Neonatal tetanus

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Neonatal tetanus
Other names: Maternal neonatal tetanus (MNT)
Neonatal tetanus 6374.jpg
Neonatal tetanus
SpecialtyPediatrics, Infectious disease
Usual onsetNewborn[1]
PreventionTetanus vaccine to unimmunized mother during pregnancy[1]
Deaths25,000/year[1]

Neonatal tetanus (trismus nascentium) is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from an immunized mother are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.[2]

The WHO recommend that unimmunized pregnant women receive two doses of tetanus toxoid, usually as Tdap, at least four weeks apart, with the first dose as early as possible in the pregnancy and the second dose at least two weeks before delivery.[1]

Globally, neonatal tetanus caused around 787,000 deaths in the early 1980s.[1] In 1989, the WHO launched a programme to vaccinate all pregnant women, and deaths from neonatal tetanus dropped to 25,000 in 2018.[1]

Signs and symptoms

In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. The fatality rate for infants has been estimated as 70% to 100%; death usually occurs by the age of 2 weeks.[3] On the basis of clinical findings, four different forms of tetanus have been described.[4] The time from exposure to symptoms may be up to several months.[5] The neonate is unable to suck and cry, is rigid, and develops spasms.

Cause

Tetanus is due to Gram-positive bacillus C tetani, and the toxin it produces[6]

Diagnosis

Differential diagnosis

The DDx of this condition is as follows:[6]

Prevention

A tetanus shot is administered to a child and her mother

The spores which cause tetanus are present everywhere, so the only prevention is immunization. Three properly spaced doses of tetanus toxoid vaccine are recommended for women of childbearing age, either before or during pregnancy; this will protect their future babies from neonatal tetanus after delivery.[3]

Public health campaigns

In 1989, the World Health Congress called for the elimination of neonatal tetanus. UNICEF took the lead, assisted by other United Nations agencies, individual governments, and non-profit organisations. By 2000, the disease was declared as eliminated from 104 of 161 developing countries.[7] "Elimination" is defined as less than 1 case per 1,000 live births in every district of the country.[3] Since tetanus can also strike postpartum mothers, the campaign has been expanded to target both maternal and neonatal tetanus.[3]

In many affected countries, there was a lack of awareness of maternal and neonatal tetanus and how to prevent it. Education and immunisation campaigns have been launched in the remaining countries at risk and are targeted particularly at pregnant women.[2] Education focuses on hygienic birth practices and infant cord care as well as the need for immunisation.[8]

In Egypt, the number of cases of neonatal tetanus dropped from 4,000 to fewer than 500 annually as the result of an immunisation campaign. In Morocco, neonatal tetanus accounted for 20% of neonatal deaths in 1987 but only 2% in 1992. In 1998 in Uganda, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda in 2011 was certified as having eliminated tetanus.[9] In 2011, Pampers joined with UNICEF to target maternal and neonatal tetanus in Yemen.[10] In 2010, Kiwanis International pledged to raise $110 million to eliminate maternal and neonatal tetanus throughout the world in partnership with UNICEF.[11]

On 15 May 2015, the World Health Organization (WHO) declared India free from maternal and neonatal tetanus. India has reduced its infant mortality rate (IMR) from 380 per 1000 live births in 1990, to 40 in 2015, and its maternal mortality rate (MMR) from 540 per 100,000 to 167 in the same years.[12] The national health programme was started in 1983 by the Government of India, when all pregnant women were given two doses of tetanus vaccine. The number of deaths from tetanus dropped from 79,000 in 1990, to less than 500 in 2013 and 2014.

Management

In terms of the treatment of tetanus the following is done:[6]

  • Toxin neutralisation
  • Bacterial elimination
  • Symptomatic control

Epidemiology

New-neonatal-tetanus-cases-per-million.png


Countries that have eliminated maternal neonatal tetanus as of 2018.[13]

In 2000, neonatal tetanus was responsible for about 14% (215,000) of all neonatal deaths.[14] In 2008, 59,000 newborns worldwide died as a result of neonatal tetanus.[15][16] In 2005, 57 countries were identified as still at risk, with 27 countries accounting for 90% of cases.[3] As of December 2013 the number of countries at risk was reduced to 25.[17]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Vesikari, Timo; Maertens, Kirsten; Finn, Adam (2021). "6. Maternal immunization". In Vesikari, Timo; Damme, Pierre Van (eds.). Pediatric Vaccines and Vaccinations: A European Textbook (2nd ed.). Switzerland: Springer. p. 50. ISBN 978-3-030-77172-0. Archived from the original on 2023-09-16. Retrieved 2023-10-10.
  2. 2.0 2.1 Roper, Martha H; Vandelaer, Jos H; Gasse, François L (12 September 2007). "Maternal and neonatal tetanus" (PDF). The Lancet. 370 (9603): 1947–1959. doi:10.1016/s0140-6736(07)61261-6. PMID 17854885. Archived (PDF) from the original on 3 November 2019. Retrieved 1 September 2015.
  3. 3.0 3.1 3.2 3.3 3.4 "Maternal and Neonatal Tetanus Elimination by 2005" (PDF). UNICEF. Archived from the original (PDF) on 11 January 2007. Retrieved 17 February 2014.
  4. "Tetanus" (PDF). CDC Pink Book. Archived (PDF) from the original on 6 March 2008. Retrieved 19 January 2014.
  5. Brauner, JS; Vieira, SR; Bleck, TP (Jul 2002). "Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil". Intensive Care Medicine. 28 (7): 930–5. doi:10.1007/s00134-002-1332-4. PMID 12122532. S2CID 21772357.
  6. 6.0 6.1 6.2 Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R (January 2015). "Maternal and neonatal tetanus". The Lancet. 385 (9965): 362–370. doi:10.1016/S0140-6736(14)60236-1. Archived from the original on 14 March 2022. Retrieved 13 May 2022.
  7. "Neonatal tetanus" (PDF). Unicef. Archived (PDF) from the original on 4 March 2016. Retrieved 19 January 2014.
  8. Saleh, JA; Nemecek, J; Jones, C (2015). "Impact of hygienic caring of the umbilical cord in the prevention of neonatal tetanus". WebmedCentral PUBLIC HEALTH. 6 (5). Archived from the original on 9 September 2015. Retrieved 1 September 2015.
  9. "Uganda announces elimination of Maternal and Neonatal Tetanus". Unicef Media Centre. Archived from the original on 11 February 2015. Retrieved 19 January 2014.
  10. "Pampers and UNICEF aim to eliminate maternal and neonatal tetanus in Yemen". AME info.com. March 29, 2011. Archived from the original on 2 February 2014. Retrieved 19 January 2014.
  11. "Maternal and Neonatal Tetanus". UNICEF United States Fund. Archived from the original on 6 February 2014. Retrieved 17 February 2014.
  12. "India declared maternal and neonatal tetanus free: Modi". The Hindu. 27 August 2015. Archived from the original on 8 May 2017. Retrieved 1 September 2015.
  13. "Year of Maternal Neonatal Tetanus (MNT) elimination". Our World in Data. Archived from the original on 7 March 2020. Retrieved 5 March 2020.
  14. "Maternal and Neonatal Tetanus Elimination by 2005" (PDF). UNICEF. November 2000. Archived from the original (PDF) on 2007-01-11. Retrieved 2007-01-26.
  15. "Maternal and Neonatal Tetanus Elimination Initiative" (PDF). Pampers UNICEF 2010 Campaign: 2. Archived from the original (PDF) on 2014-02-01. Retrieved 2021-12-12.
  16. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, Child Health Epidemiology Reference Group of WHO and, UNICEF (Jun 5, 2010). "Global, regional, and national causes of child mortality in 2008: a systematic analysis". Lancet. 375 (9730): 1969–87. doi:10.1016/S0140-6736(10)60549-1. PMID 20466419. S2CID 27812760.
  17. "Elimination of Maternal and Neonatal Tetanus". UNICEF. Archived from the original on 21 February 2014. Retrieved 17 February 2014.

Further reading

External links