3.3.4 Treatment, prevention and control of tetanus
Once a person has tetanus, he or she will be treated by an antibiotic drug. Antibiotics are medicines that destroy bacteria, or stop them from multiplying in the body. However, many people who have tetanus die despite the treatment. Hence, prevention is the best strategy, and vaccination is the best way to prevent tetanus.
Tetanus toxoid (TT) vaccination
The tetanus vaccine contains inactivated tetanus toxoid (poison), which is why it is often called TT vaccine. Tetanus toxoid vaccination is given routinely to newborns and infants as part of the threefold DPT vaccine (with diphtheria and pertussis vaccines), or the pentavalent (fivefold) vaccine, which includes vaccines for diphtheria, tetanus, pertussis, Hepatitis B (a virus), and a bacterium called Haemophilus influenzae type B (Hib). Neonatal tetanus can also be prevented by vaccinating women of childbearing age with tetanus toxoid vaccine, either during pregnancy or before pregnancy. This protects the mother and enables anti-tetanus antibodies to be transferred to the growing fetus in her uterus.
What is the name given to this mode of transmission? (You learned about it in Study Session 1 in reference to infectious agents being transferred from mother to baby).
The transmission from mother to fetus is called transplacental transmission because the mother’s antibodies pass across the placenta and into the baby.
Cleanliness is also very important, especially when a mother is delivering a baby, even if she has been vaccinated with TT vaccine.
People who recover from tetanus do not have increased natural immunity and so they can be infected again. Therefore they will need to be vaccinated.
The World Health Organization (WHO) and UNICEF set a goal to eliminate neonatal tetanus by 2005. Elimination in this case would mean that the number of neonatal tetanus cases would have to be reduced to below one case per 1,000 live births per year in every district. Notice that elimination of a communicable disease does not mean there are no cases — just very few right across a country or region. Eradication means the total and sustained disappearance of the disease from the population.
Do you think that tetanus can ever be eradicated? Explain why, or why not.
Because tetanus bacteria survive in soil in the environment, eradication of the disease is not possible.
To achieve the elimination goal, countries like Ethiopia, with a high number of tetanus cases every year, need to implement a series of prevention strategies, which include those listed in Box 3.1.
Clean delivery practices are described in the Labour and Delivery Care Module.
Box 3.1 Strategies to prevent and control tetanus
- Vaccinating a higher percentage of pregnant women against tetanus with vaccines containing tetanus toxoid (TT).
- Vaccinating all females of childbearing age (approximately 15–45 years) with TT vaccine in high-risk areas where vaccination coverage is currently low.
- Outreach vaccination campaigns where health workers go to rural villages and give TT vaccine, usually three times at intervals (known as a ‘three-round’ vaccination campaign).
- Promoting clean delivery and childcare practices, through better hygiene and care of the newborn’s umbilicus.
- Improving surveillance and reporting of cases of neonatal tetanus. The case finding and reporting will help us to give appropriate treatment and vaccination to children.