What you need to know:
- Without treatment, one out of four infected people die. The death rate for new-borns with untreated tetanus is even higher. With proper treatment however, less than 15 percent of infected people die.
One of the 12 killer diseases immunised against, among children, is tetanus. It affects the nervous system and results in uncontrollable muscle spasms, affecting different parts of the body or the whole body, depending on the type. These spasms lead to organ injury and compromise of vital functions, sometimes leading to death if untreated.
Tetanus occurs when the body takes up toxins produced by tetanus germs (clostridium tetani) that are freely living in our environment (in the soil and dirty places as its natural habitat).
Dr Erasmus Okello, the head of anaesthesiology and critical care medicine at TMR Hospital in Kampala, says the germs survive harsh conditions as spores (an adaptive developmental mechanism for germs to survive drought, heat and difficult conditions).
“When one gets pierced by a nail or thorn, it will bury some of the soil into one’s skin. Even when the wound cures, the spores remain in the wound’s dead tissue, a conducive environment for feeding and regeneration. These then hatch into bacteria and colonise the area by releasing toxins. Unfortunately, these toxins then get absorbed into our bloodstream,” he says, adding that bacteria never dwell in our bloodstream because it has oxygen which kills them.
Therefore, Dr Okello says, tetanus is common among people who work the soil or usually walk barefoot.
Vaccination and good wound care are important to help prevent tetanus infection. Dr Sabrina Kitaka, a paediatric infectious diseases specialist, says doctors can also use medicine to help prevent tetanus when someone is seriously hurt and is not up-to-date with tetanus vaccination.
Being up-to-date with tetanus vaccination is the best prevention tool.
“Protection by vaccines, as well as a prior infection, do not last a lifetime. This means people who had tetanus or got vaccinated before still need to get vaccinated regularly to keep a high level of protection against this serious disease. Centre for Disease Control (CDC) recommends tetanus vaccines for people of all ages, with booster shots throughout life on a 10 year basis,” Dr Kitaka says.
Among babies, vaccination is done before one year; at six weeks, 10 weeks and 14 weeks, given as DPT.
“The next booster is recommended before starting school at five years, then a repeat booster at 10 years and continuously, every 10 years. The boosters given are a minimum of three doses given four weeks apart,” she says.
Girls and women in the reproductive age should get their booster doses to prevent neonatal tetanus.
“To prevent neonatal tetanus, maternal immunisation is recommended with two doses of tetanus toxoid, four weeks apart during pregnancy for women who have never been vaccinated or incompletely vaccinated. For long-lasting maternal protection, a total of five doses should be given; a third dose should be given six months after the second dose and then two subsequent doses should be given five and 10 years later. Maternal vaccination provides protection for an estimated 84 percent of the neonates,” Dr Kitaka adds.
Symptoms and related fatalities
For one that is unvaccinated, when the bacteria produce toxins, they are circulated by the blood streams, ending up in the nervous system. They cause several effects and Dr Okello explains these:
● It starts by blocking the body’s nerves starting with the smallest nerves, hence facial stiffness causing one to appear as though they are smiling all the time (sardonic smile).
● The effects then progress to cause spasms in the muscles, making it almost impossible to swallow.
● Tetanus can cause spasms of the respiratory muscles so one cannot breathe well.
● There can also be an abnormality of the cardiovascular empowering nervous system causing the heart and blood vessels to malfunction, hence high blood pressure and increased heart beat which can lead to death.
● Similarly, the contraction of muscles can lead to muscle damage causing the muscles to release toxins into the muscle cells. These toxic chemicals can affect the heart, kidney leading to death.
● Because the person cannot drink, they will get dehydrated.
● Starvation also arises since one cannot eat enough yet are using a lot of energy.
● Complications such as blood clots, wounds and infections may also arise due to not being able to move.
Depending on the type one has, Dr Okello says, the symptoms may manifest differently. However, he emphasises, once symptoms start, one should seek immediate medical attention.
Treatment must be supportive because once symptoms start, the inhibitory nerves have been damaged, causing the body to react so aggressively to stimuli. This causes spasms for every action such as seeing bright light and the need to urinate, yet these must exist in our lives.
“The treatment supports the body to outlive the effect because the nerves are damaged irreversibly. The hope is that the nerves will regenerate over time which takes at least three weeks (by that time, the toxins should have reduced by half). However, that also depends on the quantity of the toxins in the body as well as how fast one seeks medical help,” Dr Okello says.
Care involves preventing the body from experiencing environmental stimuli so they do not experience spasms. Dr Okello says, previously, they would put someone in a dark, silent place but did not abolish the symptoms so patients died.
“Today, we take them to the Intensive Care Unit (ICU) and sedate them. We also put them on life support because they cannot breathe well or cough to clear secretion from their lungs, making them prone to pneumonia. Sometimes, we must paralyse the body,” he says.
The medical team also ensures the patients remain well hydrated, giving them lots of fluids so the toxins from muscle spasms do not accumulate in the body as these can affect the heart and kidneys. They also ensure the heart rate is regulated. Upon admission, the medical personnel look to cut off the transfer of toxins to the body immediately.
“Therefore, we must identify the affected part, such as a wound and do surgical cleaning up, cut out all the dead tissue to stop bacteria thriving. We also look out for infections and treat them with antibiotics to kill the bacteria,” Dr Okello says.
Most people that get tetanus are not vaccinated or have not got a booster dose in a while. Therefore, they are vaccinated immediately to prevent any future infections.
“Additionally, anti-tetanus immune globulin, an antibody against tetanus toxins is injected into the affected site and the rest of the body so the antibodies are absorbed to reduce the toxins. It reduces the duration of the illness but also quickens recovery,” Dr Okello says.