Tetanus is a deadly disease that attacks the nerves and muscles of the body. It starts off as a skin wound contaminated by bacterium that is commonly found on the ground. Initially, there is a headache and jaw stiffness that gradually spreads to the neck, making abdominal muscles rigid, leading to spams and fever. As the bacterial toxin circulates even more, it negatively affects the nerve activity leading to more spasms with excruciating pain and respiratory failure. All this while, the person is conscious, thereby making Tetanus a dreadful disease. Without treatment, tetanus can lead to death. Vaccination is the best protection against this deadly disease.
Neonatal tetanus is a generalized tetanus infection of the newborn. It usually gets transmitted from an unvaccinated mother and enters the body through infection of unhealed umbilical stump. This typically happens when the umbilical cord is cut using unsterile instruments. It is one of the leading causes of new born deaths in the developing world. Onset and progression is faster in neonatal than non-neonatal cases. However, it is a preventable disease - immunization of the mother and using hygienic practices during child birth can greatly reduce the risk of this disease and prevent more than 3 million infant deaths annually.
Neonatal tetanus starts showing symptoms in newborns about 8 days post birth. Common symptoms to watch out for are.
- Rigidity of muscles with spasms
- Irritability (continuous crying)
- Grimacing of face & restlessness
- Poor feeding / suckling ability
Neonatal tetanus generally has a poor prognosis (outlook). If any of the above signs are noted, immediate medical attention is a must.
Typical risk factors include the following:
- Unvaccinated pregnant mother
- Unhygienic conditions during child birth
- Animals / livestock kept near the vicinity of home
- Use of traditional methods for umbilical cord management (rat faeces, ash, herbs)
- Unclean hands and unsterilized instruments
- Newborn exposure to raw soil / dust
- Lack of awareness of symptoms / access to primary health care
- Traditional practices like circumcision
Tetanus is often difficult to detect so the prognosis is largely based on clinical evaluation. Cultures from tetanus patients oftentimes fail to show presence of the bacterium. Even presence of tetanus antibodies is not a reliable indicator of the disease presence. Given this challenge, differential diagnosis is relied upon and various associated conditions are investigated to draw up a conclusion. In case of neonates, it must be differentiated from metabolic disorders (eg: hypocalcaemia), meningitis, seizures, etc.
The specific objectives of tetanus treatment are
- to stop the production of toxin at the site of infection with appropriate wound care and antibiotic use
- to neutralise circulating toxin with anti-tetanus immunoglobulin
- to provide effective management of muscle spasm, respiratory failure, autonomic dysfunction, and complications that arise during the course of illness.
Therapeutic approaches depend on the resources available in the facility to which the patient presents.
Tetanus is a disease best prevented rather than cured. That said, the primary approach of tetanus treatment is to stop toxin production at the infection site along with wound care. The concurrent step is to use antibiotics along with immunoglobins that can cancel out circulating toxins. It also involves monitoring and management of muscular spasms and respiratory failure on a real time basis.
Immunological approach has proven to have the biggest impact on preventing neonatal tetanus. The vaccination with Tetanus toxoid is considered highly effective, stable, safe and relatively inexpensive. It can be administered safely during pregnancy and when handled safely, provides protective and long lasting immunity against tetanus. The antibody response is quite slow during the first dose but improves rapidly with multiple doses. It is advisable that a third booster shot is also administered to ensure longer protection.
Instead of traditional substances for umbilical cord care, usage of topical anti microbial solutions / creams leads to a dramatic improvement in reducing infections and mortality. Additionally, it also helps in controlling sepsis and other bacterial pathogens during the cord cutting procedure.