ORIGINAL ARTICLE Tetanus and diphtheria immunity among term and preterm infant-mother pairs in Turkey, a country where maternal and neonatal tetanus have recently been eliminated Tugba Erener-Ercan & Mustafa Aslan & Mehmet Vural & Ethem Erginoz & Bekir Kocazeybek & Gokmen Ercan & Lale Wetherilt Turkgeldi & Yildiz Perk Received: 17 November 2013 /Revised: 6 August 2014 /Accepted: 12 August 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract The aim of our study was to investigate the anti- tetanus and anti-diphtheria antibody titres and the placental transfer of these antibodies in a group of vaccinated and unvaccinated mothers and their term or preterm offsprings. Anti-tetanus and anti-diphtheria toxoid IgG antibodies were measured quantitatively by ELISA in 91 infant-mother pairs. Protective concentrations of anti-tetanus and anti-diphtheria were found in 58.3 and 50 % of mothers in the unvaccinated group and 94.5 and 85.5 % of the mothers in the vaccinated group. Protective concentrations were found in 63.9 and 50 % of cord samples, respectively, in the unvaccinated group and in 96.4 and 85.5 % of cord samples, respectively, in the vaccinated group (p =0.0001). There were no differences in the maternal and cord geometric mean concentrations (GMCs) of anti-toxoid antibodies between those who received two doses or one dose of Td. The GMCs of maternal and cord anti-tetanus and anti-diphtheria were statistically similar be- tween preterm and term groups. Placental transfer ratios (TR) for anti-tetanus and anti-diphtheria were 175 and 150 %, respectively, in the preterm group and 213 and 178 %, respec- tively, in the term group. There was a strong correlation between maternal and cord anti-toxoid antibody levels. Maternal vaccination was the only predictor of having protec- tive concentrations of anti-toxoid antibodies in cord blood. Conclusions: Vaccinating pregnant women with at least one dose of Td would confer protection for both the term and preterm infant-mother pairs. Therefore, health personnel caring for preg- nant women have the responsibility to emphasize the importance of Td vaccination to avoid missed immunization opportunities. Keywords Tetanus . Diphtheria . Seroprotection . Maternal vaccination . Preterm . Term Abbreviations Anti-Ttx Anti-tetanus toxoid Anti-Dtx Anti-diphtheria toxoid GMC Geometric mean concentrations MNT Maternal and neonatal tetanus NT Neonatal tetanus TR Transfer ratios Introduction Tetanus remains the leading cause of maternal and neonatal morbidity and mortality in developing countries [ 21]. Maternal and neonatal tetanus (MNT) is of particular concern since neonatal tetanus (NT) contributes to 5–7 % of neonatal Communicated by David Nadal T. Erener-Ercan : M. Vural : Y. Perk Department of Neonatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey M. Aslan : B. Kocazeybek Department of Medical Microbiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey E. Erginoz Department of Public Health, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey G. Ercan Medical Faculty, Department of Pediatrics, Maltepe University, Istanbul, Turkey L. W. Turkgeldi Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey T. Erener-Ercan (*) Libadiye Cad. Göztepe Soyak Sitesi, Blok 37 No:688 Göztepe/ Üsküdar, Istanbul, Turkey e-mail: terenerercan@gmail.com Eur J Pediatr DOI 10.1007/s00431-014-2400-9