To assess the effect of the Expanded Program on Immunization (EPI) in rural Africa, blood samples were collected in two Kenyan sublocations. Serum antibodies against tetanus toxoid were measured in 155 individuals 1-70 years of age. Titers greater than the protective level of 0.01 IU/ml were found in 47% of the population. Protection was significantly higher in children born after the launching of the EPI (68%) and in women who had been at childbearing age since then (69%). Significantly lower protection was demonstrated in other age and sex-groups. The level of protection in children was equal in the two populations, whereas protection in fertile women was significantly lower in the population living a long distance from a health center. Diphtheria anti-toxin was measured in the samples from one sublocation, and 70 of 84 individuals (83%) had antibody levels greater than the protective level. No age or sex difference could be found, and there was no correlation between response levels to diphtheria and tetanus. This implicates natural infections as an important source of diphtheria antibodies. Our findings demonstrate a need for better coverage of the adult population against tetanus. Furthermore, diphtheria transmission still appears to take place, underscoring the importance of diphtheria vaccination of travelers to rural Africa.

译文

为了评估扩大计划对非洲农村地区免疫接种 (EPI) 的影响,在两个肯尼亚子地点收集了血液样本。在1-70岁的155个体中测定抗破伤风类毒素的血清抗体。在47% 的人群中发现滴度大于0.01 IU/ml的保护水平。EPI启动后出生的儿童 (68%) 和此后处于育龄的妇女 (69%) 的保护明显更高。在其他年龄和性别组中,保护作用明显降低。在两个人群中,儿童的保护水平是相等的,而在距离保健中心较远的人群中,可育妇女的保护水平要低得多。在来自一个子位置的样品中测量白喉抗毒素,并且84个个体中的70个 (83%) 的抗体水平高于保护水平。未发现年龄或性别差异,对白喉和破伤风的反应水平之间没有相关性。这暗示自然感染是白喉抗体的重要来源。我们的发现表明,需要更好地覆盖成人人群以预防破伤风。此外,白喉传播似乎仍在发生,突显了对前往非洲农村的旅行者进行白喉疫苗接种的重要性。

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