Tetanus in School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Need for Booster Doses of Tetanus Vaccine

Abstract

Background: Tetanus still causes significant morbidity and mortality amongst children in Nigeria despite decades of immunisation with tetanus vaccine.
 Objectives: To determine the prevalence, case fatality rate and predictors of fatality amongst school age children treated for tetanus at the University of Port Harcourt Teaching Hospital.
 Materials and Methods: This was a retrospective study of all children aged 4 to 17 years treated for tetanus at the University of Port Harcourt Teaching Hospital between January 1, 2009 and December 31, 2019. Data was obtained from the case notes and ward registers. Socio-demographic characteristics, presenting complaints, incubation period, onset interval, number of Diphtheria, Pertussis and Tetanus (DPT) vaccine received at infancy, treatment outcome, duration and cost of hospital stay were obtained, entered into a spread sheet and analysed with SPSS version 20. Results are presented in tables and percentages. The level of significance was set at P value <0.05.
 Results: During the period under review, there were 53 children aged 4 to 17 years treated for tetanus, accounting for 0.3% of the total admission. The mean age was 10.79±3.35 years. There were 33 (62.26%) males and 20 (37.74%) females. Majority 26 (49.06%) of the children were of low socioeconomic class. The commonest 28(52.8%) route of infection was broomstick injury. Majority 32(60.3%) of the children were not immunised in infancy. The mean incubation period was 7.34±4.21 days and the mean onset interval was 8.87±10.44 hours. The two most common symptoms were generalized spasms 49 (21.03%) and trismus 47 (20.17%). Short incubation period (≤4 days) and short onset interval (≤4 hours) were significantly associated with higher death rates (p=0.0002; p=0.012). Patients with short incubation period of ≤4 days and short onset interval of≤ 4 hours are more likely to die (p=0.0002; p=0.012).
 Conclusion: There was a high tetanus case fatality rate amongst school age children at University of Port Harcourt. Short incubation period and onset interval were associated with higher mortality. Booster doses of TT containing vaccines should be administered to primary and secondary school children in Port Harcourt to curb the menace.

Post Neonatal Tetanus as Seen in Rivers State University Teaching Hospital, Nigeria: Prevalence, Clinical Profile and Outcome

“…The fact that the commonest portal of entry in this study was from traumatic injuries corroborates it. The higher prevalence of PNT among male children as observed in this study is well documented in other studies [26][27][28][29][30] and this has been alluded to males being more involved in outdoor activities and therefore more prone to injuries than their female counterparts.…”

“…The same observation was also noted by earlier studies reported by Yaguo Ide et al [8] in Port Harcourt and in other studies carried out in Nigeria, [26,27,29,31] and Ethiopia. [33] It is quite interesting that the mean age of the study population of 10±2.68 years, similar to that reported in other studies in the country [28][29][30] may be contributory to the higher incidence of PNT among children in the older age groups. It is pertinent to note that the 3 doses of tetanus toxoid vaccine given to infants in the primary immunization series in Nigeria protects them from tetanus for about 3-4 years.…”

“…The same observation was also made in an earlier study conducted in a different tertiary health facility in Port Harcourt. [30] This finding was however contrary to that reported in Calabar, [31] and Lagos [28] where the prevalence of PNT was higher among children aged 5-10 years. The differences observed could be as a result of geographical differences where the studies were carried out.…”

“…[33] Probably because children are prone to injuries while playing especially outdoors in the sand, where their wounds can be easily contaminated with the spores of clostridium tetani. In earlier studies conducted in Port Harcourt, [8,30] broomstick injury was however the commonest portal of entry. This portal of entry for PNT was also documented by Komomo et al [31] and Ijiezie et al [36] in Calabar and Uyo respectively.…”

“…The study at Uyo, reported that this injury is obtained when caregivers flog their children with the broom, mostly when upset with them. [36] It is however interesting to note that broomstick injury as a portal of entry was only documented in studies carried out in the south-south geopolitical region of Nigeria and not in other parts of the country [26][27][28][29][30] or in other countries. [33,35] One can only ponder at this stage if this behaviour of using broom to flog children is peculiar to this geopolitical zone of the country or if it was erroneously omitted in studies from other parts of Nigeria.…”