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  1. 1. TETANUS<br />DR. PARTH GURAGAIN<br />
  2. 2. TETANUS<br />An acute disease caused by exo-toxin of Clostridium tetani.<br />Characterized by:<br />Muscular rigidity present throughout the illness<br />Paroxysmal spasm of voluntary musle.<br />Masseter (lock jaw or trismus )<br />Facial muscle (risussardonicus)<br />Muscle of back and neck(opisthotonus)<br />Muscle of lower limb and abdomen<br />Mortality is very high(40-80%)<br />
  3. 3. Datas regarding tetanus in Nepal<br />Achievement in fiscal year 2064/65<br /> unit target achievement ach in %<br />TT2 preg 984,251 409,032 79%<br />Vacc<br />School grade1 131,368 101,734 77.4%<br />School immunization was targeted in 12 district however only 5 district completed<br />DPT3 Coverage in FY 2062/63-93%,2063/64-84.3%,2064/65-81.9%<br />TT2 Coverage 2062/63-51.3%,2063/64-49.7%,2064/65-59% <br />INDICATORS<br />Immunization coverage for TT2 Vaccine=<br />Number of pregnant women immunized with TT2 /Total estimate number of pregnant women × 100<br />NT Surveillance=<br />Number of NT cases/number of live birth×1000 per district<br />
  4. 4. EPIDEMIOLOGICAL DETERMINANT<br />Agent factor<br />a. Agent<br />Cltetani is gram positive,anaerobic,spore-bearing organism which is drum stick in appearance<br />The spores are resistant to number of agents(boiling,phenol,cresol,autoclavingfor 15 min at 120°<br />The spore germinate under anaerobic condition and produce exotoxin”tetanospasmin”<br />
  5. 5. Reservoir of infection<br />The natural habitat of organism is soil and dust.<br />The bacilli is found in intestine of many herbivorous animals and are excreated in their feaces. The bacilli may also be found in human intestine without causing ill effects.<br />Exotoxin<br />It is highly lethal.<br />Lethal dose for 70kg man -0.1mg<br />The toxin acts on nervous system ie,motor end plate in skeketal system, brain, spinal cord, sympathetic system.<br />d.Communicability<br />Not transmitted from perso to person <br />
  6. 6. 2. Host factor <br />Age<br />It is disease of active age(5-40 yrs)<br />Tetanus in new-born is k/a neonatal tetanus<br />Birth under aseptic condition or if umbilical stump is dressed improperly.<br />Sex<br />Males there is higher incidence<br />Females are more exposed to risk of tetenus during delivery or abortion leading to ‘puerperal tetanus’<br />Occupation<br />Agricultural worker <br />
  7. 7. d. Rural-urban difference<br />More in rural area<br />e. Immunity<br />No age is immune unless previously immunized<br />2 injection of tetanus toxoid can provide immunity which can last for several years<br />An immunity less than 6 month can be transferred to baby if mother is immunized during pregnancy . <br />
  8. 8. ENVIRONMENTAL AND SOCIAL FACTOR<br />ENVIRONMENT<br />Soil, agriculture, cattles.<br />SOCIAL <br />Application of dust or animal dung in wound.<br />Unhygienic delivery practice. <br />
  9. 9. MODE OF TRANSMISSION<br />First there is contamination of wound by spores. Then germination and elaboration of exotoxin takes place. Finally there is binding of exotoxin to the receptors.<br />The range of injuries and accident that lead to tetanus can be<br />Pin prick<br />Skin abrasion<br />Puncture wound<br />Burns<br />Human bite<br />Animal bite <br />Sting etc<br />
  10. 10. Incubation period- Usually 6-10 days , but can range from 1 day to several months.<br />TYPES OF TETANUS<br />Traumatic<br />Puerperal<br />Otogenic<br />Idiopathic -microtrauma, absorption of tetanus toxin from intestine, inhalation of tetanus spores.<br />Tetanus neonaturum<br />
  11. 11. PREVENTION<br />ACTIVE IMMUNIZATION<br />With tetanus toxoid<br />Toxoid stimulates the production of anti-toxin<br />The aim of vaccination is to maintain the level of anti-toxin ie, 0.01 IU/ml serum throughout the life.<br />PREPARATION FOR IMMUNIZATION<br />Combined vaccine-DPT<br />Monovalent vaccine<br />Plain or fluid(formal) toxoid<br />Tetanus vaccine, absorbed(PTAP,APT)<br />
  12. 12. Combined vaccine-DPT<br /> Tetanus vaccine is given along with diphtheria and pertusis vaccine.<br />The WHO EPI schedule is 6week,10week and 14week.<br />National schedule for India is 6week,10week,14 week followed by booster of DPT at 18 mth, booster of DT at 5-6yrs and booster of TT at 10 years.<br />
  13. 13. MONOVALENT VACCINE<br />Purified tetanus toxoid have largely replaced plain toxoid coz it stimulate a higher and long-lasting immunity response than plain toxoid.<br />1st dose-------1-2month-------2nd dose-----1year----1st booster-------5year------2nd booster.<br />
  14. 14. PASSIVE IMMUNIZATION<br />Temporary protection against tetanus can be provided by<br />Human tetanus hyperimmunoglobulin(TIG)<br />ATS(Equine)<br />ACTIVE AND PASSIVE IMMUNIZATION<br />In non-immune person 0.5ml in one arm and 1500 IU ATS(equine) or 250-500 IU(HTIG) in another arm .Followed by 6 week later 0.5 ml of tetanus toxoid and third 1 year later.<br />
  15. 15. ANTIBIOTICS<br />Single injection (IM) Benzathine Penicillin 1.2 mega unit.<br />For person sensitive to penicillin<br />Erythromycin estolate-500mg×6hrly×7days<br />Antibiotics treatment should not be relied if patient is seen 6 hour after injury.<br />It is not sure whether antibiotics reach the bacilli if dead tissues are present around.<br />
  16. 16. PREVENTION OF NEONATAL TETANUS<br />Clean delivery practice reduce neonatal tetanus.<br />Three cleans prevents neonatal tetanus<br />Clean hands<br />Clean surface<br />Clean cord care <br />