Clostridium Tetani and Tetanus

Tetanus is acquired through exposure to the environmental spore-forming Gram-positive bacillus Clostridium tetani, which may infect human wounds and cause disease by production of an exotoxin (tetanospasmin). There is no human-to-human transmission. The disease occurs worldwide and it is sporadic in high-income countries with universal access to well-accepted immunization programs. It is more common in agricultural regions and in low-income countries where contact with animal excreta is more likely and immunization programs are inadequate. Neonatal tetanus (NNT) following unclean deliveries and poor postnatal hygiene is still responsible for the majority of tetanus cases and deaths; the majority of NNT occurs in poor Asian and African countries, whereas in high-income countries the disease is extremely rare. Three forms of clinical disease can be distinguished: the most common form is generalized tetanus, whereas local tetanus and cephalic tetanus are rare. Neonatal tetanus (NNT) is a form of generalized tetanus in newborns. The case fatality rate of tetanus is high, 3%–95% depending on age, immune- and immunization-status, form of disease, and availability of proper medical care. The efficacy of tetanus toxoid vaccines was never formally studied, but cases in adequately vaccinated subjects are extremely rare and impact data (e.g. for NNT) convincingly show high vaccine effectiveness. WHO estimates that in 2018, 25,000 newborns died from NNT, an 88% reduction from the situation in 2000.

A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome

Background Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. Materials and methods This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. Results During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant’s place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. Conclusion This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.

Impact of childhood and maternal vaccination against diphtheria, tetanus, and pertussis in Colombia

Background: In Latin America, there are few studies of the impact of vaccination against diphtheria, tetanus, and pertussis. We estimate the impact of infant and maternal vaccination on the incidence of these diseases in Colombia.Design and methods: an interrupted time series study analyzing the incidence before and after of vaccination with DwPT (1975-2018) and with Tdap in pregnant women (2008-2018). A segmented regression model with negative binomial distribution estimated the change in level and trend of the predicted incidence ratio after vaccination in relation to the incidence if vaccination had not been started (IRR), using a Prais Winsten regression.Results: The pertussis IRR decreased immediately after the start of childhood vaccination (0.91, p=0.51), but this was only significant (1.01, p<0.001) along with the trend per year, after the start of maternal vaccination (0.98, p<0.001). In the absence of vaccination, the incidence would not have been reduced. Neonatal tetanus had the highest rate of change with significant reduction -1.69 - CI 95%: -2.91, -0.48). The trend after vaccination was the highest with an annual reduction of 19% (0.81, p=0.001). The change in incidence of diphtheria was significant, although slow (-0.02 - CI 95%: -0.04, -0.004). The sustained effect in the post-vaccination period was smaller (0.95, p=0.79).Conclusions: Childhood and maternal vaccination markedly reduced the incidence of pertussis and neonatal tetanus. It is necessary to maintain optimal vaccination coverage and surveillance, within an integrated elimination plan, which prevents the resurgence of these diseases.

Factors Associated With Protection of Last Live Birth Against Neonatal Tetanus Among Mother Age 15-49 in Ethiopia: A Multilevel Analysis Using EDHS 2016

Background: Neonatal tetanus is still the major public health problem in about 25 countries, mainly in Africa. Ethiopia has the highest neonatal tetanus mortality and morbidity rates in the world due to low TT immunization coverage coupled with the high amount of deliveries taking place at home. In Ethiopia, only 49% of the pregnant mothers received TT2+ in 2016. Objective: The objective of this study is to identify individual and community level factors associated with protections of last live birth against neonatal tetanus among mothers 15-49 years age in Ethiopia, evidence from Ethiopia Demographic and Health Survey 2016. Methods: The data for this study was obtained from Ethiopia Demographic and Health Survey of 2016. Population based cross-sectional study was conducted. The data were analyzed using Stata version 14. Variables that were significant in the bivariate multilevel logistic regression analysis were entered to the final model. Variables with p-value of less than 0.05 in the final model were considered as statistically significant. Interclass correlation coefficient and proportional change in variance were used to quantify the magnitude of the general contextual effect. Receiver operating characteristics curve was used to assess general accuracy of the model. Relative goodness-of-fit test was conducted using akaike’s information criterion.Results: This study depicted that, a total of 7193 women nested in 643 clusters were included in the analysis. The odds of protection of last live birth against neonatal tetanus were 1.27 and 1.53 times higher in mothers with poorer and richer respectively than mothers with poorest wealth index. Mothers who had antenatal care visit one and above had 12.3 times higher odds of protections of neonatal tetanus than those who had no antenatal care visits. The other significantly associated factors were place of delivery, region and community media exposure.Conclusion and recommendation: It can be concluded from the current study that protection of last live birth against neonatal tetanus is affected both by the individual and community level factors. Therefore, efforts to increase protection of last live birth against neonatal tetanus need to target both at individual and community level factors.

Umbilical cord and umbilical care

In most human societies, ritualized and firm rules evolved for cutting the navel-string and handling the umbilical stump. These customs were not always beneficial, and contributed to umbilical infection, neonatal tetanus, and navel hernia. After prematurity, neonatal tetanus was the most frequent cause of death in poor countries up to the 19th century. It was caused by poor cord hygiene and by the age-old habit of severing the navel-string with biological products instead of man-made tools, which included palm leaves, blades of grass, mussel shells, crusts of bread, and other devices likely to be contaminated with tetanus spores. The navel-stump was covered with zinc powder, starch, oak-gall powder, grease, musk, clarified butter, and many other substances believed to protect the baby from evil, but actually creating anaerobic conditions in the umbilical wound. Care of the cord was associated with deep-rooted rituals and customs, and dangerous techniques persisted on islands well into modern times.

Study of Tetanus in the Infectious Diseases Hospital, Dhaka, Bangladesh

Background: Tetanus is a vaccine preventable serious disease that can affect people of all age group with a high mortality. Although tetanus incidence is significantly reduced due to nationwide vaccination coverage, it is not uncommon in our country. Aims & Objectives: To determine of the socio-demographic profile, nature of injury, incubation period and outcome of the tetanus patients who were admitted in the Infectious Diseases Hospital, Dhaka during the study period. Materials and Methods: This cross sectional observational study was done in the Infectious diseases hospital, Dhaka during the period of February 2017 to January 2018. The data, were collected, compiled and analyzed. Results: Out of 149 patients, neonates were 13(8.7%) in number. Most of the cases were in middle aged group. Malefemale ratio about 4.5:1. Majority of the patients (134, 89.9%) had no history of immunization but one patient was immunized within five years. Mean incubation period tetanus was 8.45 days with ±5.56 SD. Death occurs in 41(27.5%) patients and all of them had no history of immunization. Death rate of patients having early incubation period was significantly higher (p=0.003). Death rate in neonatal tetanus (53.84%) also significantly higher than that of non-neonatal tetanus (25%) (p= 0.026). Conclusion: Tetanus is not uncommon in Bangladesh, especially in neonates and adult male and mortality rate is high. Short incubation period predicts were outcome. J Bangladesh Coll Phys Surg 2021; 39(3): 160-166