Neonatal Tetanus is a severe disease with high fatality. It should no longer be present in a country with the development status of Malaysia. However, sporadic cases still occur and the disease has not been eradicated. This editorial summarises the disease pattern, incidence and suggests reasons for the continued persistence of the condition locally.
This study aims to study the demographics, clinical presentation, treatment and outcome of neonatal tetanus patients managed at Hospital Duchess of Kent from January 1st 2006 to December 31st 2006. Five neonates were studied. All presented with fever, poor sucking and limb stiffness, with a history of unsterile delivery and uncertain maternal tetanus immunity status. All were nursed in a minimal-stimuli environment and were given IV penicillin G, IM tetanus immunoglobulin and sedatives to control spasms. Nutrition and chest physiotherapy were rendered. Three patients required artificial ventilation. Duration of treatment ranged from 25 to 44 days. All survived. Inadequate maternal immunization, unsterile delivery and inappropriate umbilical cord care are major contributing factors of neonatal tetanus in our study. Supportive measures are the mainstay of treatment in our setting with very limited resources.
Matched MeSH terms: Tetanus/complications; Tetanus/diagnosis; Tetanus/drug therapy*; Tetanus/prevention & control
A case of tetanus occurring after induced abortion is reported. The patient gave a history of low grade fever with chill and rigors, headache, neck pain and Trismus. She subsequently developed respiratory distress. However, incorrect information from the patient resulted in the delay to locate and eradicate the source of infection. Early referral to an intensive care unit for ventilatory assistance was the most appropriate step to save the patient. Complications which occurred during the course of the disease were sometimes difficult to overcome. These complications were probably related to the duration of stay in the intensive care unit. Their incidence could be reduced by more meticulous patient care.
Tetanus, especially tetanus neonatorum (T.N.) continues to be a significant medical and social problem in the developing countries. The case mortality rate remains very high even in the 'developed' countries, varying from 60-80 percent in various reports, and even higher in the case of tetanus neonatorum. Sanders et al had introduced the method of intrathecal injection of antitetanus serum (ATS) in 1976 and have achieved very encouraging results. As the conventional treatment of tetanus neonatorum had achieved very poor result, even in the very sophisticated centres, a case of tetanus neonatorum admitted to Cottage Hospital Semporna in Sabah had been treated with intrathecal ATS since June 1982. This paper reviews the results of this new approach to tetanus neonatorum treatment as compared to cases treated conventionally.
Report on 174 cases of tetanus neonatorum collected between 1946 and 1950 in the General Hospital, Singapore. There is a marked reduction in the incidence, which is attributed to a better maternity service. The results of treatment are bad – with a mortality of 90% of cases.
The relationship between the timing of maternal tetanus toxoid immunization and the presence of protective antitoxin in placental cord blood was investigated among women admitted to the obstetrical service of the University Hospital in Kuala Lumpur, Malaysia. The 1st dose was given between 13-39 weeks of gestation, with a median of 29 weeks. The 2nd dose was given an average of 4 weeks later. Protection was conferred on 80% or more of newborns whose mothers received their 1st tetanus toxoid injection 60 days or more before delivery. Protective levels were seen in all cord blood samples from infants whose mothers had received their 1st injection 90 days before delivery. Similarly,protective titers were found in 100% of cord blood samples when the 2nd maternal injection was give 60 days or more before delivery. There was no significant degree of protection when immunization was carried out less than 20 days before delivery. A single-dose schedule provided no protection when less than 70 days before delivery. Cord and maternal antiotoxin titers differed by no more than 1 2-fold dilution for almost all of the individual paired sera. A cord: maternal antitoxin ratio of 2 was more likely to occur with increasing time between the 2nd injection and delivery. Overall, these findings indicate that the 1st injection of a 2-dose maternal tetanus toxoid schedule should be given at least 60 days and preferably 90 days before delivery.
A 66-year-old man sustained an injury to his right foot while gardening. Despite receiving tetanus toxoid one hour later and adequate wound toilet, he developed severe tetanus complicated with autonomic dysfunction six days later. He died 20 days after admission. This case shows that tetanus toxoid alone may not be sufficient to prevent tetanus in wounded patients. Careful consideration must be given to the immune status of the patient and to the nature of the wound sustained. Incompletely immunised patients or patients with unknown immune status who sustain a tetanus prone wound should be protected with both tetanus toxoid and tetanus immunoglobulin.
There is a high incidence of tetanus in the Malaysian state of Kelantan. Out of 162 reported cases of tetanus in Peninsular Malaysia during 1979 - 1984, 62 cases were from Kelantan, i.e. 38% of the total reported cases in Peninsular Malaysia. Thus a retrospective study was carried out to analyse the possible factors responsible for this high incidence. 62 cases of tetanus admitted to the General Hospital, Kota Bharu, over a period of 1979 - 1984 were studied.
Neonatal tetanus, though still existing, had been considerably reduced compared to the preceding five-year period (1975-1979). There was notable absence of cases in the two months to four-year age group, 24% of the cases occurred in the 10 - 20 years, and 29% in the age group 25 - 40 years. Since tetanus is a disease preventable by active immunization. l every effort must be taken to improve immunization coverage and increase the public awareness to prevent unnecessary loss of lives.
Vaccines, used appropriately and efficiently, have changed the landscape of infectious diseases. Poliomyelitis is almost completely eliminated globally. In many industrialised countries, there has been over 99 percent reduction in incidence of diphtheria, tetanus, measles, mumps, rubella, Haemophilus in-fluenzae b meningitis and over 97 percent reduction in whooping cough.',2Unlike anti-biotics, most vaccines have remained equally effective despite years of continuous usage.
This paper examines the influence of maternal education on the acceptance of tetanus toxoid vaccine, using data from two villages in rural Yogyakarta, Indonesia. Maternal education results in increased tetanus toxoid uptake. Irrespective of the level of formal education, correct knowledge of the function of tetanus toxoid is positively associated with the probability of using the vaccine. It is therefore recommended that health education campaign be run to provide correct information on the importance of tetanus toxoid. This study can be used as a model for health programmes in other population with low levels of women education.
Key words: Neonatal tetanus, maternal education, tetanus toxoid, binomial logistic regression, multinomial logistic regression.
Kertas ini mengkaji pengaruh pendidikan ibu ke atas penerimaan vaksin tetanus toxoid, dengan menggunakan data daripada dua buah kampung di pendalaman Yogyakarta, Indonesia. Kajian ini mendapati pendidikan ibu dapat meningkatkan kadar pengambilan tetanus toxiod. Pengetahuan yang tepat tentang kepentingan vaksin tersebut didapati mempunyai hubungan yang positif dengan pengambilannya, tanpa mengira tahap pendidikan wanita. Dengan itu dicadangkan agar kempen pendidikan kesihatan dijalankan untuk menyebarkan maklumat yang jelas ten tang kepentingan tetanus toxoid. Kajian ini boleh dijadikan model bagi program kesihatan untuk populasi lain yang mempunyai tahap pendidikan wanita yang rendah.
Kata kunci: Tetanus neonatal, pendidikan ibu, tetanus toxoid, regresi logistik binomial, regresi logistik multinomial.
Tetanus is an acute, potentially fatal disease caused by Clostridium tetani. It is characterized by generalized, painful spasms and rigidity of skeletal muscles. We present two fatal cases and discuss the potential causes that lead to mortality in cases of tetanus infection
Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.