Neonatal tetanus
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
For details about tetanus, click here.
Overview
Neonatal tetanus is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from the mother having been immunised are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.[1]
Classification
Tetanus may be classified according to its patterns of presentation as follows:[2][3][4][5]
| Tetanus | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generalized | Local | Neonatal | Cephalic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
For the pathophysiology of tetanus click here.
Causes
Neonatal tetanus is caused by Clostridium tetani. For details about Clostridium tetani, click here.
Differentiating Tetanus from other Diseases
For review the differential of tetanus, click here.
Epidemiology and Demographics
In 2000 neonatal tetanus was responsible for about 14% (215,000) of all neonatal deaths.[6] In 2008 59,000 newborns worldwide died as a result of neonatal tetanus.[7][8] In 2005, 57 countries were identified as still at risk, with 27 countries accounting for 90% of cases.[9] As of December 2013 the number of countries at risk was reduced to 25.[10]
To review the epidemiology and demographics of tetanus, click here.
Risk Factors
To view the risk factors of tetanus, click here.
Natural History and Complications
To view the natural history and complications of tetanus click here.
Signs and symptoms
In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. The fatality rate for infants has been estimated as 70% to 100%; death usually occurs by the age of 2 weeks.[9] On the basis of clinical findings, four different forms of tetanus have been described.[11] The time from exposure to symptoms may be up to several months.[12][13]
- Unhealed, unhygienic umbilical stump
- Trismus (spasm of masseter muscle)
- Risus sardonicus (spasm of facial muscles)
- Clenched hands
- Dorsiflexion of the feet
- Opisthotonus (spasm of spinal muscles)
For details about the diagnosis of tetanus, click here.
Treatment
For the treatment of tetanus, click here.
Prevention
The spores which cause tetanus are present everywhere, so the only prevention is immunization. Three properly spaced doses of tetanus toxoid vaccine are recommended for women of childbearing age, either before or during pregnancy; this will protect their future babies from neonatal tetanus after delivery.[9]
Public health campaigns
In 1989 the World Health Congress called for the elimination of neonatal tetanus. UNICEF took the lead, assisted by other United Nations agencies, individual governments, and non-profit organisations. By 2000 the disease was declared as eliminated from 104 of 161 developing countries.[14] "Elimination" is defined as less than 1 case per 1,000 live births in every district of the country.[9] Since tetanus can also strike postpartum mothers, the campaign has been expanded to target both maternal and neonatal tetanus.[9]
In many affected countries, there was a lack of awareness of maternal and neonatal tetanus and how to prevent it. Education and immunisation campaigns have been launched in the remaining countries at risk and are targeted particularly at pregnant women.[1] Education focuses on hygienic birth practices and infant cord care as well as the need for immunisation.[15]
In Egypt, the number of cases of neonatal tetanus dropped from 4,000 to fewer than 500 annually as the result of an immunisation campaign. In Morocco, neonatal tetanus accounted for 20% of neonatal deaths in 1987 but only 2% in 1992. In 1998 in Uganda, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda in 2011 was certified as having eliminated tetanus.[16] In 2011, Pampers joined with UNICEF to target maternal and neonatal tetanus in Yemen.[17] In 2010, Kiwanis International pledged to raise $110 million to eliminate maternal and neonatal tetanus throughout the world in partnership with UNICEF.[18]
India
On 15Template:NbspMay 2015, The World Health Organization (WHO) declared India free from maternal and neonatal tetanus.[19][20] This announcement was made by Prime Minister Narendra Modi in his inaugurating speech at the Call to Action Summit in New Delhi[21] on 27Template:NbspAugust 2015. India has reduced its infant mortality rate (IMR) from 380 in 1990, to 40 in 2015, and its maternal mortality rate (MMR) from 540 to 167 in the same years.[22] The national health programme was started in 1983 by the Government of India, when all pregnant women were given two doses of tetanus vaccine. Surprisingly ,the number of deaths from tetanus dropped from 79,000 in 1990, to less than 500 in 2013 and 2014.[19]
For details about prevention of tetanus click here.
References
- ↑ 1.0 1.1 Roper, Martha H; Vandelaer, Jos H; Gasse, François L (12 September 2007). "Maternal and neonatal tetanus" (PDF). The Lancet. Retrieved 1 September 2015.
- ↑ Angurana SK, Jayashree M, Bansal A, Singhi S, Nallasamy K (2017). "Post-neonatal Tetanus in a PICU of a Developing Economy: Intensive Care Needs, Outcome and Predictors of Mortality". J Trop Pediatr. doi:10.1093/tropej/fmx020. PMID 28460120.
- ↑ Gulamhussein MA, Li Y, Guha A (2016). "Localized Tetanus in an Adult Patient: Case Report". J Orthop Case Rep. 6 (4): 100–102. doi:10.13107/jocr.2250-0685.592. PMC 5288609. PMID 28164065.
- ↑ Kotani Y, Kubo K, Otsu S, Tsujimoto T (2017). "Cephalic tetanus as a differential diagnosis of facial nerve palsy". BMJ Case Rep. 2017. doi:10.1136/bcr-2016-216440. PMID 28108438.
- ↑ Felter RA, Zinns LE (2015). "Cephalic Tetanus in an Immunized Teenager: An Unusual Case Report". Pediatr Emerg Care. 31 (7): 511–3. doi:10.1097/PEC.0000000000000360. PMID 25853723.
- ↑ "Maternal and Neonatal Tetanus Elimination by 2005" (PDF). UNICEF. November 2000. Retrieved 2007-01-26.
- ↑ "Maternal and Neonatal Tetanus Elimination Initiative" (PDF). Pampers UNICEF 2010 campaign: 2.
- ↑ Black, RE (Jun 5, 2010). "Global, regional, and national causes of child mortality in 2008: a systematic analysis". Lancet. 375 (9730): 1969–87. doi:10.1016/S0140-6736(10)60549-1. PMID 20466419. Unknown parameter
|coauthors=ignored (help) - ↑ 9.0 9.1 9.2 9.3 9.4 "Maternal and Neonatal Tetanus Elimination by 2005" (PDF). UNICEF. Retrieved 17 February 2014.
- ↑ "Elimination of Maternal and Neonatal Tetanus". UNICEF. Retrieved 17 February 2014.
- ↑ "Tetanus" (PDF). CDC Pink Book. Retrieved 19 January 2014.
- ↑ Brauner, JS; Vieira, SR; Bleck, TP (Jul 2002). "Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil". Intensive Care Medicine. 28 (7): 930–5. doi:10.1007/s00134-002-1332-4. PMID 12122532.
- ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter
|month=ignored (help) - ↑ "Neonatal tetanus" (PDF). Unicef. Retrieved 19 January 2014.
- ↑ Saleh, JA; Nemecek, J; Jones, C (2015). "Impact of hygienic caring of the umbilical cord in the prevention of neonatal tetanus". WebmedCentral PUBLIC HEALTH. 6 (5). Retrieved 1 September 2015.
- ↑ "Uganda announces elimination of Maternal and Neonatal Tetanus". Unicef Media Centre. Retrieved 19 January 2014.
- ↑ "Pampers and UNICEF aim to eliminate maternal and neonatal tetanus in Yemen". AME info.com. March 29, 2011. Retrieved 19 January 2014.
- ↑ "Maternal and Neonatal Tetanus". UNICEF United States Fund. Retrieved 17 February 2014.
- ↑ 19.0 19.1 "Almost a year after eliminating polio, India declared free of maternal and neonatal tetanus". www.ibnlive.com. CNN-IBN. 3 June 2015. Retrieved 1 September 2015.
- ↑ "India declared maternal and neonatal tetanus free: PM Modi". www.timesofindia.indiatimes.com. The Times of India. 27 August 2015. Retrieved 1 September 2015.
- ↑ "Call to Action Summit 2015". www.calltoaction2015.org. Call to Action. Retrieved 1 September 2015.
- ↑ "India declared maternal and neonatal tetanus free: Modi". www.thehindu.com. The Hindu. 27 August 2015. Retrieved 1 September 2015.
Further reading
- Stanfield, JP; Galazka, A (1984). "Neonatal tetanus in the world today". Bulletin of the World Health Organization. 62 (4): 647–69. PMC 2536335. PMID 6386211.
- Blencowe, H; Lawn, J; Vandelaer, J; Roper, M; Cousens, S (Apr 2010). "Tetanus toxoid immunization to reduce mortality from neonatal tetanus". International Journal of Epidemiology. 39 (Suppl 1): i102–9. doi:10.1093/ije/dyq027. PMC 2845866. PMID 20348112.
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