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Introduction: Tetanus infection associated with men who had male circumcision has been reported in East Africa, suggesting a need for tetanus toxoid-containing vaccines (TTCV). Objective: To determine the prevalence of tetanus toxoid antibodies following vaccination among men seeking circumcision. Methods: We enrolled 620 consenting men who completed a questionnaire and received TTCV at enrollment (day 0) prior to circumcision on day 28. Blood samples were obtained at day 0 from all enrollees and on days 14, 28 and 42 from a random sample of 237 participants. Tetanus toxoid (TT) IgG antibody levels were assayed using EUROIMMUN. Analyses included prevalence of TT antibodies at enrollment and used a mixed effects model to determine the immunological response. Results: Mean age was 21.4 years, 65.2% had knowledge of tetanus, 56.6% knew how tetanus was contracted, 22.8% reported ever receipt of TTCV, and 16.8% had current/recently healed wounds. Insufficient tetanus immunity was 57.1% at enrollment, 7.2% at day 14, 3.8% at day 28, and 0% at day 42. Antibody concentration was 0.44IU/ml (CI 0.35–0.53) on day 0, 3.86IU/ml (CI 3.60–4.11) on day 14, 4.05IU/ml (CI 3.81–4.29) on day 28, and 4.48IU/ml (CI 4.28–4.68) on day 42. TT antibodies increased by 0.24IU/ml (CI 0.23, 0.26) between days 0 and 14 and by 0.023IU/ml (CI 0.015, 0.031) between days 14 and 42 days. Immunological response was poorer in HIV-infected clients and men aged 35+ years. Conclusion: Insufficient immunity was common prior to TTCV, and a protective immunological response was achieved by day 14. Circumcision may safely be provided 14 days after vaccination in HIV-uninfected men aged less than 35 years. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality due to tetanus persists in Uganda despite the mandatory vaccination of pregnant mothers. Maternal antibodies wane within a year. Uganda's maternal vaccination guidelines do not specify the timing or frequency of tetanus shots, contributing to suboptimal transfer of tetanus antibodies to neonates. We aimed to determine the prevalence and factors associated with protective tetanus antibodies among newborns at Kawempe National Referral Hospital., Methods: We conducted a cross-sectional study among 293 mother-newborn pairs. At delivery, neonatal cord and maternal venous blood were collected and titred for antitetanus antibodies using a quantitative ELISA kit. The primary outcome of the study was the proportion of newborn babies with tetanus antibodies ≥0.1 IU/mL. Associated factors were determined using generalised linear models for the Poisson family with a log link and robust variance estimation., Results: A total of 258/293 (88.1%) newborns had protective antibody titres. Factors associated with adequate protective antibodies in the newborn included: high (≥0.1 IU/mL) maternal antibody titres, first antenatal visit ≥12 weeks of gestation and receiving a tetanus toxoid (TT) shot ≥28 weeks of gestation. However, number of doses received before current pregnancy was not associated with adequate protective antibody titres., Conclusion: There is a high prevalence of adequate protective levels of antibodies among TT-vaccinated mothers. Maternal titres and a third trimester TT dose correlate with adequate levels of protective anti-TT antibodies among newborns. A third trimester TT dose is recommended., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)