoid vaccine (TTI) is a toxoid vaccine against infections with the bacterium Clostridium tetani , the trigger for the often fatal infectious disease tetanus or tetanus . The tetanus vaccine is on the World Health Organization's list of Essential Medicines .

properties

The first tetanus vaccine was developed and produced as a passive immunization (tetanus immunoglobulin, TIG) in the group of Emil von Behring from 1890 onwards. The antitoxin was used in soldiers during the First World War. The tetanus vaccine used today is a toxoid vaccine and was first developed in 1924. In the 1930s, the vaccine came on the market in the United States and Germany. The active ingredient in tetanus vaccines is the fixed tetanus toxin .

Studies on safety, immunogenicity and clinical benefit were not conducted at the time. In addition to a self- experiment from Germany, observations made by US soldiers from the Second World War are used as evidence of the benefit : The soldiers fell ill with tetanus much less often than soldiers in the First World War. A randomized, double-blind study in young women ( neonatal tetanus ) and further observational studies show that immunization at least twice produces a protective effect with a reduction in mortality.

It is difficult to say whether the decline in tetanus incidence and mortality in the industrialized countries at the beginning of the 20th century was caused by vaccinations or by technical (mechanization of agriculture, aseptic surgical techniques) or medical advances ( antibiotics , improved wound care). In Germany the incidence of tetanus fell from 0.20 / 100,000 (1952) to 0.02 / 100,000 cases (1990). In 2000 the reporting requirement for tetanus ended. Nowadays it is especially older people who have not been vaccinated or have not been vaccinated enough to develop tetanus.

Today's vaccines are obtained from C. tetani cultures without allergenic substances such as horse protein , peptone or blood group substances . Here, 40% formaldehyde is added to the culture filtrate , incubated for several weeks at 37 ° C. and the crude toxoid is isolated. After various cleaning steps, the end product may still contain traces of formaldehyde. Aluminum adjuvants are added as a potentiator . The concentration of the toxoid is given in IU or Lf (unit of the flocculation test); Children's vaccines contain around 40 IU (= 10 LF), vaccines for adults contain 20 to 40 IU

Vaccine variants of tetanus vaccines are the combination vaccines DTaP (with vaccines against Corynebacterium diphtheriae and Bordetella pertussis ), Tdap, DT (diphtheria tetanus) and Td. The small letters indicate lower concentrations of the respective component. DTaP is mostly used to immunize children, while Td or Tdap is mostly used for repeat immunization of adults. The DTP vaccine was used from 1930 to 1991, when the pertussis vaccine was replaced by a cell-free form ( acellular pertussis vaccine , aP), subsequently referred to as TDaP or DTaP, in 50% of those vaccinated due to pain and redness at the injection site .

immunology

The vaccine is usually given four times for the primary vaccination. After a four-time vaccination, neutralizing antibodies against the tetanus toxin develop in 100% of the vaccinated both with DTAP and with Tdap, which protect against a new tetanus infection for about 10 years. The titer for neutralizing antibodies against the tetanus toxin after ten years is comparable to that before the revaccination. A titer for neutralizing antibodies of ≥ 0.01 IU / mL indicates immunity. A fifth vaccination in adulthood is recommended by the CDC .

Seniors are considered to be the least vaccinated group of people, while Bundeswehr soldiers are more likely to be overimmunized.

Side effects

Adverse drug reactions with the combined diphtheria and tetanus vaccines include injection site pain (80%), redness (25%), headache (25%), fatigue (25%) and fever (rarely). Very rarely do a small nodule form at the puncture site or, in vaccinated people, a slight to moderate increase in temperature, flu-like symptoms or gastrointestinal complaints.

literature

  • D. M. Knipe, Peter M. Howley , D. E. Griffin, (Eds.): Fields Virology. 5th edition, Lippincott Williams & Wilkins, Philadelphia 2007, ISBN 978-0-7817-6060-7 .
  • Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 319 f.
  • F. Hofmann: Tetanus. In: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg (Eds.): Impfkompendium. 8th edition, Thieme, ISBN 978-3134989083 , p. 272 ​​ff.

Individual evidence

  1. ^ WHO Model Lists of Essential Medicines. (PDF) In: WHO. 2019, accessed April 4, 2020 .
  2. ^ Emil von Behring: About the creation of diphtheria immunity and tetanus immunity in animals. In: German Medical Weekly . No. 49 of December 4, 1890 ( digitized version from the University of Marburg).
  3. ↑ a b c d e f Documentation of the benefits of standard vaccines: Tetanus. Arznei-Telegram , February 19, 2016, pp. 17-20 , accessed on October 12, 2019 .
  4. ↑ a b c d Centers for Disease Control and Prevention (CDC): Tetanus . In: Epidemiology and Prevention of Vaccine-Preventable Diseases (pdf), Public Health Foundation, Washington, DC 2011, ISBN 0-01-706609-3 (accessed June 7, 2015).
  5. ↑ a b c d F. Hofmann: Tetanus. From: Vaccination Compendium . Ed .: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg. 8th edition. Georg Thieme Verlag, 2015, ISBN 978-3-13-498908-3 , p. 272 ff .
  6. ↑ a b A. Tomovici, L. Barreto, P. Zickler, W. Meekison, F. Noya, T. Voloshen, P. Lavigne: Humoral immunity 10 years after booster immunization with an adolescent and adult formulation combined tetanus, diphtheria, and 5-component acellular pertussis vaccine. In: Vaccine. No. 30, 2012, p. 2647, doi : 10.1016 / j.vaccine.2012.02.013 . PMID 22353673 .
  7. ^ Vaccines: VPD-VAC / Tetanus / main page . Centers for Disease Control. Retrieved June 4, 2012.
  8. ↑ Ian J. Amanna, Mark K. Slifka: Contributions of humoral and cellular immunity to vaccine-induced protection in humans. In: Virology. Volume 411, Issue 2 (2011), pp. 206-215. doi : 10.1016 / j.virol.2010.12.016 . PMID 21216425 . PMC 3238379 (free full text).
  9. ↑ Centers for Disease Control and Prevention: Vaccine Information Statement: Td (Tetanus, Diphtheria) .