Intensity of immunity to measles, tetanus and diphtheria among the population of Dnipro city
Conducting a comprehensive analysis of the intensity of immunity to measles, tetanus and diphtheria. The study of antitoxic immunity by determining the titers of IgG / IgM antibodies to diphtheria and tetanus toxins, as well as to measles antigens.
| Рубрика | Медицина |
| Вид | статья |
| Язык | английский |
| Дата добавления | 16.04.2023 |
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Oles Honchar Dnipro National University
Department of General Medicine with a Course of Physical Therapy
Intensity of immunity to measles, tetanus and diphtheria among the population of Dnipro city
Svitlana Latsynska
Candidate of Medical Sciences
Associate Professor
Tetyana Dyklenko
Senior Lecturer
Albert Vinnikov
Doctor of Biological Sciences, Professor
Olha Voronkova
Doctor of Biological Sciences, Professor
Tetyana Shevchenko
Doctor of Biological Sciences, Professor
Abstract
immunity measles tetanus diphtheria
It is known that such infectious diseases as measles, diphtheria and tetanus pose a significant threat to people, regardless of their age group. These infections, unfortunately, are quite common even now and require constant epidemiological surveillance to avoid outbreaks. This can be achieved through vaccination, if the timing of its application, established by the calendar plan, is followed.
The aim of the research was to conduct an analysis of the intensity of immunity to measles, tetanus, and diphtheria based on the results of surveys of humoral immunity indicators of the population of Dnipro city.
To solve the tasks of research, we used the data analysis of the results of the study of biological material (blood serum) from people aged 0 to 58 years, who want to get results to make a decision about the need for vaccination against diphtheria, tetanus and measles and with suspicion of these infections. A total of 485 samples were examined. The study of antitoxic immunity was carried out by determining the titers of IgG / IgM antibodies against diphtheria and tetanus toxins, as well as against measles antigens. The level of anti-measles, anti-diphtheria and anti-tetanus immunity was assessed in accordance with the recommendations of the World Health Organization (WHO).
As a result of the analysis, it was found that the group of people 48 years and older, whose level of antibodies indicates a decrease in immunity with increasing age and insufficient vaccination coverage of this age group, is the largest risk group for diphtheria, tetanus and measles. In general, there is a reduced population immunity to diphtheria, measles and tetanus, which indicates the need to expand vaccination among the population to prevent epidemic outbreaks. The obtained data confirm that vaccination of children, according to the calendar of preventive vaccinations and revaccination of adults (every 10 years) can become a powerful tool for the prevention of infectious diseases under conditions of mass vaccination.
Keywords: immune intensity, measles, tetanus, diphtheria.
Formulation of the problem
The issue of prevention of infectious diseases always occupies one of the prominent places in the health care system of all countries. In particular, for Ukraine among such diseases that have significant risks of spreading among the population. you can name measles, diphtheria and tetanus. Constant monitoring of the population's immune protection status can be used as a basis for substantiating vaccine-preventive measures.
Analysis of recent research and publications
Infectious diseases - such as measles, tetanus, diphtheria - are the most important social and medical problem at present. These diseases harm not only the health of the population, but have a serious negative social and economic effect on society due to the loss of working capacity and premature death of the population of working age [7, 8, 9, 12, 15].
Recently, there has been a downward trend in the incidence of diphtheria and tetanus in Ukraine, although there have been outbreaks. A small number of measles cases are also recorded, in particular, according to the World Health Organization (WHO), 16 cases of the disease were recorded in 2021 [13]. However, it should be noted that in 2017-2019, there was an outbreak of measles in Ukraine, which affected more than 90 thousand people [14]. These infections are characterized by seasonality and the development of specific complications. And although vaccines are available, the overall decline in the number of vaccinated individuals leads to outbreaks. Most often, unvaccinated children get sick [1, 5], but cases of infection are also recorded among the adult population [2, 10, 15]. With low levels of coverage by preventive vaccinations, there is a risk of a large number of cases of infectious diseases [3, 13].
One of the most effective methods of protection against most infectious diseases is immunoprophylaxis [9]. Universal mass vaccination of children of the first year of life protects babies, prevents life-threatening consequences - the chronicity of the disease, the possibility of developing complications in the future [3, 10, 15, 16].
The consequences of a possible outbreak of diphtheria can be much more serious. In the case of measles, according to statistics, one person dies among a thousand patients, for diphtheria this indicator can reach from 50 to 100 deaths per thousand infected [8, 12]. In the period 2010-2018, 56 patients with diphtheria were registered in Ukraine, including 12 children and 44 adults. No fatalities were recorded. In 2019, 20 cases of diphtheria were registered [6].
Measles, diphtheria, and tetanus vaccinations are usually scheduled only for children, and only a small percentage of adults are revaccinated against these infections, while adults need to be revaccinated, for example, against diphtheria, every 10 years [6, 10]. At the same time, the effectiveness of vaccination against these infections is widely known, in particular for anti-measles measures [2, 3, 7].
The situation regarding tetanus in Ukraine has worsened since 2018: in 8 months, compared to 2017, the intensive rate increased from 0.02 to 0.03 per 100,000 populations. It is also combined with an unfavorable tendency to "rejuvenate" tetanus. Among the adults who fell ill, more than 30% were under the age of 60, which is atypical for countries with an established vaccine prevention system. It was also noted that the number of registered cases of tetanus among children exceeded the number of cases among adults. In 2018, childhood tetanus was mainly associated with the age group of 5-9 years, including severe and moderate forms of the disease, as well as some fatal cases. The fact that tetanus among children has recently been registered several times more often than diphtheria, an infection with airborne transmission, is surprising [11]. This indicates the need to vaccinate children to reduce the risk of infection [5].
The vaccine that prevents tetanus in mothers and newborns was introduced in more than 100 countries, which, according to various estimates, allowed to protect more than 80% of newborns [4, 17] and which is another evidence of the effectiveness of immunoprophylaxis among the population.
The aim of the research was to conduct an analysis of the intensity of immunity to measles, tetanus, and diphtheria based on the results of surveys of humoral immunity indicators of the population of Dnipro city.
Research materials and methods
Data from the results of the analysis of biological samples (serum) from people aged 0 to 58 years, who want to get results to make a decision about the need for vaccination against diphtheria, tetanus and measles and with suspicion of these infections were analyzed. A total of 485 samples were examined. The research was carried out on the basis of the PE “Center of Laboratory Medicine” “Vis-Medic” (Dnipro city, Ukraine).
The study of antitoxic immunity was carried out by determining the titers of IgG / IgM antibodies against diphtheria and tetanus toxins, as well as against measles antigens.
Equipment and reagents were used to determine the level of measles antibodies Euroimmun Medizinische Labordiagnostika AG (Germany).
Reference values:
- IgM antibodies: R <0.8 - negative result; 0.8 < R <1.1 - doubtful result; R> 1.1 is a positive result.
- IgG antibodies: Up to 0.8 - negative result; more than 1.1 - a positive result; 0.9-1.0 is a questionable result.
Interpretation of results:
IgG+, IgM- - past infection (there is no risk to the fetus).
IgG+, IgM+ - infection within the last 7-120 days (possible risk for the fetus).
IgG-, IgM+ - acute infection (maximum risk for the fetus).
IgG-, IgM- - the mother does not have specific immunity, there is a risk of infection. There are no signs of an acute infection. It is necessary to repeat the serological examination after 3 weeks. At the same time, the appearance of IgM indicates an acute infection.
Determination of the level of specific antibodies against diphtheria and tetanus toxins was carried out by the passive hemagglutination reaction method using standardized erythrocyte antigen diagnostics - diphtheria and tetanus (JSC “Biomed”, Ukraine).
The specific activity of diphtheria diagnosticum was 1:3200, tetanus 1:1280. The main indicator of anti-diphtheria and anti-tetanus immunity was the concentration of antibodies in IU/ml.
The results were evaluated according to the instructions for the given set, which provides for the gradation of immune protection depending on the titer of antitoxic antibodies (table 1).
Table 1. Grading of immune protection depending on the titer of antitoxic antibodies
|
IgG antibody titer (IU/ml) |
Vaccination recommendation |
|
|
<0,1 |
basic vaccination |
|
|
0,1-0,9 |
booster vaccination |
|
|
1,0-1,4 |
booster vaccination after 5 years |
|
|
1,5-2,0 |
booster vaccination after 7 years |
|
|
>2,0 |
booster vaccination after 10 years |
The assessment of the level of anti-measles, anti-diphtheria and anti-tetanus immunity was carried out in accordance with WHO recommendations according to the following criteria: persons with an antibody content of 0.015-0.06 IU / ml should be considered conditionally protected, 0.1-0.5 IU / ml - with an average level of protection, > 1.0 IU / ml - highly immune. The minimum protective level of both anti-diphtheria and anti-tetanus antibodies is a concentration of 0.1 lU/ml.
The results of the study were processed using the statistical package of the license program «STATISTICA® for Windows 6.0».
Table 2. Research results. The intensity of immunity against measles in the population of the city of Dnipro was determined according to the results of studies of biological material (table 2)
|
Age groups (years) |
Number of surveyed |
0 lU/ml |
0.015-0.06 lU/ml |
0.1-0.5 lU/ml |
1.0 lU/ml and more |
|||||
|
Abs. |
% |
Abs. |
% |
Abs. |
% |
Abs. |
% |
|||
|
1 |
19 |
1 |
5.3 |
2 |
10.5 |
11 |
57.9 |
5 |
26.3 |
|
|
2 |
15 |
0 |
0.0 |
6 |
40.0 |
5 |
33.3 |
4 |
26.7 |
|
|
3 |
28 |
1 |
3.6 |
4 |
14.3 |
20 |
71.4 |
3 |
10.7 |
|
|
4 |
27 |
1 |
3.7 |
2 |
7.4 |
20 |
74.1 |
4 |
14.8 |
|
|
5 |
28 |
2 |
7.1 |
2 |
7.1 |
14 |
50.0 |
10 |
35.7 |
|
|
6 |
23 |
0 |
0.0 |
3 |
13.0 |
12 |
52.2 |
8 |
34.8 |
|
|
7 |
24 |
0 |
0.0 |
2 |
8.3 |
20 |
83.3 |
2 |
8.3 |
|
|
8 |
15 |
0 |
0.0 |
3 |
20.0 |
10 |
66.7 |
2 |
13.3 |
|
|
9 |
21 |
2 |
9.5 |
9 |
42.9 |
5 |
23.8 |
5 |
23.8 |
|
|
10 |
14 |
0 |
0.0 |
2 |
14.3 |
7 |
50.0 |
5 |
35.7 |
|
|
11 |
19 |
3 |
15.8 |
2 |
10.5 |
11 |
57.9 |
3 |
15.8 |
|
|
12 |
17 |
0 |
0.0 |
3 |
17.6 |
10 |
58.8 |
4 |
23.5 |
|
|
13 |
29 |
1 |
3.4 |
5 |
17.2 |
17 |
58.6 |
6 |
20.7 |
|
|
14 |
17 |
0 |
0.0 |
2 |
11.8 |
6 |
35.3 |
9 |
52.9 |
|
|
15 |
22 |
4 |
18.2 |
1 |
4.5 |
8 |
36.4 |
9 |
40.9 |
|
|
16 |
18 |
2 |
11.1 |
7 |
38.9 |
1 |
5.6 |
8 |
44.4 |
|
|
17 |
17 |
1 |
5.9 |
5 |
29.4 |
8 |
47.1 |
3 |
17.6 |
|
|
18-27 |
32 |
1 |
3.1 |
5 |
15.6 |
14 |
43.8 |
12 |
37.5 |
|
|
28-37 |
22 |
1 |
4.5 |
1 |
4.5 |
11 |
50.0 |
9 |
40.9 |
|
|
38-47 |
32 |
1 |
3.1 |
3 |
9.4 |
19 |
59.4 |
9 |
28.1 |
|
|
48-57 |
26 |
3 |
11.5 |
8 |
30.8 |
8 |
30.8 |
7 |
26.9 |
|
|
58 and more |
20 |
3 |
15.0 |
3 |
15.0 |
10 |
50.0 |
4 |
20.0 |
|
|
Total |
485 |
27 |
5.6 |
80 |
16.5 |
247 |
50.9 |
131 |
27.0 |
The intensity of immunity against measles in the population of the Dnipro city
From the data of Table 2, it can be seen that the most unfavorable situation was recorded among young people (11-18 years old), where the number of people unprotected against measles was (36.3%). Among children, the largest number of unprotected population was noted in the age groups of 1-5 years (18.5%). Among the adult population, the largest number of unprotected population was noted in the age groups of 48 years and more (1.2%).
The intensity of immunity against tetanus and diphtheria in the population of the city of Dnipro was analyzed according to the data in Table 3.
Table 3. The intensity of immunity against tetanus and diphtheria in the population of the Dnipro city
|
Age groups (years) |
Number of surveyed |
0 lU/ml |
0.015-0.06 lU/ml |
0.1-0.5 lU/ml |
1.0 lU/ml and more |
|||||
|
Abs. |
% |
Abs. |
% |
Abs. |
% |
|||||
|
1 |
19 |
0 |
0.0 |
1 |
5.3 |
8 |
42.1 |
10 |
52.6 |
|
|
2 |
15 |
0 |
0.0 |
2 |
13.3 |
5 |
33.3 |
8 |
53.3 |
|
|
3 |
28 |
1 |
3.6 |
5 |
17.9 |
14 |
50.0 |
8 |
28.6 |
|
|
4 |
27 |
1 |
3.7 |
1 |
3.7 |
17 |
63.0 |
8 |
29.6 |
|
|
5 |
28 |
0 |
0.0 |
4 |
14.3 |
13 |
46.4 |
11 |
39.3 |
|
|
6 |
23 |
0 |
0.0 |
0 |
0.0 |
12 |
52.2 |
11 |
47.8 |
|
|
7 |
24 |
0 |
0.0 |
3 |
12.5 |
10 |
41.7 |
11 |
45.8 |
|
|
8 |
15 |
0 |
0.0 |
4 |
26.7 |
6 |
40.0 |
5 |
33.3 |
|
|
9 |
21 |
0 |
0.0 |
5 |
23.8 |
7 |
33.3 |
9 |
42.9 |
|
|
10 |
14 |
0 |
0.0 |
0 |
0.0 |
9 |
64.3 |
5 |
35.7 |
|
|
11 |
19 |
1 |
5.3 |
2 |
10.5 |
8 |
42.1 |
8 |
42.1 |
|
|
12 |
17 |
0 |
0.0 |
2 |
11.8 |
6 |
35.3 |
9 |
52.9 |
|
|
13 |
29 |
0 |
0.0 |
0 |
0.0 |
18 |
62.1 |
11 |
37.9 |
|
|
14 |
17 |
0 |
0.0 |
1 |
5.9 |
2 |
11.8 |
14 |
82.4 |
|
|
15 |
22 |
0 |
0.0 |
1 |
4.5 |
11 |
50.0 |
10 |
45.5 |
|
|
16 |
18 |
0 |
0.0 |
2 |
11.1 |
4 |
22.2 |
12 |
66.7 |
|
|
17 |
17 |
0 |
0.0 |
3 |
17.6 |
8 |
47.1 |
6 |
35.3 |
|
|
18-27 |
32 |
0 |
0.0 |
1 |
3.1 |
18 |
56.3 |
13 |
40.6 |
|
|
28-37 |
22 |
0 |
0.0 |
0 |
0.0 |
8 |
36.4 |
14 |
63.6 |
|
|
38-47 |
32 |
0 |
0.0 |
2 |
6.3 |
16 |
50.0 |
14 |
43.8 |
|
|
48-57 |
26 |
0 |
0.0 |
5 |
19.2 |
10 |
38.5 |
11 |
42.3 |
|
|
58 and more |
20 |
3 |
15.0 |
0 |
0.0 |
9 |
45.0 |
8 |
40.0 |
|
|
Total |
485 |
6 |
1.2 |
44 |
9.1 |
219 |
45.2 |
216 |
44.5 |
From the data in Table 3, it can be concluded that the highest number of seronegative and conditionally protected persons against tetanus was among adults in the age group of 58 years and older (15%), the share of conditionally protected adults was the largest in the age group of 48-57 years (19.2%). The low immunity against diphtheria, tetanus and measles of persons 48 years and older indicates a decrease in immunity with increasing age and insufficient vaccination coverage of this age group. In the children's group, the category of 8-9 years was the least protected, for whose representative's immunity can be considered conditional in more than 23% of cases.
As can be seen from the obtained results, about 90% of the population had a sufficient level of immunological protection against tetanus. As with diphtheria, the number of seronegative persons was 1.5%, and the conditionally protected contingent was 3.3%. Importantly, children under the age of 7 had mostly high and medium levels of antitoxic immunity.
Also attracting attention is the group of people aged 28 to 37 years who, with diphtheria, had a high level of conditionally protected and unprotected persons - 18.2%.
Conclusions
Reduced population immunity to diphtheria, measles and tetanus in the population of Dnipro was revealed, which calls for raising the question of the need to expand vaccination among the population to prevent epidemic risks.
The obtained data confirm that vaccination of children, according to the calendar of preventive vaccinations and revaccination of adults (every 10 years) can become a powerful tool for the prevention of infectious diseases under conditions of mass vaccination.
The greatest risk group for diphtheria, tetanus and measles is the group of people 48 years and older, whose antibody level indicates a decrease in immunity with increasing age and insufficient vaccination coverage of this age group.
References
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