Tetanus: Its epidemiology & preventive measures

Author: Dr. Ali Raza

Co Author: Dr. Muhammad Tahir Aleem

From beginning, humanity is fighting with different infections that includes bacterial, fungal, protozoal and viral infections. Some infections are still un noticeable like tetanus that causing a great damage to humanity.

Even after great efforts of WHO to eradicate this disease throughout the globe, this disease is still present in some under developing countries. In 1992 almost 100000 deaths had been reported throughout the globe out of which 34000 death is of neonates. In Pakistan almost 3000 to 5000 people die annually due to tetanus.

Tetanus is caused by gram positive bacteria called clostridium tetani. These bacteria produce spores which remains inactive in soil for many years and germinate only in favourable conditions and release toxins which effects nervous system and show signs and symptoms. These spores can be killed by high temperature and pressure.

Pathophysiology: 

In case of any injury these spores enters into the body and if there is insufficient oxygen then these spores germinate and release two toxin Tetanolysine and tetanospasmin. Tetanolysine have not such lethal effect only tetanospasmin is dangerous and cause disease. These toxins enter to peripheral nerves then through blood stream they reach brain and central nervous system. Then through motor nerves they fixed into the gangliosides at the presynaptic inhibitory motor nerves endings and blocked gama-aminobutaryic acid and neurotransmitters glycine at synaptic cleft ad finally cause paralysis of muscles.

Signs and symptoms:

Incubation period of this disease varies from  to 21 days after  exposure. Mostly cases occur within   14 to 19 days.

In humans: Lock jaw, inability to open mouth Muscles seizures occurs mostly back and abdomen muscles. Difficulty in swallowing, Persistent headache and fever. Blood pressure changes abruptly.

In neonates: Muscles spasms occur, Excessive crying and inability to suck milk from breast of mother.

In animals: Lock jaw, inability to swallow, Loss of appetite, 3^rd eye lips prolapse, Salivation, Flaccid tail and paralysis of facial and back muscles usually very common.

Vaccination protocol:

Clostridium tetani are opportunistic organism and enter in body through wound or laceration . Proper vaccination courses are available against this disease. Usually these vaccinations are routinely used in neonate babies with diphtheria. Five vaccinations shots are given on arm and thigh of muscles at the following age.

• 1^st shot at 2 months of age.
• 2^nd shot at 4 months of age
• 3^rd shot at 6 months of age
• 4^th shot is at 15 to 18 months of age
• 5^th shot is at 4 to 6 years of age

A boaster dose is given at the age of 11 to 18 years then finally repeat this after every 10 years throughout life.

In Animals: Two shots are  given with interval of 4 to 6 weeks and after that boasters should be given annually        

Preventive measures:

 Following measures should be adopted to minimize this issue.

• Seminar should be conducted for awareness of people about this disease.
• All farmers workers and vet doctors should be trained properly to diagnose this disease timely.
• Complete vaccination courses should be made compulsory for both humans and animals to avoid this disease.
• In case of any injury or laceration immediately near by doctor should be consulted.
• In case of any suspect repeat vaccination should be done.
• Teams should be made on both humans and animals side to check out the vaccination status of both humans and animals.
• All government and private sectors should realize their responsibility to eradicate this problem.

By great efforts of WHO,  OIE and other national health care authorities we are successful to reduce incidence of tetanus but still this is present and there is need to work a lot to eradicate this disease throughout the globe especially developing countries of Asia and Africa.