.

Wednesday, June 5, 2019

Effect of Tetanus Toxoid Vaccine on Neonatal Tetanus

Effect of tetanus Toxoid Vaccine on Neonatal Tetanusmilitary rating of the effect of Tetanus Toxoid vaccine on neonatal lockjawClinical scenarioTetanus is a vaccine preventable disease caused by a ubiquitous spore-forming bacteria called Clostridium tetani (reference need). Due to its ubiquity, the disease cannot be eradicated (Roper et al. 2007). Tetanus that occurs in neonates between 3-28 days of life is termed neonatal tetanus (CDC, 1997) and the most parkland nidus of infection in neonates is through the freshly cut umbilical cord (Bennett et al. 1996 Roper et al. 2007). Substantial progress has been made towards the elimination of maternal and neonatal tetanus (MNT) by the WHO initiative, although it still stiff a major problem in more than 30 developing countries (figure 1) (WHO, 2015).Figure 1. The global map sowing the packaging towards the elimination of maternal and neonatal tetanus.Source WHO. (2015). Online.http//www.who.int/immunization/diseases/MNTE_initiative/en/in dex4.htmlDeveloped countries such as the United States of America, England and Denmark, have long ago eliminated tetanus connect neonatal deaths compared to developing countries (Pascual et al. 2003 Simonsen et al. 1987 Rushdy et al. 2003). Haws et al. (2007) mentioned that in areas where the prevalence of neonatal tetanus is common, vaccinating women against tetanus during pregnancy is likely to prevent the disease. Neonatal tetanus still remains one of the leading causes of infant mortality in many developing countries despite the fact that tetanus vaccine has been available for years (Stanfield et al. 1984). Hence, the aim of this unfavourable appraisal is to evaluate the effect of tetanus toxoid vaccine given to pregnant women to provide effective protection and reduce deaths from neonatal tetanus in comparison to no vaccine.Focused Clinical QuestionTable 1 Search StrategyInclusion and Exclusion CriteriaTable 2 search and cover version resultsTotal number of studies = 3 (Blen cowe et al., 2010 Maral et al., 2001 and Demicheli et al., 2013). Table 3 CASP screening tool for the appraisal of two Systematic Reviews and one Cross-sectional Study*A cross-sectional appraisal tool does not exist, therefore Maral et al., 2001 was appraised using the systematic review appraisal tool.ExclusionsSummary of best evidence Blencowe et al., 2010 Systematic reviewAim/ object lens of the Systematic reviewTo evaluate the effect of Tetanus Toxoid vaccination of pregnant women or women of child bearing age on neonatal tetanus mortality.Study DesignSearch StrategyA range of appropriate databases were used such as PubMed, EMASE, Cochrane Libraries and World Health Organisation Regional Databases. able search terms were used such as Neonatal Tetanus, Tetanus Toxoid, Neonatal Mortality and Women. Publications in any language were also included.Selection Criteria for cellular inclusion of studiesThe PICO format (Patient, Intervention, Comparison and Outcome) was used in this re view to identify the studies to be included as followsPopulation NeonatesIntervention At least two Tetanus Toxoid vaccine dosesComparison Neonates born with forth Tetanus Toxoid vaccinationOutcome Mortality from Neonatal TetanusRandomised trails and observational studies meeting the to a higher place criterias were considered in this review.MethodsA systematic review of various databases was carried out to identify suitable studies meeting inclusion criteriaStandardised abstraction forms were used for all(prenominal) outcome of interest for studies meeting the inclusion criteriaStudies not meeting the inclusion criteria, studies which only reported serological outcomes and duplicate reports of studies or trails were all excludedQuality of item-by-item studies and evidence were evaluated according to the CHERG version of the GRADE method to generate an approximate calculation of the effects in reducing neonatal mortalityA meta-analysis was carried out using STATA version 10.0 statistic software and stated the mantel-haenszel pooled relative risk and corresponding 95% confidence intervals (CI)FindingsTwo studies which had no heterogeneity between them (p=0.16) i.e. a high-quality randomise controlled trial and a well-designed cohort study with adjustment for publication bias in its analysis, were joined into one meta-analysis to give an estimate of relative risk (RR)= 0.06 (95% CI 0.02-0.2) (Fig. 1). While, three case-control studies each with adjustment for publication bias showed a protective effect of two tetanus toxoid injections during pregnancy (odd ratio (OR) = 0.05 (0.005-0.4) OR=0.1 (0.03_0.4) OR=0.2 (0.03-0.7).Overall resultA 94% reduction in neonatal tetanus mortality (95% CI 80-98%). The confidence interval of 95% for these results appear to be accurate.

No comments:

Post a Comment