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Tetanus  [PDF]
P Poudel,S Budhathoki,S Manandhar
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i3.2744
Abstract: Tetanus is now a rare disease in developed world. However it remains an important cause of death worldwide and is associated with a high case fatality, particularly in the developing world. Tetanus is caused by contamination of wound by spores of Clostridium tetani. Neonatal tetanus results from contamination of the umbilical stump at or following delivery of a child born to a mother who did not possess sufficient circulatory antitoxin to protect the infant passively by transplacental transfer. It produces its clinical effects via a powerful exotoxin, tetanospasmin, which leads to uncontrolled disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, causing intense muscular rigidity and spasm. Shorter incubation and onset times are associated with more severe disease and poorer prognosis. Four clinical forms of tetanus are recognised. They are generalised, localised, cephalic and neonatal tetanus. Tetanus is associated with several complications like respiratory failure, cardiovascular instability, renal failure and autonomic dysfunctions. Recovery from tetanus takes a long time. Diagnosis is established clinically. Symptomatic management, early recognition of complications, careful monitoring for dysautonomia and respiratory assistance are the anchors for successful outcome of patients. Tetanus is preventable through vaccination. Vaccination is highly safe and efficacious. Active immunisation should be instituted in all partially immunised, unimmunised persons and those recovering from tetanus. Passive immunisation is given as treatment of a case as well as prevention following high risk injury. Nepal has achieved neonatal tetanus elimination status on 2005 and is running different programs to sustain the status.
TETANUS
Muhammad Shuja Tahir
The Professional Medical Journal , 1995,
Abstract: Tetanus is a serious problem which follows injuries, accidents, surgery, injections and sometimes no obviouscause. In civilized communities it has been almost eradicated with adequate immunization. Illitracy, povertyand lack of awareness are the main reasons for higher incidence of tetanus in third world countries. Properimmunization of the whole population, adequate management of injuries and by adopting the hygenic measureswe can get rid of this highly fatal but preventable disease.
INVISIBLE MURDERER: NEONATAL TETANUS
Yonca S?NMEZ
TAF Preventive Medicine Bulletin , 2006,
Abstract: Neonatal tetanus (NNT) has been secondary in the whole world in the death list of diseases which can be protected by the help of vaccine. It’s an important community health problem in the less-developed countries in which pre-birth care services are limited, assisting a mother at childbirth by uneducated people in dirty atmosphere and the immunity against tetanus is not enough. Studies have shown that minor part of the cases have been expressed in most of the countries. Because of that NNT have been called as “silent/invisible murderer”. In Turkey, in the year of 2003 it has been seen 15 cases, and 12 of them have been resulted in death. The methods which will be applied to carry out the elimination of NNT are; the vaccination of pregnant women with at least two doses tetanus toxoid and providing clean birth conditions for all of the pregnant women. However, in Turkey the proportion of the women who have two doses of tetanus vaccine is 41%. To eliminate NNT in our country, all the pregnant women must be attained, the ones who are attained must be presented with qualified pre-birth care service which also includes tetanus immunity and the births must be carried out under healty conditions. As smallpox and polio eradication, NNT elimination will also be accomplished by self-sacrificing works of personnel in primary health care.
Features of Tetanus in Eight Adult Patients in stanbul Metropolis
G?nül ?ENG?Z,Filiz YILDIRIM,Kadriye KART YA?AR,Mehmet BAKAR
Trakya Universitesi Tip Fakultesi Dergisi , 2009,
Abstract: Although tetanus is a vaccine-preventable disease, it still occurs due to deficiency in vaccination. We followed eight patients (median age 44 years; %75 men) with tetanus referred to our center between 1998-2002. They had contracted tetanus by surgical wound, burn, animal bite or minor wounds. Five of them had sought medical care when injured. Their wounds were treated (four patients), but tetanus vaccination was applied to only one patient, none were given tetanus immune globulin (TIG). Tetanus was fatal in half of the patients and death occurred within 2-30 days. Even minor injuries carry a risk for this highly fatal illness, and the patients' primary vaccination history is very important for treatment. Knowledge and awareness of healthcare workers, especially emergency department workers should be refreshed periodically. Wound treatment, TIG and tetanus toxoid applications are as important as primary immunization.
PENETAPAN STANDAR NASIONAL TOKSOID SERAP TETANUS  [cached]
Muljati Prijanto,Farida S.,Siti Mariani S.
Bulletin of Health Research , 2012,
Abstract: To check the potency of DPT vaccine, standard preparations of the components, namely Adsorbed Diphtheria Toxoid, Pertussis Vaccine and Adsorbed Tetanus Toxoid, are needed. Since WHO International Standard Preparations are distributed only in limited amounts, WHO has suggested that each member country should develop a National Standard, which is matched against International Standard Preparations. An Indonesian National Standard of DPT vaccine (lot 1) has been prepared and lyophilized at the National Institute of Health in Tokyo. The potency of the National Standard of Tetanus Toxoid adsorbed was determined by challenge method in guinea pigs. After several experiments, the potency of the National Standard of Tetanus Toxoid adsorbed was decided i.e. 76 IU/ml. Using the same standard preparations, namely the National Standards, it is hoped that from a lot of DPT vaccine, similar results of potency could be achieved when determined by the Government Vaccine Quality Control Laboratory and the Manufacturer's laboratory.
TREATMENT OF TETANUS
SAJID SHEIKH
The Professional Medical Journal , 2007,
Abstract: Objective: (1) To find out the result of drug to what extent it reduces the need for sedatives. (2) Tocompare the results with other treatment. Study Design: Prospective analytical. Setting: Tetanus ward D.H.Q.Hospital Faisalabad/ Subjects & Methods: Six patients with Tetanus were studied Inclusion Criteria: Adultmale&females suffering from Tetanus. Exclusion Criteria: Patient with known peptic ulcer disease and benignprostatic hyperplasia. Results: Six patients were given trial of Atropine infusions with continuous monitoring of pulseand blood pressure. Patients were provided conventional sedation along with Atropine infusion. The requirement ofsedative drug was significantly reduced when the dose of Atropine was gradually increased. The patients remainedmentally alert with marked reduction in muscle spasm, convulsion ,no element of anxiety or agitation. Respiratoryproblems were minimized. One female expired probably due to septic shock from induced abortion. Conclusion:Atropine sulphate is cheaper drug ,easily available ,short half life, minimal side effect and much important in developingand under developed countries where ICU facilities are not available.
Immunogenicity test of tetanus component in adsorbed vaccines by toxin binding inhibition test
Matos, Denise Cristina Souza;Marcovistz, Rugimar;Cabello, Pedro Hernan;Georgini, Ricardo Amaral;Sakauchi, Dirce;Silva, Luciana Leite da;
Memórias do Instituto Oswaldo Cruz , 2002, DOI: 10.1590/S0074-02762002000600030
Abstract: samples from 20 lots of diphtheria-tetanus (adult use dt) vaccine and from 20 lots of diphtheria-tetanus-pertussis (dtp) vaccine were used to standardize and validate the in vitro toxin binding inhibition (tobi) test for the immunogenicity test of the tetanus component. the levels of tetanus antitoxin obtained by tobi test were compared to those obtained using the toxin neutralization (tn) test in mice routinely employed to perform the quality control of the tetanus component in adsorbed vaccines. the results ranged from 1.8 to 3.5 iu/ml for dt and 2 to 4 iu/ml for dtp by tobi test and 1.4 to 3 iu/ml for dt and 1.8 to 3.5 iu/ml for dtp by tn in mice. these results were significantly correlated. from this study, it is concluded that the tobi test is an alternative to the in vivo neutralization procedure in the immunogenicity test of the tetanus component in adsorbed vaccines. a substantial refinement and a reduction in use of animals can be achieved.
Immunogenicity test of tetanus component in adsorbed vaccines by toxin binding inhibition test  [cached]
Matos Denise Cristina Souza,Marcovistz Rugimar,Cabello Pedro Hernan,Georgini Ricardo Amaral
Memórias do Instituto Oswaldo Cruz , 2002,
Abstract: Samples from 20 lots of diphtheria-tetanus (adult use dT) vaccine and from 20 lots of diphtheria-tetanus-pertussis (DTP) vaccine were used to standardize and validate the in vitro toxin binding inhibition (ToBI) test for the immunogenicity test of the tetanus component. The levels of tetanus antitoxin obtained by ToBI test were compared to those obtained using the toxin neutralization (TN) test in mice routinely employed to perform the quality control of the tetanus component in adsorbed vaccines. The results ranged from 1.8 to 3.5 IU/ml for dT and 2 to 4 IU/ml for DTP by ToBI test and 1.4 to 3 IU/ml for dT and 1.8 to 3.5 IU/ml for DTP by TN in mice. These results were significantly correlated. From this study, it is concluded that the ToBI test is an alternative to the in vivo neutralization procedure in the immunogenicity test of the tetanus component in adsorbed vaccines. A substantial refinement and a reduction in use of animals can be achieved.
Generalised tetanus: A rare complication of Richter’s hernia
MA Alhaji, AG Farouk, RB Imam, FL Bukar
Nigerian Journal of Paediatrics , 2013,
Abstract: We present a case report of generalized tetanus following umbilical Richter’s hernia in a 10 month old unimmunized boy. This case is reported because tetanus is a rare complication of Richter’s hernia and to emphasize the need for immunization of all unimmunized children with tetanus vaccine. A high index of suspicion is important in the diagnosis of Richter’s hernia in order to avoid complication, as diagnosis is often delayed or missed. The co-exiting tetany is also a rare co-morbidity of Richter’s hernia.
Post-neonatal Tetanus in Nigeria: The need for Booster doses of Tetanus Toxoid
OJ Fatunde, JB Familusi
Nigerian Journal of Paediatrics , 2001,
Abstract: Eighty-two (87 per cent) of the 94 cases of post-neonatal tetanus patients seen in the department of paediatrics, University College Hospital, Ibadan, over an 11-year period were aged five years and above. Persistent occurrence of this preventable condition for which an effective vaccine is available indicates deficiencies in the health system of the country. Although, a case fatality rate of 12 per cent compared favourably with those of centres employing more sophisticated treatment modalities, morbidity was high with patients spending an average of 23 days (range 3 to 76 days) in hospital. Although no reliable record of tetanus immunization was obtained in 37 of the patients, 34, 8 and 15 patients received doses of DPT immunization of 0, 1 - 2 and 3, respectively, during infancy. No patient had tetanus toxoid (TT) administered after infancy. The findings indicate that the current Expanded Programme on Immunisation (EPI) recommended by the WHO for developing countries of which three doses of DPT are given during infancy with no provision for booster doses, is inadequate for tetanus prevention during childhood. It is suggested that a clause be added to the EPI schedule, advising two extra doses of TT between ages four to six years and 11 to 12 years (entry into primary school and secondary school, respectively) for all children. In order to ensure compliance, these booster doses of TT could be made prerequisites for entry into these schools. Nigerian Journal of Paediatrics 2001; 28:35. pp. 35-38
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