first lecture by Dr-C. its about tetanus immunization and prophylaxis. this will cover the basics of national immunization schedule which follows WHO recommendations and national advisory board for immunization.

1. LECTURE 1-TETANUS
VACCINATION IN SRI LANKA
A LECTURE BY-DR C

2. WHAT IS TETANUS?
• TETANUS IS AN INFECTION CAUSED BY A BACTERIUM CALLED
CLOSTRIDIUM TETANI. SPORES OF TETANUS BACTERIA ARE
EVERYWHERE IN THE ENVIRONMENT, INCLUDING SOIL, DUST, AND
MANURE. THE SPORES DEVELOP INTO BACTERIA WHEN THEY ENTER
THE BODY.
• TETANUS CAN NEVER BE ERADICATED, BECAUSE THE SPORES ARE
COMMONLY
PRESENT IN THE ENVIRONMENT.

3. WHAT IS TETANUS?
• INFECTED BY A CONTAMINATED WOUND USUALLY.
• NEONATAL TETANUS RISES DUE TO INFECTED UMBILICAL STUMP.
• INCUBATION PERIOD OF THE BACTERIUM 6-21 DAYS.
• IF THE DISEASE RISES IN A HUMAN MORTALITY RATE IS VERY HIGH. (10-90%)

4. SYMPTOMS OF TETANUS
• JAW CRAMPING
• SUDDEN, INVOLUNTARY MUSCLE TIGHTENING (MUSCLE SPASMS) — OFTEN IN THE
STOMACH
• PAINFUL MUSCLE STIFFNESS ALL OVER THE BODY
• TROUBLE SWALLOWING
• JERKING OR STARING (SEIZURES)
• HEADACHE
• FEVER AND SWEATING
• CHANGES IN BLOOD PRESSURE AND A FAST HEART RATE

5. PREVENTION OF TETANUS
• PROTECTION ONLY ACHIEVED BY ACTIVE OR PASSIVE
IMMUNIZATION.
• ACTIVE-TETANUS VACCINE
• PASSIVE-TETANUS SPECIFIC IMMUNOGLOBULIN.
• NEONATAL TETANUS CAN BE PREVENTED BY IMMUNIZING THE
PREGNANT MOTHERS.

6. TETANUS VACCINE
• IT IS AN INACTIVATED TOXOID.
• IT IS CELL FREE PURIFIED VACCINE AND TREATED WITH FORMALDEHYDE.
• THEN THE TREATED VACCINE IS COMBINED WITH A CHEMICAL SUCH AS
• ALUMINIUM PHOSPHATE OR ALUMINIUM HYDROXIDE
• IT IS A CLOUDY SUSPENSION. IF IT HAS A SEDIMENTATION SHAKE BEFORE USE.
• IF THE SEDIMENT IS NOT DISAPPEARS BY A SIMPLE SHAKE DON’T USE VIGOROUS
SHAKING. IT MEANS THE VACCINE ISN’T SUITABLE FOR USE.

8. NATIONAL IMMUNIZATION SCHEDULE
CONTINUED.

9. NATIONAL IMMUNIZATION SCHEDULE
CONINUED

10. NATIONAL IMMUNIZATION SCHEDULE
CONTINUED.

11. NATIONAL IMMUNIZATION SCHEDULE
CONTINUED.

12. • IN FIRST PREGNANCY EVERY OTHER SHOULD GET 2 DOSES OF TT.
• FOLLOWING PREGNANCIES WILL BE RECEIVE ONE TT EACH TIME UP TO A TOTAL
OF FIVE TIMES.
• ACTIVE IMMUNIZATION WITH TT INDICATED TO ALL GROUPS OF PEOPLE WHO
ARE NOT ADEQUATELY IMMUNIZED.
• DIFFERENT COUNTRIES HAVE DIFFERENT SCHEDULES WHICH ARE CONVENIENT
FOR THEM. BUT AS A RULE MOST OF THE COUNTRIES TRYING TO STICK IN TO
WHO RECOMENDATIONS

14. • CHILDREN USUALLY GET FIVE DOSES OF TETANUS VACCINES SINCE CHILDHOOD.
• THEY ARE BY DTP, DT, DTP-HEP B-HIB (PENTAVALENT), DTAP-HEPB-HIB-
IPV(HEXAVALENT VACCINE)
• PRIMARY 3 DOSES GIVEN AT 2MONTHS, 4MONTH, 6MONTHS OF AGE BY
PENTAVALENT OR HEXAVALENT VACCINES.
• THEN A BOASTER SHOT GIVEN AT 18MONTHS OF AGE
(DTWP/DTAP/PENTAVALENT/HEXAVALENT)
• A BOASTER BEFORE SCHOOL (AT AGE 5) BY DT/TDAP.

15. • WHO RECOMMENDS A SIXTH DOSE TO KEEP THE IMMUNITY IN ADULT LIFE ALSO.
• POSSIBLY A LIFE LONG IMMUNITY.
• SIXTH DOSE GIVEN AT AGE 12-15 FOR ADOLESCENTS AS ATD OR TDAP.
• FOR YOUNG ADULTS AS TT

16. • TAKE AN ADEQUATE HISTORY REGARDING TETANUS VACCINATION PRIOR TO
APPLICATION OF TT
• THOSE WHO ARE NOT VACCINATED PROPERLY OR PEOPLE WHO HAVEN’T TAKEN
PROPER VACCINATION ACCORDING TO SCHEDULE MUST RECEIVE 3 DOSES. 1ST
DOSE STAT, SECOND DOSE IN 4-6 WEEKS, THIRD DOSE IN 6 MONTHS.
• A SINGLE DOSE ISN’T ENOUGH IF THE PERSON ISN’T VACCINATED PREVIOUSLY.
• TETANUS DOSE NOT GIVEN TO CHILDREN WHO HAVE BEEN VACCINATED BY 5
DOSES ACCORDING TO NATIONAL IMMUNIZATION SCHEDULE.
• YOUNG ADULTS WITH A HISTORY OF 5 TETANUS DOSE VACCINATION ACCORDING
TO NATIONAL IMMUNIZATION SCHEDULE NEED I BOOSTER SHOT OF TT.
• ADULTS WHO HAS A HISTORY OF 5 DOSE CHILDHOOD IMMUNIZATION AND 6TH
DOSE OF BOOSTED DON’T NEED IMMUNIZATION.
• IF A PATIENT IS IMMUNIZED IN ADOLESCENT OR ADULTHOOD TIME WITH 5 DOSES
FURTHER IMMUNIZATION WITH BOOSTED DOSES NOT NEEDED.

17. • THERE IS NO MINIMUM INTERVAL REQUIRED OR ADVISED BETWEEN GIVEN DOSE
OF TT OR ATD AND A DOSE OF TDAP WHEN IT IS INDICATED.(IF THERE IS A NEED
IT CAN BE GIVEN ANY TIME)
• IF A PATIENT IS RECOVERING FROM TETANUS HIS IMMUNITY ISN’T ENOUGH. SO
3 DOSES TT COURSE WILL BE GIVEN TO SUCH PATIENTS ON DISCHARGE.
• ROUTE OF ADMINISTRATION - DEEP INTRAMUSCULARLY INTO DELTOID OR
ANTERO-LATERAL ASPECT OF THIGH.
• STORE IN AN ENVIRONMENT 2C - 8C. DO NOT FREEZE.