Elimination and Eradication of
MBBCh, 2016, Alexandria University.
• Throughout these years, many scientists and
researchers are trying to find the ways to
eliminate and eradicate the one called disease
‘tetanus’. Many control and preventive measures
are planned to ensure this objective can be
• As the science world knows that this disease that
caused by anaerobic organism, Clostridium
tetani, is a global disease that brings fatal and
worse complication to the infected person. It is
characterized by painful muscular contractions
due to the neurotoxin released by this organism
that blocked the inhibition of spinal reflexes.
Mainly respiratory failure is the cause of death
underlying by this tetanus disease.
• Based on the definition provided by the
Centre of Disease Control and Prevention
(CDC), we can compare the definition
between control, elimination, eradication and
extinction to study and understand the
processes being run.
• Control : The reduction • Elimination of disease :
of disease incidence,
Reduction to zero of the
prevalence, morbidity or
incidence of a specified
mortality to a locally
disease in a defined
acceptable level as a
geographical area as a
result of deliberate
result of deliberate
are required to maintain
are required. Example
the reduction. Example
• Elimination of
infections : Reduction
to zero of the incidence
of infection caused by a
specific agent in a
area as a result of
Continued measures to
prevent reestablishment of
• Eradication : Permanent
reduction to zero of the
worldwide incidence of
infection caused by a
specific agent as a
result of deliberate
measures are no longer
• Extinction : The specific infectious agent no
longer exists in nature or in the laboratory.
• For the process of elimination and eradication,
there are some criteria should be followed to
ensure the process can be aimed and
Criteria for diseases suitable for elimination or eradication
Causative agent is antigenically potent and stable.
Antigenically potent and stable.
Man is the only reservoir.
Soil and gastrointestinal tract of animals. *
Disease occur in clinically apparent form that can be detected.
Clinically apparent form can be detected.
Disease has long incubation period.
Incubation period for 4-21 days.
Modes of transmission are limited.
Not certainly limited.*
Post infection immunity is life lasting.
Long lasting immunity after 5 doses. Booster
Availability of effective control measures and resources to implement program
for elimination and eradication.
• Based on the criterias listed above, this
disease can only be control for the meantime
and still ongoing process towards its
elimination and eradication. Despite of this
limitation, still there are some steps that had
been conducted to control and limit its
occurrence to the world.
• There are some control and preventive
- Vaccination program.
- Increase effectiveness in reporting cases.
- Health education towards women community
regarding the danger and consequences of
unclean practice of delivery.
- Improving the surveilance system on detecting
and identifying the high risk areas for the
implementation of corrective action.
Diphteria Pertussis Tetanus vaccine
Tetanus diphteria (Td)
Every 10 years.
( exposed to the infection ) previously
First 2 doses are given at 4-8 weeks
interval and the third dose at 6-12
months after the 2nd dose.
Primary series of 3 doses TD is given.
Reproductive period of woman ( for
prevention of neonatal tetanus )
Tetanus toxoid (TT)
1 : as early as possible during
2 : at least 4 weeks after TT1
3 : at least 6 weeks after TT2
4 : at least 1 year after TT3
5 : at least 1 year after TT4
Given at the end of 2nd, 4th, and 6th
month of age.
Given 18-24 months of age.
Given at the 4th primary.
• The vaccine will starts it
reaction two weeks after
the administration of the
second dose. Any
administered after the
first dose will counts as a
dose towards the five
doses schedule even if it
administered after a long
• Until now, there is no
evidence proven on the
contraindications of this
immunization of pregnant
women at any time
during pregnancy. It is
recommended by the
Centre for Disease
Control (CDC) for the
women who received the
last tetanus toxoid
vaccine less than 10 years
ago to receive Tdap in the
post partum period.
• Up till now, this
can be concluded that it
has been in a good
progress all over the
world. Many countries
program and succeed to
decrease the incidence
of tetanus in their
• Other than vaccine, there
is also another
chemoprophyaxis for the
treatment of tetanus. This
type of immunity is a
passive artificial type
which is tetanus
immunoglobulin (TIG) or
tetanus antitoxin. This
immunity is indicated for
the person that
and required an urgent
protection due to injury
with a risk of getting
infected with tetanus.
• In Malaysia, with concern
and role of responsibility
towards the nation, the
government supported this
vaccination program and
participated in it thus
implemented it all over the
country. It was a successful
in decreasing tetanus cases
in Malaysia. By the order
from ministry of health,
there is a mandatory list of
vaccine that should be
taken by every newborn in
this country after taking
consideration and consent
from the parents and
guardian of the newborn.
Increase effectiveness in reporting
• Not only in the case of tetanus, other than this
disease also need to be improve in aspect of
reporting to the local and legal authorities.
Statistics showed that in every disease that
having the good reporting and surveilance
system will result in a good feedback and
• People should be awaken
and aware about the
importance of knowing the
consequences of getting
infected with tetanus. This
will be conducted in a
health community program.
After getting the community
to realise about this matter,
it should improve in the
reporting the incidence and
prevalence of this disease.
Thus, it can be success
towards achieving the aim
of elimination and
Health education towards women
• In cases of neonatal tetanus, many of it
resulted from unclean and unsterile practice
of delivery. This occurred especially to those
who are going to deliver in homes in the
practice of strict asepsis of umbilical stump of
newborn infants. Usually this incidence can be
seen in less developed and educated areas
where contaminated substances are
• Health officers and
aware and concern
about this matter and
construct a plan of
health program to
ensure this women
educated and realised
to practice a safe baby
delivery even doing it at
Example of messages that should be
included in the women health program
• Advise the mother on the importance of
practicing clean and sterile baby delivery at
• Inform the dangerous of getting tetanus infection
and the factors of risk to get infected.
• Educate them on how to practicing healthy and
clean baby delivery at home.
• Explain to them about the control and prevention
measures of tetanus and the advantages of
Improving the surveilance system on
detecting and identifying the high risk
areas for the implementation of
• By improving the mechanism of running the
surveilance system itself, it should help in increasing
the reported cases. Thus from here, this improvement
can help in identifying the high risk areas that can be
focus on for the implementation of corrective
program such vaccination administration and health