Tetanus Awareness:Tetanus Awareness:

Dr. Tridib Ghose

Bangladesh

July 2009

Issues to be discussed:Issues to be discussed: What is Tetanus?What is Tetanus?

What Causes it?What Causes it?

Where is it found?Where is it found?

What are the health effects?What are the health effects?

Prevention and MedicinesPrevention and Medicines

What should you do?What should you do?

What is Tetanus?What is Tetanus?

An infectious, often fatal disease caused by a specific bacterium An infectious, often fatal disease caused by a specific bacterium that enters the body through wounds and characterized by that enters the body through wounds and characterized by respiratory paralysis and tonic spasms and rigidity of the respiratory paralysis and tonic spasms and rigidity of the

voluntary muscles, esp. those of the neck and lower jaw.voluntary muscles, esp. those of the neck and lower jaw.

The spore forming bacterium called Clostridium enters the body.The spore forming bacterium called Clostridium enters the body.

It can be prevented by immunization with tetanus toxoid. It can be prevented by immunization with tetanus toxoid.

Characterized by generalized rigidity and convulsive spasms of Characterized by generalized rigidity and convulsive spasms of skeletal muscles. The muscle stiffness usually involves the jaw skeletal muscles. The muscle stiffness usually involves the jaw (lockjaw) and neck and then becomes generalized.(lockjaw) and neck and then becomes generalized.

Worldwide:Worldwide:

Tetanus Remains a major public health problem in the developing world and is still encountered in the developed world.

Each year 800,000 to 1 million people die due to tetanus.

80% of these deaths occur in Africa and South East Asia and it remains endemic in 90 countries Worldwide.

Statistics:Statistics: It is the disease of active age (5-40 years), New born It is the disease of active age (5-40 years), New born

baby and female during delivery or abortion.baby and female during delivery or abortion.

Higher incidence in males than females.Higher incidence in males than females.

Agricultural workers are at higher risk.Agricultural workers are at higher risk.

Incidence of tetanus is much lower in city than in rural Incidence of tetanus is much lower in city than in rural areas.areas.

Environmental and social factors - Unhygienic Environmental and social factors - Unhygienic customs and habits, Unhygienic delivery practices.customs and habits, Unhygienic delivery practices.

The Tetanus Bacteria:The Tetanus Bacteria:

Tetanus occurs worldwide but is Tetanus occurs worldwide but is most frequently encountered in most frequently encountered in densely populated regions in hot, densely populated regions in hot, damp climates with soil rich in damp climates with soil rich in organic matter.organic matter.

Organisms are found primarily in Organisms are found primarily in the soil and intestinal tracts of the soil and intestinal tracts of animals and humans.animals and humans.

Tetanus Bacteria Spores:Tetanus Bacteria Spores:

Injury Types allowing Injury Types allowing Infections:Infections:

acute injury such as -puncture wounds, lacerations, abrasions and animal bites

Stepping on a nail accounted for 39% of the puncture wounds (US study).

Injury Types allowing Injury Types allowing Infections…Infections…

Burn victims, patients receiving intramuscular Burn victims, patients receiving intramuscular injections, and with frostbite, dental infections, injections, and with frostbite, dental infections, penetrating eye injuries, and umbilical stump penetrating eye injuries, and umbilical stump infections. infections.

Tetanus has been reported after tooth Tetanus has been reported after tooth extractions, root canal therapy, and intraoral soft extractions, root canal therapy, and intraoral soft tissue traumatissue trauma

Once in the body…Once in the body…

Under anaerobic conditions, the spores geminate Under anaerobic conditions, the spores geminate

and produce toxins. and produce toxins.

The toxins are distributed via the lymphatic and The toxins are distributed via the lymphatic and

vascular circulations and then enters the nervous vascular circulations and then enters the nervous

system.system.

Toxin binds in central nervous system.Toxin binds in central nervous system.

Interferes with neurotransmitter release to block Interferes with neurotransmitter release to block

inhibitor impulsesinhibitor impulses

Leads to unopposed muscle contraction and Leads to unopposed muscle contraction and

spasm.spasm.

What Are the Symptoms?What Are the Symptoms?

You should suspect tetanus if a cut or wound is You should suspect tetanus if a cut or wound is followed by followed by

one or more of these symptoms:one or more of these symptoms:

Stiffness of the neck, jaw, and other muscles, often Stiffness of the neck, jaw, and other muscles, often

accompanied by a grotesque, grinning expression. accompanied by a grotesque, grinning expression.

Irritability. Irritability.

Uncontrollable spasms of the jaw and neck muscles. Uncontrollable spasms of the jaw and neck muscles.

Painful, involuntary contraction of other muscles. Painful, involuntary contraction of other muscles.

In some cases, symptoms will develop in the absence of any cut In some cases, symptoms will develop in the absence of any cut

or wound that you can recall. or wound that you can recall.

In addition, you may notice restlessness, lack of appetite, and In addition, you may notice restlessness, lack of appetite, and

drooling. drooling.

Muscle Spasm:Muscle Spasm:

Neonatal Tetanus:Neonatal Tetanus:

People of all ages can get tetanus but it is People of all ages can get tetanus but it is particularly common and serious in particularly common and serious in newborn babies. This is called neonatal newborn babies. This is called neonatal tetanus. tetanus.

Most infants who get the disease die. It is Most infants who get the disease die. It is particularly common in rural areas where particularly common in rural areas where most deliveries are at home without most deliveries are at home without adequate sterile procedures.adequate sterile procedures.

Common in newborn infant born without Common in newborn infant born without passive immunity.passive immunity.

Unvaccinated mothers, home delivery, and Unvaccinated mothers, home delivery, and unhygienic cutting of the umbilical cord.unhygienic cutting of the umbilical cord.

History of neonatal tetanus in a previous History of neonatal tetanus in a previous child is a risk factor for subsequent child is a risk factor for subsequent neonatal tetanus.neonatal tetanus.

Estimated more than 257,000 deaths Estimated more than 257,000 deaths worldwide in 2000-2003*worldwide in 2000-2003*

6,653 reported cases in 20086,653 reported cases in 2008

Neonatal Tetanus:Neonatal Tetanus:

Mode of Transmission: Mode of Transmission: Through a punctured wound contaminated with soil, street dust or Through a punctured wound contaminated with soil, street dust or

animal or human feces, through lacerations, burns or even unnoticed animal or human feces, through lacerations, burns or even unnoticed wounds wounds

It can also follow after surgical operations including circumcision

Incubation period: 3-21 days (average 10 days)

Control and Prevention: Prenatal check-up Vaccination with tetanus toxoid (TT) Training of birth attendants on safe delivery and proper cord dressing.

How Do I Know If I Have Tetanus?How Do I Know If I Have Tetanus?

Some affected people may experience only pain and tingling at the wound site and some spasms in nearby muscles,

most people suffer stiff jaw and neck muscles, irritability and difficulty swallowing.

It is seldom possible to find either the bacterium or the toxin in a suspected tetanus patient,

so diagnosis can be made only on the basis of clinical observations combined with the absence of a history of tetanus immunization.

Medical Test:Medical Test:

A simple test involves touching the oropharynx with A simple test involves touching the oropharynx with a spatula or tongue blade. a spatula or tongue blade.

Usually, this test causes a gag reflex with the Usually, this test causes a gag reflex with the patient, and the patient tries to expel the spatula. patient, and the patient tries to expel the spatula.

((This means they have tested negativeThis means they have tested negative) )

In tetanus, patients develop a reflex spasm of the In tetanus, patients develop a reflex spasm of the masseters and bite the spatula. masseters and bite the spatula.

((a positive testa positive test).).

Your outlook following Infection:Your outlook following Infection:

In general, In general, If muscle spasms develop early, chances of recovery are poor.

Patients usually survive tetanus and return to their pre-Patients usually survive tetanus and return to their pre-disease state of health.disease state of health.

Recovery is slow and usually occurs over 2-4 months.Recovery is slow and usually occurs over 2-4 months.

Clinical tetanus does not produce a state of immunityClinical tetanus does not produce a state of immunity; ; therefore, patients who survive the disease require active therefore, patients who survive the disease require active immunization with tetanus toxoid to prevent a recurrence.immunization with tetanus toxoid to prevent a recurrence.

What Are the Treatments?What Are the Treatments?

Proactive:Proactive: Tetanus immune globulins (Hyper-Tet) -- Used to induce active Tetanus immune globulins (Hyper-Tet) -- Used to induce active

immunity against tetanus in suspected patients.immunity against tetanus in suspected patients.

Reactive:Reactive:If tetanus does develop, seek hospital treatment immediately. If tetanus does develop, seek hospital treatment immediately.

This includes – This includes – wound care, wound care, a course of antibiotics and a course of antibiotics and an injection of tetanus antitoxin.an injection of tetanus antitoxin.

You may receive medications such as – You may receive medications such as – chlorpromazine or diazepam to control muscle spasms, or chlorpromazine or diazepam to control muscle spasms, or a short-acting barbiturate for sedation. a short-acting barbiturate for sedation.

You may require the aid of an artificial respirator or other life-You may require the aid of an artificial respirator or other life-

support measures during the several weeks needed for the support measures during the several weeks needed for the disease disease

to run its course.to run its course.

Remember….Remember…. See the doctor for ImmunizationSee the doctor for Immunization

If you cut or injure yourself (puncture wounds If you cut or injure yourself (puncture wounds lacerations, abrasions and animal bites) see the doctor.lacerations, abrasions and animal bites) see the doctor.