TETANUS

Tetanus is a bacterial disease caused by the action of a potent neurotoxin produced during the growth of the bacteria in dead tissues e.g. in dirty wounds or in the umbilicus following non sterile delivery. Tetanus is acquired through exposure to the spores of the bacteria clostridium tetani which are universally present in the soil.

People of all ages can get tetanus. But the disease is particularly common and serious in newborn babies. This is called neonatal tetanus. Most infants who get the disease die. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures. World Health Organization estimates that neonatal tetanus killed about 200,000 babies.

HOW TETANUS SPREAD

Tetanus is not transmitted from person to person. A person usually becomes infected with tetanus when dirt enters a wound or cut. Tetanus germs are likely to grow in deep punctured wounds caused by dirty nails, knives, tools, wood splinters, and animal bites. Women face an additional risk of infection if a contaminated tool is used during childbirth or during an abortion.

A newborn baby may become infected if the knife, razor or other instruments used to cut its umbilical cord is dirty, if dirty material is used to dress the cord, or if the hands of the person delivering the baby are not clean.

Infants and children may also contract tetanus when dirty instruments are used for circumcision, scarification, and skin piercing, and when dirty charcoal or other unclean substances are rubbed into a wound.

SIGN AND SYMPTOMS

The time between getting the infection and showing symptoms is usually between three and 10 days. But it may be as long as three weeks, the shorter the incubation period, the higher the risks of death.

In children and adults muscular stiffness in the jaw (called lock Jaw) is a common first sign of tetanus. This symptom is followed by stiffness in the neck, difficulty swallowing, and stiffness in the stomach muscles, muscles spasms, sweating, and fever. Newborn babies with tetanus are normal at birth, but stop sucking between three and 28 days after birth. They stop feeding and their bodies become stiff while severe muscles contractions and spasms occur. Death follows in most cases.

COMPLICATION OF TETANUS

Fractures of the spine or other bones may occur as a result of muscle spasms and convulsions. Abnormal heartbeats and coma can occur, as can also develop pneumonia and other infections. Death is particularly likely in the very young and in old people.

TREATMENT OF TETANUS

Tetanus at any age is a medical emergency best managed in a referral hospital.

PREVENTION OF TETANUS

Immunizing infants and children with DPT and adults with TT prevent tetanus. More recently, some countries have been using a combination of vaccines that includes vaccine for diphtheria, tetanus, Pertussis, hepatitis B (hepB), and sometimes Haemophilis influenza type b (Hib).

Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoids, either during pregnancy or outside of pregnancy. This protects the mother and enables tetanus antibodies to be transferred to her baby.

Clean practices are especially important when a mother is delivering a child, even if she has been immunized. People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.

GLOBAL ACCELERATED DISEASE CONTROL ISSUES

WHO, UNICEF and UNFPA agreed to set the year 2005 as the target date for worldwide elimination of neonatal tetanus. This implies the reduction of neonatal tetanus incidence to below one case per 1000 live birth per year in every district. This goal was reaffirmed by the United Nation General Assembly Special Session (UNGASS) in 2002. Because tetanus survives in the environment, eradication of the disease is not feasible and high levels of immunization have to continue even after the goal has been achieved.

To achieve the elimination goal, countries implements series of strategies:

* Improve the percentage of pregnant women immunized with vaccines containing tetanus toxoids.

* Administer vaccines containing tetanus toxoids to all women of child bearing age in high risk areas. This is usually implemented through a three round campaign approach.

* Promote clean delivery and child care practices.

* Improve surveillance and reporting of neonatal tetanus cases.