Neonatal tetanus is a major cause of infant mortality in India. Many mothers also die after child birth because of tetanus caused by unsafe delivery practices. These deaths may be due to improper and unhygienic cutting of umbilical cord after birth with dirty and rusted blades. Sometimes unhygienic dressings used may also cause tetanus.
Neonatal tetanus can be prevented by giving every pregnant woman two doses of tetanus toxoid and maintaining sterile conditions during child birth.
Tetanus is caused by the exotoxin produced by Clostridium tetani. It is a gram positive spore bearing bacteria which is present in the faeces of man and animal. The spores germinate under anaerobic conditions and produce a powerful exotoxin.
Mode of Spread:
It is always through injury and abrasion from where the contaminated matters with tetanus spores enter into the body.
The road side injuries and injuries caused by iron articles are the major causes of tetanus. The other causes of tetanus include pin prick, abrasion, wound, burns, human bite, animal bite, and stings, use of unsterile injectable needles and syringes as well as surgical instruments. Tetanus may also be caused when spores are introduced through surgical catgut, dressings and various powders such as talcum and sulphonamides etc.
Incubation period varies from 3 to 21 days.
Signs and Symptoms:
The first symptoms of tetanus usually appear from 3 days to 3 weeks, after the micro-organisms enter the body through the wound. The first indications of the trouble are irritability, restlessness, headache, and fever. Gradually the neck becomes stiff and there is difficulty in chewing and swallowing. Subsequently spasms of muscles of the jaw and face take place and thus ‘Lock jaw’ occurs.
The temperature may raise even up to 105°F. There is severe pain and a large number of patients die after a few days. Mortality rate tends to be high varying from 40 to 80 percent.
Prevention and Control:
(i) Tetanus can be prevented by giving active immunisation with tetanus toxoid. It is the most effective, safest and practical method of tetanus prevention. (ii) Infants and children are best immunised by giving DPT i.e. diphtheria, pertusis and tetanus triple vaccine. Every child should be vaccinated with DPT vaccine.
Three doses of 0.5 ml at one month interval are given followed by another dose after a year or so. Thereafter booster doses of 5-10 years intervals are given to maintain immunity. (iii) Pregnant women should be given tetanus toxoid doses as a routine to prevent neonatal tetanus.
(iv) Complete sterility precautions should be taken during child birth. (v) All wounds should be thoroughly cleaned and long acting penicillin (benzyl penicillin) should be administered. It strongly inhibits the growth of Clostridium tetani and “stops further production of toxin. (vi) The patient should be given muscle relaxants and sedatives. He should be kept in a dark and calm room free from noise. (vii) The patient with a wound should be immediately given an injection of ATS or human tetanus immunoglobulin.
This is the best prophylactic measure against tetanus and provides passive immunity to the patient. ATS has certain disadvantages that it is rapidly excreted from the body and causes sensitivity reactions in certain persons therefore the use of ATS is discontinued in many countries and in its place human tetanus immunoglobulin is used.