TETANUS

Tetanus is acquired through exposure to the spores of the bacterium Clostridium tetani which are universally present in the soil. The disease is caused by the action of a potent neurotoxin produced during the growth of the bacteria in dead tissues, e.g. in dirty wounds or in the umbilicus following non-sterile delivery (1).

People of all ages can get tetanus. But the disease is particularly common and serious in newborn babies. This is called neonatal tetanus. Most infants who get the disease die. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures. In 2000, WHO estimates that neonatal tetanus killed about 200 000 babies (1).

Mode of transmission
Tetanus is not transmitted from person to person. A person usually becomes infected with tetanus when dirt enters a wound or cut. Tetanus germs are likely to grow in deep puncture wounds caused by dirty nails, knives, tools, wood splinters, and animal bites. Women face an additional risk of infection if a contaminated tool is used during childbirth or during an abortion (1).

A newborn baby may become infected if the knife, razor, or other instrument used to cut its umbilical cord is dirty, if dirty material is used to dress the cord, or if the hands of the person delivering the baby are not clean (1).

Signs and symptoms
The time between getting the infection and showing symptoms is usually between 3 and 10 days. But it may be as long as 3 weeks. The shorter the incubation period the higher the risk of death (1).

In children and adults muscular stiffness in the jaw is a common first sign of tetanus. This symptom is followed by stiffness in the neck, difficulty swallowing, stiffness in the stomach muscles, muscle spasms, sweating, and fever. Newborn babies with tetanus are normal at birth, but stop sucking between 3 and 28 days after birth. They stop feeding and their bodies become stiff while severe muscle contractions and spasms occur. Death follows in most cases (1).