Tetanus. Incidences, Vectors, Complications, Types and Prevention

INTRODUCTION.

Tetanus is the only vaccine-preventable disease that is infectious but not contagious. It is a bacterial infection caused by wound contamination. It affects the nervous system, leading to painful muscle contractions, particularly the jaw and neck muscles.

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Tetanus is recognized for centuries as an environmentally acquired infectious but preventable disease.  It is caused by bacteria, Clostridium tetani or the spores they produce that live in the soil and animal feces. This causative bacterium is an organism capable of living inside the soil in form of spores for many years. Infection follows when the spores become activated and develop into gram-positive bacteria. The bacteria multiply and produce very powerful toxin that affects the muscles. The toxin can travel throughout the body via the bloodstream and lymph system. As it widely circulates, the toxin interferes with normal activity of nerves throughout the body, leading to generalized muscle spasms. Spasms can be so forceful that they tear muscles or even cause spine fractures.

INCIDENCES OF TETANUS

Tetanus, especially the neonatal form, remains a significant public health problem in developing countries. Neonatal tetanus happens in newborns delivered in unsanitary conditions, especially if the umbilical cord stump becomes contaminated.  Tetanus occurs almost exclusively in persons unvaccinated or inadequately immunized. Tetanus is a worldwide infection more common in hot and damp climates where there are manure-treated soils rich in organic matter.

The highest mortality rates from tetanus are in unvaccinated people, people over 60 years and newborns. Neonatal tetanus is common in many developing countries. It is responsible for more than 215,000 deaths annually. The incidence of tetanus is much higher in less developed countries.  Generally, many developing countries lack effective prevention. There are no locally effective vaccination programs against tetanus. Therefore tetanus and deaths associated with it are much more common. Globally around a million cases of tetanus occur each year and causes about half that number of deaths.

It’s important you partner in tetanus control and management. Know and promptly report signs and symptoms of tetanus for easier treatment. This is why this publication supports the timely prevention of tetanus through proper and timely awareness campaign.

WHAT IS TETANUS INFECTION?

Tetanus is a serious medical condition characterized by prolonged contraction of skeletal muscle fibers. It is a bacterial infection that causes forceful and painful muscle contractions, particularly the jaw and neck muscles. Tetanus is commonly known as “lockjaw.” It can interfere with the ability to breathe and ultimately death. Tetanus is a dangerous nerve ailment that enters the body through deep cut from such as knife or nail. The bacterial spores that produce the poisonous microbial toxin can remain infectious inside soil for over 40 years. They also exist in environments as diverse as animal excreta, house dust and the human colon. If the spores enter wound that penetrated the skin and extended deeper than where oxygen can reach, they germinate. They equally produce toxin that enter the bloodstream, circulating to the nerves where they cause infections. After approximately 8 days (ranging from 3- 21 days), the toxin begins to short-circuit nerve signals and block muscles relaxation. This result in sustained muscle contractions, notably the lockjaw for which tetanus is nicknamed. Here the victim cannot open mouth or swallow.

TYPES OF TETANUS INFECTION

There are four types of tetanus infection. The most common is generalized tetanus which can affect all skeletal muscles. The local tetanus manifests as muscle spasms at or near the bacteria- infected wound. The Cephalic tetanus primarily affects one or several muscles in the face. This occurs in one to two days following a head injury or ear infection and may cause “lockjaw”. The neonatal tetanus which is rare in developed countries is similar to generalized tetanus. The difference is that this type affects babies (neonates) of less than 1 month old.

COMPLICATIONS OF TETANUS INFECTION

Tetanus infection has some complications. The possible complications are:

  • Airway obstruction
  • Heart failure
  • Fractures due to severity of spasms
  • Lasting brain damage (especially in infants). This complication ranges from minor mental deficits to cerebral palsy due to lack of oxygen that is common during spasms
  • Permanent disability due to prolonged immobility sequel to the use of powerful sedatives to control muscle spasms
  • Death due to respiratory failure and pneumonia.

DISTRIBUTION OF TETANUS SPORES

Tetanus spores are found throughout the environment. It is mainly located in the soil, dust and animal waste. The spores are widely distributed in the intestines and feces of many animals. The animal vectors are horses, sheep, cattle, dogs, cats, rats, guinea pigs and chickens. In agricultural areas, significant numbers of human adults harbour the organism. The spores can also be found on skin surfaces and in contaminated heroin.

CONDITIONS THAT EXPOSE PEOPLE TO TETANUS INFECTION

Heroin users, particularly those that inject the drug are at high risk for tetanus infection.   The potential entry posts for the bacteria into the human body are cuts or deep puncture wounds.  The wounds are caused by rusty nails, splinters, insect bites, burns or intravenous injections. However, it should be noted that injuries that involve dead skin such as burns, frostbite, gangrene or bruises can cause tetanus. Wounds contaminated with soil, saliva or feces, especially if not properly cleaned and disinfected expose people to tetanus. Skin punctures such as injection, self-performed tattooing or body piercing from unsterilized needles and instruments increase risk of tetanus infection. Other tetanus-prone injuries include surgery, crush wound, abscesses and childbirth.  Among are wounds with devitalized (dead) tissue (crush injuries) or foreign bodies (debris in them). Tetanus may develop in people who are not immunized against it. It is common in people who have failed to maintain adequate immunity with active booster doses of vaccine.

 DIAGNOSIS AND TREATMENT OF TETANUS INFECTION?

There are currently no blood tests for diagnosing tetanus; and there is no cure for tetanus infection. Palliative treatment consists of wound care and medications to ease symptoms. Others are supportive care and management of complications until the effects of tetanus toxin resolve. Without treatment, tetanus can be very fatal. Therefore, the best approach to tetanus infection is prevention through vaccination.

SYMPTOMS AND SIGNS OF TETANUS INFECTION

Symptoms and signs of tetanus may appear anytime from few days to several weeks after tetanus bacteria have entered the body.  Tetanus presents painful progressive spasms of the chest, neck, back, upper arms, thighs, bottom and abdominal muscles. Sudden stiffness in jaw (lockjaw), abdominal and neck muscles and difficulty in swallowing are noticed.  Painful body spasms lasting for several minutes (typically triggered by such as draft, loud noise, physical touch or light) are reported. Fever and elevated blood pressure are common.  There may be presentations of episodic rapid heart rate and breathing problems that can cause suffocation to death.  Fracture, muscle tears and drooling are among. Others include hand or foot spasms, excessive sweating, irritability and poor sucking ability or difficulty in swallowing especially in neonates. Equally observed are uncontrolled urination or defecation, weakness and facial muscle spasms.

HOW TO AVOID/REDUCE THE INCIDENCES OF TETANUS INFECTION

Open wound caused by dirty or dusty object that has been outdoors or in contact with soil should be avoided. Disallow injuries caused by rusty and dirty nails and inadequate vaccination (failure to receive timely booster shots) against tetanus. Other thing to avoid includes penetrating injury that can result in tetanus spores being introduced to the wound site. Unprotected contact with foreign body such as nail or splinter and swelling around injury site should be avoided. We must not allow splinters’ puncture wounds, body piercings and tattoos. It is important to avoid animal bites and bacterial infection of foot ulcers.  Discourage bacterial infection of umbilical stumps in newborns (especially babies of inadequately immunized mothers).

IMPORTANCE OF ROUTINE VACCINATION AND OTHER HEALTH HABITS IN TETANUS MANAGEMENT

Tetanus infection can be prevented by proper vaccination and by post-exposure prophylaxis. The tetanus vaccine can prevent tetanus among children, adolescents and adults.  But its protection does not last forever. Pregnant women should have advanced discussion regarding vaccination before their due date or Expected Date of Delivery (EDD). They should follow the routine vaccination (immunization) schedule against tetanus to produce the essential antibodies to pass to their unborn babies. Comply strictly with the sanitary cord-care techniques to check newborn tetanus. Be sure you and your children do not miss any vaccination appointments. Visit health care providers if you have never been vaccinated against tetanus as an adult or child. Or if you are unsure of your tetanus vaccination status especially if a deep or dirty wound is sustained.

Any skin wound, especially a deep puncture that may be contaminated with feces, manure, soil or saliva should be properly cleaned and dressed quickly. Remember that cleaning and dressing all wounds are not substitute for vaccination against tetanus. After cleaning the wound, apply thin layer of antibiotic cream or ointment such as multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics do not make the wound heal faster, but they can prevent bacteria growth and infection. They help the wound to heal more efficiently. Wounds thoroughly cleaned with antiseptic soap and running water can be covered with bandages until scab forms. Change the dressing when necessary to prevent infection. Also, leave unclean wounds open to avoid trapping tetanus bacteria into the wound with bandage.

Maintain proper airway and nutrition (at least 150 g of protein daily) to balance the metabolic strain caused by increased muscle activity. Take adequate bed rest in conducive environment with dim light, reduced noise and ambient temperature.

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