Tetanus: 5 Things You Should Know About The Fatal Disease

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mrsam

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Tetanus is a fatal disease of the nervous system that results in painful, violent muscular contractions involving different parts of the body. It is a noncommunicable disease that cannot be transmitted from one person to another.

Statistics have revealed that tetanus is particularly deadly when it affects neonates (babies under 1 month old) or adults above 50 years. Globally, about 800000 children die of tetanus annually. Sadly, the majority of these cases occur in the developing countries where many pregnant women are not immunized against the infection. Also, in some cases, the bacterium gets into the baby when the umbilical cord is cut with an unsterile instrument or the umbilical stump is not properly cared for.

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In stemming the tides of tetanus and tetanus-related deaths in developing countries, here are answers to some questions you may have about tetanus

1. How is tetanus contracted?

Tetanus starts when the spores of the bacterium (Clostridium tetani) gain entrance into the body through a wound, abrasion or cut that has come in contact with soil, dust or animal faeces that contains the infective spores. On entering the body, the bacterium can only multiply in an anaerobic (that is oxygen-free) environment. Deep puncture wounds and dirty wounds with lots of dead tissues provide such favourable environment. Soon, it excretes tetanospasmin into the blood, a very poisonous toxin that invades the nervous system and leads to continuous unopposed stimulation of the muscles and generalised spasms.

2. What are the signs and symptoms of tetanus?

In about 50% of all cases, the first symptom of tetanus is trismus or a stiff 'locked' jaw in which the patient is unable to open his mouth as a result of painful spasms of the jaw muscles. Shortly afterwards, the muscles of the neck become stiff and the patient is unable to swallow. This is followed by other symptoms such as drooling of saliva, seizures, fever, sweating, fast heart rate and high blood pressure.

3. What complications can arise from tetanus?

Sometimes, tetanus leads to uncontrolled involuntary contractions of the vocal cords (laryngospasm) which prevents entry of air into the lungs thus making breathing difficult, if not impossible. This complication has been found to lead to death in up to 10 - 20% of cases. Furthermore, in a few people, the spasms are so severe as to lead to broken bones (fractures). Also, tetanus patients are more likely to aspirate since the cough reflex has been depressed in them. Hence, they are at risk of aspiration pneumonia. Lastly, patients that have been bedridden for long from tetanus may suffer from pulmonary embolism, a condition in which a dislodged blood clot obstructs the main artery (or one of its branches) of the lung.

4. How is tetanus treated?

Tetanus is treatable although its prognosis is poor in the extremes of ages or when it has a rapid onset and incubation period. It is a medical emergency that requires immediate hospitalisation and admission into a quiet environment with good nursing care since noise tends to stimulate spasms. Human tetanus immune globulin (ATS) is immediately given to mop up unbound tetanus toxins. In addition, it is important that drugs are administered to abort muscle spasms and keep the patient sedated. If the virus got in through a wound, the wound must be thoroughly cleaned and debrided. It should also be washed with hydrogen peroxide (which releases oxygen) since the bacterium cannot survive in the presence of oxygen. Furthermore, the patient may benefit from antibiotics such as penicillin or flagyl to kill any residual bacteria at the portal of entry. Prior to discharge, the healthcare giver must not forget to administer tetanus vaccine to the patient since the last infection does not confer immunity against a future one.

5. How is tetanus prevented?

Tetanus is a vaccine-preventable infection. Hence tetanus vaccines are recommended for people of all ages. Under the National Programme on Immunization, it is given in 3 doses as part of the DPT (Diphtheria, Pertussis, Tetanus) vaccine. Also, to prevent neonatal tetanus, women are encouraged to receive a total of 5 doses of tetanus toxoid at specified intervals in order to transfer protective antibodies to their foetuses during pregnancy.

In conclusion, the need to ensure adequate hygiene in the care of the umbilical cord of newborns cannot be overemphasised in the prevention of tetanus infection.

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