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Tetanus

    Disease Outbreak

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    Overview

    Tetanus, or lockjaw, is a bacterial infection that is characterized by painful muscle spasms, serious complications, and can lead to eventual death. Tetanus is not transmitted from person-to-person. A person usually becomes infected with tetanus when dirt enters a wound or cut.

    Tetanus germs are likely to grow in deep puncture wounds caused by dirty nails, knives, tools, wood splinters, and animal bites. The disease is caused by a potent neurotoxin that is produced by the bacteria in the absence of oxygen.

    People of all ages can get tetanus but it can be prevented by the administration of tetanus toxoid, which induces specific antitoxins. To prevent maternal and neonatal tetanus, tetanus toxoid needs to be given to the mother before or during pregnancy, and clean delivery and cord care needs to be ensured.

    The disease is particularly common and serious in newborn babies. This is called neonatal tetanus and most infants die who get the disease. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures.

    People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.

    Factsheet

    Key Facts

    • Tetanus is acquired when the spores of the bacterium Clostridium Tetani infect a wound or a newborn's umbilical stump.
    • These spores are universally present in the soil.
    • People of all ages can get tetanus but the disease is particularly common and serious in newborn babies (neonatal tetanus).
    • Neonatal tetanus, which is mostly fatal, is particularly common in rural areas where deliveries are at home without adequate sterile procedures.
    • Neonatal tetanus requires treatment in a medical facility, often in a referral hospital.
    Prevention
    • Tetanus can be prevented through immunization with tetanus-toxoid (TT) containing vaccines.
    • Neonatal tetanus can be prevented by immunizing women of childbearing age with TT, either during pregnancy or outside of pregnancy. This protects the mother and – and through a transfer of tetanus antibodies to the fetus – also her baby.
    • Clean practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus.
    • People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.
    • To be protected for life, an individual should receive 3 doses of diphtheria/tetanus/pertussis vaccine in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood.
    Elimination goal
    • The global neonatal tetanus elimination goal was launched at the World Health Assembly in 1989 to reduce neonatal tetanus as a public health problem (defined as less than one case of neonatal tetanus per 1,000 live births in every district) in all countries.
    • The Maternal and Neonatal Tetanus (MNT) Elimination Initiative was launched by the United Nations Children’s Fund (UNICEF), WHO and the United Nations Population Fund (UNFPA) in 1999, revitalizing the goal of MNT elimination as a public health problem. Maternal tetanus was added as it is assumed to be eliminated once neonatal tetanus elimination has been achieved.
    • Currently, the target year for global elimination of MNT is 2015.
    • Within the partnership1, partners bring in their own field of expertise:
      • Countries: implementation of recommended strategies;
      • UNICEF: coordination of accelerated activities and strengthening routine immunization to achieve and maintain MNT elimination;
      • UNFPA: promotion of clean deliveries;
      • WHO: monitoring and validation of elimination status, development of strategies for maintaining elimination and strengthening routine immunization.
    • The recommended strategies for achieving MNT elimination include:
      • Strengthening routine immunization of pregnant women with TT;
      • TT Supplementary Immunization Activities (SIAs) in selected high-risk areas, targeting women of child bearing age with 3 properly spaced doses of TT;
      • Promotion of clean deliveries;
      • Reliable neonatal tetanus surveillance.
    • Once MNT elimination has been achieved, maintaining elimination will require continued strengthening of routine immunization activities for both pregnant women and children, maintaining and increasing access to clean deliveries, reliable NT surveillance, and introduction of school-based immunization, where feasible.
    Global progress 1999-2011
    • Over 113 million women of child bearing age were reached with 2 doses of TT.
    • 25 countries2 (plus Ethiopia (all except Somali region), 15/33 States and Union Territories in India3 and 29/34 Provinces in Indonesia eliminated MNT.
    • WHO estimates that in 2008 (the latest year for which estimates are available), 50,000 newborns died from neonatal tetanus, a 92% reduction from the situation in the late 1980s.
    • 34 countries have yet to eliminate MNT4.
    1. WHO, UNICEF and UNFPA have been joined by other partners including Becton Dickinson (BD), USAID, CDC, Immunisation Basics, Government of Japan and JICA, Save the Children, GAVI, Procter&Gamble (Pampers), PATH, RMHC, the Gates Foundation, UNICEF National committees and governments throughout the world and most recently the Kiwanis International.
    2. Bangladesh, Benin, Burundi, Burkina Faso, Comoros, Congo (the), Egypt, Eritrea, Guinea-Bissau, Liberia, Malawi, Mozambique, Myanmar, Namibia, Nepal, Rwanda, Senegal, South Africa, Togo, Turkey, Uganda, Viet Nam, Zambia and Zimbabwe.
    3. Andhra Pradesh, Chandigarh & Goa, Gujarat, Haryana, Himachal Pradesh, Karnataka, Kerala, Lakshadweep, Maharashtra, Pondicherry, Punjab & Sikkim, Tamil Nadu & West Bengal.
    4. Afghanistan, Angola, Cambodia, Cameroon, Central African Republic, Chad, China, Cote D’Ivoire, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Haiti, India (18 of 33 states), Indonesia (5/34 provinces), Iraq, Kenya, Lao People’s Democratic Republic, Madagascar, Mauritania, Mali, Gabon, The Gambia, Guinea, Niger, Nigeria, Pakistan, Papua New Guinea, Philippines, Sierra Leone, Somalia, South Sudan, Sudan, Tanzania, Yemen.

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