General Health

Tetanus: Transmission, diagnosis and treatment

Overview

Tetanus is an infection caused by a bacterium called Clostridium tetani. It is found everywhere in nature, including dust, soil, and fertilizer. It is also called ‘Pile Fever’ because it often causes severe contractions in the neck and jaw muscles and the person cannot open his/her mouth.

Transmission

Tetanus is different from other vaccine-preventable diseases because it cannot be spread from person to person. Clostridium tetani is a bacterium that can survive for years in an oxygen-free environment, especially in moist and warm soils, dust, and fertilizers, and can also survive in the digestive systems of humans and animals.

It is transmitted to humans through cuts made by contaminated objects (such as fingernails, needles, nails) or wounds contaminated with dust, soil, feces, or saliva, dead tissues from burns and accidents, and the umbilical cord in newborns.

According to a 2002 report by the World Health Organization, there are 213,000 deaths worldwide each year due to tetanus. Most of the cases are reported to be women who do not give birth hygienically. This condition, called Maternal Neonatal Tetanus, occurs when women who are not immunized against tetanus are infected during childbirth.

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Symptoms and Signs

After the tetanus germs enter the body, the toxins they produce cause symptoms. The incubation period is usually 3-21 days (average 10 days). Depending on the type of wound, this can vary from 1 day to several months. Generally, a short incubation period is seen in highly contaminated wounds and is a sign of a more serious disease with a poor prognosis. The most common first symptom is a spasm (contraction) of the jaw muscles. Other symptoms include headache, sudden and involuntary muscle contractions (most commonly in the stomach), painful muscle stiffness throughout the body, swallowing problems, seizures, fever and sweating, high blood pressure, and rapid heartbeat.

Complications that can develop due to tetanus are as follows: Uncontrolled and involuntary spasm of the vocal cords (vocal cords), bone fractures, nosocomial infections, pulmonary embolism, aspiration pneumonia due to foreign materials in the respiratory tract, respiratory distress that may result in death (10-20% of cases die). In non-hospitalized cases, mortality is 100%.

Diagnosis and Treatment

Doctors diagnose the patient based on examination and certain signs and symptoms. There are no laboratory tests to confirm tetanus. Tetanus is a disease that requires urgent medical attention as soon as it is diagnosed. The patient is immediately hospitalized and human tetanus immunoglobulin or horse-derived antitoxin is started immediately. Tetanus vaccination is given. Treatment is continued with drugs to control convulsions, aggressive wound care, and antibiotics. If respiratory distress develops, the patient should be supported with a respirator. The individual who has had the disease is not immune. The only way of immunization is vaccination.

Prevention

There is a very effective vaccine against tetanus that has been used safely for many years. The most effective way to protect against tetanus is to be fully vaccinated.

Tetanus vaccine is administered as a quintuple mixed vaccine (DaBT-IPA-Hib) at 2,4,6 months and 18 months.

Our calendar includes a booster dose of quadrivalent mixed vaccine (DaBT-IPA) at 48 months (starting with those born on July 1, 2016). For children born before July 1, 2016, and who have not yet started primary education, the DaBT-IPA booster dose will be administered as school vaccinations in the 2020-2021, 2021-2022, and 2022-2023 academic years.

At the age of 13 (156th month), a separate booster dose of the adult diphtheria-tetanus (Td) vaccine continues to be administered.

Tetanus vaccination in adults with unknown previous vaccination status is Td (adult diphtheria-tetanus) vaccine. The primary administration scheme is three doses; there should be at least four weeks between the first and second dose and at least 6 months between the second and third dose. It is continued every 10 years with reminder doses.

Every woman of childbearing age should be immunized against tetanus. Pregnant women who have never been vaccinated should receive at least two doses of the Td vaccine. The second dose should be completed at least two weeks before delivery. If not enough time has elapsed, it should be taken into account that the pregnant woman who has received a single dose of Td and her baby are at risk for tetanus. It is even more important to ensure clean delivery conditions and proper care of the baby’s umbilicus.

In addition, in case of injuries, tetanus vaccine and/or tetanus anti-toxin/tetanus immunoglobulin are administered by the physician according to the severity of the injury by evaluating the previous tetanus vaccination records of the person.

References

1.https://www.cdc.gov/tetanus/index.html#:~:text=Tetanus%20is%20an%20infection%20caused,open%20the%20mouth%20or%20swallow.

  1. https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625

  2. https://www.medicalnewstoday.com/articles/163063#treatment

 

Author

 Yash Batra

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