Tetanus immunisation in a cohort of adults seen in an accident and emergency unit of a tertiary health facility in Nigeria

Abstract

Background: Tetanus remains a major health problem in many developing countries including Nigeria. Most cases of tetanus in the developing countries are in the young people under 40 years. In view of the high mortality from tetanus, prevention remains the best form of treatment. Objective: The objective was to determine the effectiveness of anti-tetanus immunisation in a cohort of Nigerian adult population. Methods: Patients with open injuries and controls without open injuries were investigated. Blood samples for IgG Anti-Tetanus Antibody (ATAb) assessments were taken from patients and controls on admission before giving anti-tetanus toxoid (ATT) and at 4 weeks later. Serum ATAb was quantitated using Tetanus Toxoid IgG ELISA Kit (Demeditec Diagnostics, Germany). ATAb results were expressed in International Units per millilitre (IU/mL). ATAb levels > 0.1 IU/mL were considered protective. Results: A total of 159 patients and 90 controls were studied. The mean of ATAb patient was 1.13 (2.37) IU/mL, higher than the mean of 0.76 (1.4) IU/mL) in controls. In both the patients and controls, females had higher baseline ATAb levels; this was statistically significant in controls (P < 0.002). Seventy-five (47.2%) patients and 47 (52.2%) controls did not have protective ATAb levels. Four weeks after immunisation, the rise in ATAb was, however, >8-fold and the percentage of patients that required immunisation dropped from 47.2% to 10%. Although 11 (30%) patients had a history of ATT, their serum ATAb was not higher than those who did not have a history of ATT - 1.02 (1.51) IU/mL and 1.19 (2.67) IU/mL, respectively. Conclusion: There was a good response to ATT immunisation. Therefore, anti-tetanus immunisation should be continued in hospitals.