Tetanus Awareness:

Dr. Tridib
Ghose
Bangladesh
 Issues to be discussed:
 What is Tetanus?

 What Causes it?

 Where is it found?

 What are the health effects?

 Prevention and Medicines

 What should you do?

 What is Tetanus?
 An infectious, often fatal disease caused by a specific bacterium that
enters the body through wounds and characterized by respiratory
paralysis and tonic spasms and rigidity of the voluntary muscles, esp.
those of the neck and lower jaw.

 The spore forming bacterium called Clostridium enters the body.

 It can be prevented by immunization with tetanus toxoid.

 Characterized by generalized rigidity and convulsive spasms of

skeletal muscles. The muscle stiffness usually involves the jaw
(lockjaw) and neck and then becomes generalized.
 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:
 It is the disease of active age (5-40 years), New born
baby and female during delivery or abortion.

 Higher incidence in males than females.

 Agricultural workers are at higher risk.

 Incidence of tetanus is much lower in city than in rural

areas.

 Environmental and social factors - Unhygienic

customs and habits, Unhygienic delivery practices.
 The Tetanus Bacteria:

 Tetanus occurs worldwide but is

most frequently encountered in
densely populated regions in hot,
damp climates with soil rich in
organic matter.

 Organisms are found primarily in

the soil and intestinal tracts of
animals and humans.
Tetanus Bacteria Spores:
 Injury Types allowing
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
Infections…

 Burn victims, patients receiving intramuscular

injections, and with frostbite, dental infections,
penetrating eye injuries, and umbilical stump
infections.

 Tetanus has been reported after tooth extractions,

root canal therapy, and intraoral soft tissue
trauma
 Once in the body…
 Under anaerobic conditions, the spores geminate
and produce toxins.
 The toxins are distributed via the lymphatic and
vascular circulations and then enters the nervous
system.
 Toxin binds in central nervous system.
 Interferes with neurotransmitter release to block
inhibitor impulses
 Leads to unopposed muscle contraction and
spasm.
 What Are the Symptoms?

You should suspect tetanus if a cut or wound is

followed by
one or more of these symptoms:

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

accompanied by a grotesque, grinning expression.
 Irritability.
 Uncontrollable spasms of the jaw and neck muscles.
 Painful, involuntary contraction of other muscles.
 In some cases, symptoms will develop in the absence of any cut
or wound that you can recall.
 In addition, you may notice restlessness, lack of appetite, and
drooling.
Muscle Spasm:
 Neonatal Tetanus:
 People of all ages can get tetanus but it is
particularly common and serious in
newborn babies. This is called neonatal
tetanus.

 Most infants who get the disease die. It is

particularly common in rural areas where
most deliveries are at home without
adequate sterile procedures.

 Common in newborn infant born without

passive immunity.

 Unvaccinated mothers, home delivery, and

unhygienic cutting of the umbilical cord.

 History of neonatal tetanus in a previous

child is a risk factor for subsequent
neonatal tetanus.

 Estimated more than 257,000 deaths

worldwide in 2000-2003*
 6,653 reported cases in 2008
 Neonatal Tetanus:
 Mode of Transmission:
 Through a punctured wound contaminated with soil, street dust or animal or human feces, through lacerations, burns or
even unnoticed 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?

 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:

 A simple test involves touching the oropharynx with

a spatula or tongue blade.
 Usually, this test causes a gag reflex with the
patient, and the patient tries to expel the spatula.
(This means they have tested negative)

 In tetanus, patients develop a reflex spasm of the

masseters and bite the spatula.
(a positive test).
 Your outlook following Infection:

 In general, If muscle spasms develop early, chances of

recovery are poor.

 Patients usually survive tetanus and return to their pre-

disease state of health.

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

 Clinical tetanus does not produce a state of immunity;

therefore, patients who survive the disease require active
immunization with tetanus toxoid to prevent a recurrence.
 What Are the Treatments?
Proactive:
 Tetanus immune globulins (Hyper-Tet) -- Used to induce active
immunity against tetanus in suspected patients.

Reactive:
If tetanus does develop, seek hospital treatment immediately.
This includes –
 wound care,
 a course of antibiotics and
 an injection of tetanus antitoxin.

You may receive medications such as –

 chlorpromazine or diazepam to control muscle spasms, or
 a short-acting barbiturate for sedation.

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

support measures during the several weeks needed for the
disease
to run its course.
 Remember….
 See the doctor for Immunization

 If you cut or injure yourself (puncture wounds

lacerations, abrasions and animal bites) see the doctor.