Epidemiological and clinical aspects of neonatal tetanus from a tertiary care hospital

Abstract

Background and objectivesTo study the epidemiology, clinical presentation and outcome of all patients diagnosed with neonatal tetanus and to provide a recommendation for maternal and neonatal tetanus elimination.Design and settingRetrospective study of all cases of neonatal tetanus admitted from 1991 to 2013.Neonatal intensive care unit, King Fahad Central Hospital, Jazan, Saudi Arabia.ResultsThirty patients were diagnosed with neonatal tetanus over 22 years. Eighteen (60%) of the patients were born to Saudi mothers, and 12 (40%) were born to non-Saudi mothers. Twenty-seven (90%) deliveries occurred at home. Most of the mothers lived in the mountainous zone of the region. Two (10%) of the mothers had only a single dose of the tetanus toxoid; the status of the remaining pregnant women was unknown or unimmunized before or during conception. In 18 of the 30 patients (60%), the umbilical cord was severed using household knife, razor blade or plain scissors. Most of the patients presented with muscle spasms (96.7%), refusal to eat and abnormal posture. All of the patients were intubated and receiving mechanical ventilation. Six (20%) of the patients died.ConclusionIt is essential to begin campaigns or integrate complete maternal tetanus toxoid immunization at primary health centers (PHC) during antenatal care. Immunization needs to be arranged so pregnant women can be educated regarding the importance of ANC and the risks of unhygienic home delivery, and immunization should be addressed with adequate information. Pregnant women and those of childbearing age in mountainous areas should be the first targets for these activities.

Increasing Frequency of Antenatal Care Visits May Improve Tetanus Toxoid Vaccination Coverage in Pregnant Women in Pakistan

“…Hygienic childbirth practices in homes and healthcare centers with sterilized instruments provided are an essential additional preventive measure to reduce MNT. 5 Besides, regular antenatal care visits and improved vaccination can also result in a reduction of pregnancy and obstetric complications. 6…”

“…Hygienic childbirth practices in homes and healthcare centers with sterilized instruments provided are an essential additional preventive measure to reduce MNT. 5 Besides, regular antenatal care visits and improved vaccination can also result in a reduction of pregnancy and obstetric complications. 6 Poor maternal vaccination, inadequate antenatal care, home deliveries with the unhygienic umbilical stump, and delivery kits are still triggering MNT in developing countries, 7 such as Pakistan, that is a low-income country facing this serious public health issue of MNT elimination.…”

Generalized tetanus: a pediatric case report and literature review

“…It should be kept in mind that completing the full tetanus vaccination series during childhood, and maintaining immunity with tetanus booster shots during adulthood is essential and life-saving 28 . As seen in our review, this fatal disease (neonatal tetanus) still exists in areas where vaccination is not sufficient 22 . It is essential to vaccinate previously unvaccinated mothers in the prenatal period to prevent neonatal tetanus 33 .…”

Routine Vaccination During COVID-19: A Case of Maternal Neonatal Tetanus From Pakistan

“…Similarly, “disinfected” childbirth practices in homes and healthcare centers with provided sterilize instruments could also be an important preventive measure to reduce maternal neonatal tetanus toxoid ( 11 ). It has been reported that only 55% of births in Pakistan are attended by skilled health personnel ( 12 ).…”