Tetanus antibody levels among adolescent girls in developing countries

Neonatal and maternal tetanus infections remain an important cause of death in many countries. Few studies have reported tetanus toroid antibody level s of adolescent girls. As part of the Expanded Programme on Immunization mo st girls receive up to 3 injections in early childhood, and many subsequent ly do not receive booster vaccinations until pregnant. We determined (by EL ISA) tetanus antibody seropositivity in adolescent girls from Malawi (in 19 96), Nigeria (in 1993) and Pakistan (in 1996), and response to tetanus vacc ination in adolescent girls from Pakistan. Geometric mean titres (GMT, IU/m L) were 0.94 in 117 Malawian, 0.32 in 154 Nigerian and 1.08 in 162 Pakistan i girls. In Nigeria, 54.7% of adolescents were seronegative, of whom 26.8% had a history of unsafe abortion. In Malawi and Pakistan all girls were ser opositive and in Pakistan, following a booster vaccination, titres increase d 3-fold, with a lower response in older girls. The results indicated that adequate childhood immunization is likely to provide protective levels thro ugh adolescence. Booster vaccination in late childhood/early adolescence sh ould protect the majority of women throughout their reproductive lives. Thi s practice would reduce the risks of girls exposed to infection through uns afe abortions, and may be the best option for countries seeking to improve their vaccination schedule, especially where tetanus vaccine coverage in pr egnant women is unacceptably low.