Gebelerde ve umblikal kordda tetanos antitoksin seroprevalansının ve ilişkili faktörlerin değerlendirilmesi
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Tarih
2024
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Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Tetanos, yenidoğanlarda ve gebelerde ölümcül olabilen bir enfeksiyon hastalığıdır. Tetanos toksoid aşısı, tetanosa karşı korunmada en etkili yöntemdir. Bu çalışmada, gebelerde ve umblikal kordda tetanos antitoksin seroprevalansı ve ilişkili faktörleri değerlendirilmesi amaçlandı. Gereç ve Yöntem: Kadın hastalıkları ve doğum bölümüne doğum için başvuran gebelere onayı alındıktan sonra sosyodemografik bilgilerini ve aşı öyküsünü içeren anket formu uygulandı. Gebelerden ve doğumu takiben umblikal korddan antikor düzeyi çalışılmak üzere kan örneği alındı. Çalışma yapılıncaya kadar bütün örnekler −80°C'de donduruldu. Antitetanos IgG antikor düzeyleri mikro-elisa yöntemi ile çalışıldı. Tüm veriler SPSS for Windows 25.0 programı kullanılarak değerlendirildi. Bulgular: Çalışmaya katılan gebelerin yaş ortalaması 28,32±5,3 (18-43) idi. Gebelerin %72,4'ünün (n=192) tanı almış bir hastalığı yoktu. Gebelerin %48,3'ünün (n=128) mevcut gebeliğinde 1 doz, %30,2'inin (n=80) 2 doz tetanos aşısı olduğu, %21,5'inin (n=57) olmadığı tespit edildi. Gebelerin toplam aşı dozu incelendiğinde %3,0'unun (n=8) aşılanmamış olduğu, %30,6'sının (n=81) aşı takviminde eksiklikler bulunduğu, %54,3'ünün (n=144) 3 doz primer dozunu tamamladığı ve %12,2'sinin (n=32) 5 doz aşı serisinin tamamını aldığı belirlendi. Gebelerin %85,3'ünün (n=226) en son tetanos aşısını son 5 yıl içinde yaptırdığı, %9,4'ünün (n=25) 5 ile 10 yıl arasında ve %2,3'ünün (n=6) ise 10 yıldan uzun bir süre önce yaptırdığı tespit edildi. Doğum sayısı 2 ve üzerinde olan annelerin aşı olma sıklığı (%63,0), 1 kez doğum yapmış olan (%83,3) ve doğum öyküsü olmayan gebelerin (%91,4) aşı olma sıklığından istatistiksel olarak anlamlı derecede düşüktü (p<0,001). Doğum öncesi bakım alanlarda aşı olma sıklığı (%82,8) almayanlara göre (%76,4) daha yüksek saptandı ancak istatistiksel olarak anlamlı değildi (p>0,05). Planlı gebeliği olanlarda aşı olma sıklığı (%79,7) olmayanlara (%63,2) daha yüksek saptandı ancak istatistiksel olarak anlamlı bulunmadı (p>0,05). Aşı olma sıklığı lise ve üzerinde eğitim görenlerde (%80,4) ilköğretim ve altı eğitim görenlere (%75,3) göre daha yüksek saptandı ancak istatistiksel olarak anlamlı bulunmadı (p>0,05). Annelerin %99,6'sının koruyucu düzeyde antikora sahip olduğu, kord örneklerinin %100'ünün koruyucu düzeyde antikora sahip olduğu saptandı. Kord antikor düzeyi ile anne antikor düzeyi arasında pozitif yönlü çok güçlü korelasyon tespit edildi (r=0,761, p<0,001). Gebelerin yaşı arttıkça anne ve kord antikor düzeyinin azaldığı tespit edildi (sırasıyla r=-0,217; p<0,001; r=-0,137; p=0,026). Gebelik sayısı arttıkça anne ve kord antitetanos IgG düzeylerinin azaldığı tespit edildi (sırasıyla r=-0,220; p<0,001; r=-0,198; p<0,001). Mevcut gebeliğinde aşı olanların anne ve kord antikor düzeyi aşı olmayanlara göre anlamlı düzeyde yüksek saptandı (p<0,001). Doğum haftası 32 altında olan gebelerde antikor düzeyi ortancası (5,550) 37 haftadan büyük (5,082) ve 33-37 hafta arasında olanlara (4,969) göre daha yüksek saptandı ancak istatistiksel olarak anlamlı bulunmadı. Tetanosa karşı plasental geçiş oranının anne antikor düzeyi ile negatif yönde orta güçte korelasyon olduğu saptandı ancak kord antikor düzeyi ile korelasyon saptanmadı (sırasıyla r=-0,471; p<0,001; r=0,103; p=0,095). Sonuç: Araştırmamız, mevcut gebelik döneminde yapılan tetanos aşısının tetanos antikor seviyelerini yükseltmede olumlu bir etkiye sahip olduğunu göstermektedir. Bu sebeple, her gebelikte aşı uygulaması, ideal gebelik sonuçlarını elde etmek ve neonatal tetanosun eliminasyonunu devam ettirmek adına büyük önem arz etmektedir. Gebelerin aşı hakkında kapsamlı bilgilendirilmesi, aşı konusunda farkındalığının artırılmasının sağlanması ve sağlık hizmetlerine ulaşımının daha erişilebilir kılınması için çaba gösterilmelidir.
Objective: Tetanus is an infectious disease that can be fatal in newborns and pregnant women. The tetanus toxoid vaccine is the most effective method to protect against tetanus. The objective of this study was to evaluate the seroprevalence of tetanus antitoxin in pregnant women and umbilical cord and associated factors. Materials and Methods: A questionnaire form comprising sociodemographic information and vaccination history was administered to pregnant women presenting to the department of obstetrics and gynaecology for delivery, following the women's consent. Blood samples were collected from the pregnant women and from the umbilical cord following delivery for antibody levels. All samples were frozen at -80°C until the study was performed. The anti-tetanus IgG antibody levels were analysed by micro-ELISA method. All data were subjected to statistical analysis using the SPSS for Windows 25.0 programme. Results: The mean age of the pregnant women who participated in the study was 28.32±5.3 years (18-43). Of the pregnant women, 72.4% (n=192) had no diagnosed disease. It was determined that 48.3% (n=128) of the pregnant women received 1 dose of vaccine in their current pregnancy, 30.2% (n=80) received 2 doses of vaccine, and 21.5% (n=57) were not vaccinated. Upon analysis of the total vaccine dose administered to pregnant women, it was determined that 3.0% (n=8) had not received any vaccine, 30.6% (n=81) had deficiencies in the vaccination schedule, 54.3% (n=144) had completed three doses of the primary vaccine, and 12.2% (n=32) had received the entire five-dose vaccine series. It was determined that 85.3% (n=226) of the pregnant women received their last tetanus vaccination within the last 5 years, 9.4% (n=25) between 5 and 10 years and 2.3% (n=6) more than 10 years ago. The frequency of vaccinations among mothers with two or more births (63.0%) was found to be statistically significantly lower than that of mothers who had given birth once (83.3%) and those without a birth history (91.4%) (p < 0.001). The frequency of vaccination in those who received antenatal care (82.8%) was higher than in those who did not (76.4%), but it was not statistically significant. The frequency of vaccination was found to be higher in those with planned pregnancies (79.7%) than those without (63.2%), but it was not statistically significant (p>0.05). The frequency of vaccination was found to be higher in those with high school education and above (80.4%) than in those with primary education and below (75.3%), but it was not statistically significant (p>0.05). It was found that 99.6% of the mothers had protective level antibodies and 100% of the cord samples had protective level antibodies. There was a very strong positive correlation between cord antibody level and maternal antibody level (r=0.761, p<0.001). The maternal and cord antibody levels demonstrated a negative correlation with the age of the pregnant women (r = -0.217, p < 0.001 and r = -0.137, p = 0.026, respectively). As the number of pregnancies increased, maternal and cord anti-tetanus IgG levels decreased (r=-0.220; p<0.001; r=-0.198; p<0.001, respectively). Antibody levels in the maternal and cord blood of those who had received the vaccine during the current pregnancy were significantly higher than those who had not received the vaccine (p<0.001). The median antibody level in pregnant women with a gestational age of less than 32 weeks (5.550) was found to be higher than those with a gestational age of more than 37 weeks (5.082) and between 33-37 weeks (4.969), although this difference was not statistically significant. The rate of placental transmission against tetanus was found to be negatively correlated with maternal antibody level, but not with cord antibody level (r = -0.471; p < 0.001; r = 0.103; p = 0.095, respectively). Conclusion: The results of our study indicate that tetanus vaccination during pregnancy has a positive effect on raising tetanus antibody levels. Therefore, it is of great importance to vaccinate pregnant women in every pregnancy in order to achieve ideal pregnancy outcomes and to continue the elimination of neonatal tetanus. Efforts should be made to inform pregnant women comprehensively about the vaccine, to increase their awareness about the vaccine and to make access to health services more accessible.
Objective: Tetanus is an infectious disease that can be fatal in newborns and pregnant women. The tetanus toxoid vaccine is the most effective method to protect against tetanus. The objective of this study was to evaluate the seroprevalence of tetanus antitoxin in pregnant women and umbilical cord and associated factors. Materials and Methods: A questionnaire form comprising sociodemographic information and vaccination history was administered to pregnant women presenting to the department of obstetrics and gynaecology for delivery, following the women's consent. Blood samples were collected from the pregnant women and from the umbilical cord following delivery for antibody levels. All samples were frozen at -80°C until the study was performed. The anti-tetanus IgG antibody levels were analysed by micro-ELISA method. All data were subjected to statistical analysis using the SPSS for Windows 25.0 programme. Results: The mean age of the pregnant women who participated in the study was 28.32±5.3 years (18-43). Of the pregnant women, 72.4% (n=192) had no diagnosed disease. It was determined that 48.3% (n=128) of the pregnant women received 1 dose of vaccine in their current pregnancy, 30.2% (n=80) received 2 doses of vaccine, and 21.5% (n=57) were not vaccinated. Upon analysis of the total vaccine dose administered to pregnant women, it was determined that 3.0% (n=8) had not received any vaccine, 30.6% (n=81) had deficiencies in the vaccination schedule, 54.3% (n=144) had completed three doses of the primary vaccine, and 12.2% (n=32) had received the entire five-dose vaccine series. It was determined that 85.3% (n=226) of the pregnant women received their last tetanus vaccination within the last 5 years, 9.4% (n=25) between 5 and 10 years and 2.3% (n=6) more than 10 years ago. The frequency of vaccinations among mothers with two or more births (63.0%) was found to be statistically significantly lower than that of mothers who had given birth once (83.3%) and those without a birth history (91.4%) (p < 0.001). The frequency of vaccination in those who received antenatal care (82.8%) was higher than in those who did not (76.4%), but it was not statistically significant. The frequency of vaccination was found to be higher in those with planned pregnancies (79.7%) than those without (63.2%), but it was not statistically significant (p>0.05). The frequency of vaccination was found to be higher in those with high school education and above (80.4%) than in those with primary education and below (75.3%), but it was not statistically significant (p>0.05). It was found that 99.6% of the mothers had protective level antibodies and 100% of the cord samples had protective level antibodies. There was a very strong positive correlation between cord antibody level and maternal antibody level (r=0.761, p<0.001). The maternal and cord antibody levels demonstrated a negative correlation with the age of the pregnant women (r = -0.217, p < 0.001 and r = -0.137, p = 0.026, respectively). As the number of pregnancies increased, maternal and cord anti-tetanus IgG levels decreased (r=-0.220; p<0.001; r=-0.198; p<0.001, respectively). Antibody levels in the maternal and cord blood of those who had received the vaccine during the current pregnancy were significantly higher than those who had not received the vaccine (p<0.001). The median antibody level in pregnant women with a gestational age of less than 32 weeks (5.550) was found to be higher than those with a gestational age of more than 37 weeks (5.082) and between 33-37 weeks (4.969), although this difference was not statistically significant. The rate of placental transmission against tetanus was found to be negatively correlated with maternal antibody level, but not with cord antibody level (r = -0.471; p < 0.001; r = 0.103; p = 0.095, respectively). Conclusion: The results of our study indicate that tetanus vaccination during pregnancy has a positive effect on raising tetanus antibody levels. Therefore, it is of great importance to vaccinate pregnant women in every pregnancy in order to achieve ideal pregnancy outcomes and to continue the elimination of neonatal tetanus. Efforts should be made to inform pregnant women comprehensively about the vaccine, to increase their awareness about the vaccine and to make access to health services more accessible.
Açıklama
Anahtar Kelimeler
Antitetanos Antikoru, Gebe, Neonatal Tetanos, Tetanos Aşısı, Umblikal Kord, Anti-Tetanus Antibody, Pregnancy, Neonatal Tetanus, Tetanus Vaccine, Umbilical Cord
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çavdar, K. (2024). Gebelerde ve umblikal kordda tetanos antitoksin seroprevalansının ve ilişkili faktörlerin değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
