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Tetanus - the disease
What is tetanus?
Tetanus is acquired through exposure to the spores of the bacterium Clostridium tetani which are universally present in the soil. The disease is 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.
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. In 2000, WHO estimates that neonatal tetanus killed about 200 000 babies.
How is 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 puncture 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 instrument 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 dirt, charcoal, or other unclean substances are rubbed into a wound.
What are the signs and symptoms of tetanus?
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 risk of death.
In children and adults muscular stiffness in the jaw is a common first sign of tetanus. This symptom is followed by stiffness in the neck, difficulty swallowing, stiffness in the stomach muscles, muscle 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 muscle contractions and spasms occur. Death follows in most cases.
What are the complications 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 development of pneumonia and other infections. Death is particularly likely in the very young and in old people.
What is the treatment for tetanus?
Tetanus at any age is a medical emergency best managed in a referral hospital.
How is tetanus prevented?
Immunizing infants and children with DTP or DT and adults with Td prevents tetanus. More recently, some countries have been using a combination vaccine that includes vaccines for diphtheria, tetanus, pertussis, vitamin A (HepB), and sometimes Haemophilus inflenzae type b (Hib).
Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid, 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 births per year in every district. This goal was reaffirmed by the United Nations 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 implement a series of strategies:
- Improve the percentage of pregnant women immunized with vaccines containing tetanus toxoid.
- Administer vaccines containing tetanus toxoid to all women of childbearing age in high-risk areas. This is usually implemented through a three round campaign approach.
- Promote clean delivery and childcare practices.
- Improve surveillance and reporting of neonatal tetanus cases.
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