Is Adult Tetanus an Endemic in India?

Surabhi GS; Renuka Prithviraj; Lavanya R

doi:10.55489/njcm.13072022468

Authors

Surabhi GS S Nijalingappa Medical College, Bagakot, Karnataka, India
Renuka Prithviraj Sapthagiri Institute of Medical sciences and Research centre, Bengaluru, India
Lavanya R Sapthagiri Institute of Medical sciences and Research centre, Bengaluru, India

DOI:

https://doi.org/10.55489/njcm.13072022468

Keywords:

Tetanus, Adult immunization

Abstract

Background: Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked.

Methods: An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tetanus, clinical features and the outcome of tetanus.

Results: Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status.

Conclusion: An early diagnosis, a proper wound management immediately after the injury, health education programs to create awareness among the public not to neglect even trivial injuries would definitely lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immunization beyond the age of 10 years.

References

Kyu HH, Shannon HS, Georgiades K, Boyle MH. Association of urban slum residency with infant mortality and child stunting in low and middle income countries. Biomed Res Int. 2013 ;2013:604974. doi: https://doi.org/10.1155/2013/604974 PMid:24151612 PMCid:PMC3789321

Park K. Park's Text book of Preventive and social medicine.25th ed.Jabalpur: Banarasidas Banot,2019,p 338

Saiyed HN, Tiwari RR. Occupational health research in India. Industrial health. 2004; 42(2):141-8. Doi: https://doi.org/10.2486/indhealth.42.141 PMid:15128163

Galazka, Artur M, Milstien, Julie B, Robertson, Susan E, Cutts, Felicity T & WHO Expanded Programme on Immunization. (‎1993)‎. The Immunological basis for immunization, Reprinted 2001. World Health Organization. Available from https://apps.who.int/iris/handle/10665/58891. Updated (2022 Mar 5); cited (2022 Mar 5)

Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep. 2012;61: 468-70. [PubMed] [Google Scholar]

Muruganathan A, Mathai D, Sharma SK, editors. Adult Immunization. J Assoc Physicians India. 2014:1-270. [Google Scholar]

Koul PA, Swaminathan S, Rajgopal T, Ramsubramanian V, Joseph B, Shanbhag S, Mishra A, Raut SK. Adult immunization in occupa-tional settings: A consensus of Indian experts. Indian Journal of Occupational and Environmental Medicine. 2020 Jan; 24(1):3. Doi: https://doi.org/10.4103/ijoem.IJOEM_50_20 PMid:32435109 PMCid:PMC7227733

Executive Summary : The Association of Physicians of India .Evidence-Based Clinical Practice Guidelines on Adult Immunization. Expert Group of the Association of Physicians of India on Adult Immunization in India.JAPI. 2009 April; vol 57

CDC. National Notifiable Disease Surveillance System: Tetanus 2010 case definition. Atlanta, GA: CDC [cited 2022 March 5] Available from https://wwwn.cdc.gov/nndss/conditions/tetanus/case-definition/2010/ . Updated (2022 Mar 5); cited (2022 Mar 5)

Rama Chaudhry et al. Tetanus in elderly: A forgotten illness. The Lancet . 2001 June ; 1357(9270), p 1805. Doi: https://doi.org/10.1016/S0140-6736(00)04924-2

Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases. World Journal of Emergency Surgery. 2011 Dec; 6(1):1-8. Doi: https://doi.org/10.1186/1749-7922-6-20 PMid:21740539 PMCid:PMC3159100

Lau LG, Kong KO, Chew PH. A ten-year retrospective study of tetanus at a general hospital in Malaysia. Singapore medical journal. 2001 Aug 1; 42(8):346-50.

Feroz AH, Rahman H. A ten-year retrospective study of tetanus at a teaching hospital in Bangladesh. Journal of Bangladesh College of Physicians and Surgeons. 2007; 25(2):62-9. Doi: https://doi.org/10.3329/jbcps.v25i2.371

Gergen PJ, McQuillan GM, Kiely M, Ezzati-Rice TM, Sutter RW, Virella G. A population-based serologic survey of immunity to tetanus in the United States. New England Journal of Medicine. 1995 Mar 23; 332(12):761-7. Doi: https://doi.org/10.1056/NEJM199503233321201 PMid:7862178

Marulappa VG, Manjunath R, Babu NM, Maligegowda L. A ten year retrospective study on adult tetanus at the Epidemic Disease (ED) Hospital, Mysore in southern India: a review of 512 cases. Journal of Clinical and Diagnostic Research: JCDR. 2012 Oct; 6(8):1377. Doi: https://doi.org/10.7860/JCDR/2012/4137.2363 PMid:23205351 PMCid:PMC3471487

Patel JC, Mehta BC. Tetanus: study of 8,697 cases. Indian journal of medical sciences. 1999 Sep 1; 53(9):393-401.

Ramachandra L, Shobha KL, Arun Kannan P. A retrospective clinical study on the factors which affected Tetanus. The Internet Jour-nal of Microbiology. 2009; 7(1). Doi: https://doi.org/10.5580/1d03

Fan Z, Zhao Y, Wang S, Zhang F, Zhuang C. Clinical features and outcomes of tetanus: a retrospective study. Infect Drug Resist. 2019 May 16;12:1289-1293. doi: https://doi.org/10.2147/IDR.S204650 PMid:31190917 PMCid:PMC6529615

Gkartziou F, Giormezis N, Spiliopoulou I, Antimisiaris SG. Nanobiosystems for Antimicrobial Drug-Resistant Infections. Nano-materials. 2021 May; 11(5):1075. Doi: https://doi.org/10.3390/nano11051075 PMid:33922004 PMCid:PMC8143556

CDC.VPD surveillance Manual. Amanda E. Faulkner, Tejpratap S. P. Tiwari: Tetanus. Atlanta, GA: CDC. Available from https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.pdf. Updated (2022 Mar 5);cited (2022 Mar 5)