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Do Unsafe Tetanus Toxoid Injections Play a Significant Role in the Transmission of HIV/AIDS? Evidence From Seven African Countries

April 14, 2008

Sexual transmission is generally considered to be the main factor driving the HIV/AIDS epidemic in Africa. However, some recent studies have asserted that iatrogenic transmission should be considered as an important infection route. Specifically, receipt of tetanus toxoid injections during pregnancy has been reported to be associated with HIV infection in Kenya. In the current study, the researchers set out to "assess the robustness of this association among women in nationally representative HIV surveys in seven African countries."

Using individual-level data from women who gave birth in the preceding five years, the researchers analyzed the association between prophylactic tetanus toxoid injections during pregnancy and HIV infection. The data were taken from the nationally representative Demographic and Health Surveys, which included HIV testing in Burkina Faso 2003 (N=2,424), Cameroon 2004 (N=2,600), Ethiopia 2005 (N=2,886), Ghana 2003 (N=2,560), Kenya 2003 (N=1,617), Lesotho 2004 (N=1,278) and Senegal 2005 (N=2,126).

After the researchers adjusted odds ratios (OR) for five-year age groups and for ethnic, urban and regional indicators, the association between prophylactic tetanus toxoid injections during pregnancy and HIV infection was never statistically significant in any of the seven countries. An association was found in Cameroon between previous tetanus toxoid injection and HIV infection, but this became weaker after adjusting for urban location and ethnic group (OR 1.53, 95 percent CI, 0.91 to 2.57).

"Although the risk of HIV infection through unsafe injections and health care should not be ignored and should be reduced, it does not seem that there is, at present and in the seven countries studied, strong evidence supporting the claim that unsafe tetanus toxoid injections are a major factor driving the HIV epidemic," the authors concluded.

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Adapted from:
Sexually Transmitted Infection
4.08.2008; Vol. 84; No. 2: P. 122-125; D. de Walque

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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