By Adaobi Rhema Oguejiofor
Isn’t it dreadful how a simple cut or bruise from a nail can result in a grave disease that can lead to untimely death? Tetanus, a life-threatening bacterial disease, remains a significant public health concern, especially in low-income countries where immunisation rates are low and unclean birth practices persist.
According to the World Health Organization (WHO), the disease continues to pose a serious threat in many parts of the world, leading to preventable deaths. In 2018, WHO records estimated that about 25,000 newborns died from neonatal tetanus, a 97 per cent reduction from what was obtainable in 1988 when an estimated 787,000 newborn babies died of tetanus within their first month of birth. This death toll reduction was largely due to scaled-up immunisation with Tetanus-Toxoid-Containing Vaccines (TTCV).
Tetanus, also referred to as lockjaw, is an uncommon but deadly infection caused by a bacterium called Clostridium tetani (C. tetani), which is found in the environment. It is acquired through the infection of a cut or wound with the spores of the bacterium found everywhere in the environment, particularly in soil, ash, intestinal tracts/faeces of animals and humans, and on the surfaces of skin and rusty tools like nails, needles, barbed wire, etc.
The disease usually occurs more often in warmer climates or during the warmer months. Consequently, these spores can survive for years as they are very resistant to heat and most antiseptics. It can lead to death by suffocation.
Although the disease cannot be transmitted from person to person, victims will require immediate medical attention once infected. People who recover from tetanus do not have natural immunity and can be infected again. Anyone can get tetanus, but the disease is particularly common and serious in newborn babies and pregnant women who have not been sufficiently immunised with TTCV. It could occur during pregnancy or after pregnancy. Tetanus during pregnancy or within 6 weeks of the end of pregnancy is called maternal tetanus, and tetanus within the first 28 days of life is called neonatal tetanus.
Symptoms
The incubation period of tetanus ranges between 3 and 21 days after infection. Most cases occur within 14 days.
The symptoms can include:
– Jaw cramping or the inability to open the mouth.
– Muscle spasms often in the back, abdomen and extremities.
– Sudden painful muscle spasms often triggered by sudden noises.
– Trouble swallowing.
– Seizures.
– Headache
– Fever and sweating
– Changes in blood pressure or fast heart rate.
For neonatal tetanus, symptoms include muscle spasms, which are often preceded by the newborn’s inability to suck or breastfeed, and excessive crying.
Tetanus is diagnosed based on clinical features and does not require laboratory confirmation.
Treatment
Treatment of the disease depends on the symptoms, age, and general health of the patient. It also depends on how severe the condition is. The disease requires:
– Care in the hospital
– Immediate treatment with medicine called human tetanus immune globulin (TIG)
– Aggressive wound care
– Drugs to control muscle spasms
– Antibiotics
– Tetanus vaccination
Prevention
Tetanus can be prevented through immunisation with tetanus-toxoid-containing vaccines (TTCV), which are included in routine immunisation programmes globally and administered during antenatal care contacts.
WHO recommended that an individual receive 6 doses (3 primary doses plus 3 booster doses) of TTCV. The 3-dose primary series is recommended to begin as early as 6 weeks of age, with subsequent doses given with a minimum interval of 4 weeks between doses.
The 3 booster doses are to be administered preferably during the second year of life (12–23 months), at 4–7 years of age, and 9–15 years of age. Ideally, there should be at least 4 years between booster doses.
There are many kinds of vaccines used to protect against tetanus, all of which are combined with vaccines for other diseases like diphtheria and tetanus (DT) vaccines
Diphtheria, tetanus, and pertussis (whooping cough) (DTaP) vaccines, tetanus and diphtheria (Td) vaccines, tetanus, diphtheria, and pertussis (Tdap) vaccines.
Neonatal tetanus on the other hand can be prevented by immunizing women of reproductive age with TTCV, either during pregnancy or outside of pregnancy. Also, robust medical practices can also prevent tetanus disease including clean delivery and cord care during childbirth, and proper wound care for surgical and dental procedures.
Complications of Tetanus
The disease can have certain possible complications which can include:
– Breathing Problems:
Tetanus can result in life-threatening breathing problems ranging from tightening of the vocal cords to muscle rigidity in the neck and abdomen, especially during a generalised spasm.
– Blockage of a lung artery (pulmonary embolism):
With tetanus, the possibility of blood clots travelling from elsewhere in the body to block the main artery of the lung or one of its branches can occur.
– Pneumonia:
A lung infection caused by accidentally inhaling something into the lungs (aspiration pneumonia) may be a complication of generalised spasms.
– Broken bones:
Generalized spasms can also cause fractures of the spine or other bones.
– Death:
Tetanus can further result in death. This is often caused by a blocked airway during spasms or damage to the nerves that regulate breathing, heart rate or other organ functions.
Despite its deadly nature, tetanus is an entirely preventable disease. With proper vaccination, clean medical practices, and awareness, patients do not have to suffer or die from the infection. It is important to protect oneself and stay up to date with tetanus immunisation, seek immediate care for wounds, and encourage others to get immunisations.