The who case definition for neonatal tetanus was used. Neonatal tetanus cases january 1 march 3, 2018 figure 8. It begins when tetanus bacteria enter the body, usually through a wound or cut exposed to contaminated soil. In general, the physical examination findings are similar to those of generalized tetanus. It is for this reason that the deaths are greater than the numbers indicate. Fifteen percent of patients with tetanus had diabetes mellitus, which is three times the estimated prevalence of diabetes in the united states.
Of these, we report on five cases of neonatal tetanus diagnosed and managed in the duchess of kent hospital, sandakan which is a 323bedded district hospital serving a population of 676,000 living. Neonatal tetanus is a completely preventable disease. Only one case of neonatal tetanus was reported between 2001 and 2008. Elimination is defined as less than 1 case per 1,000 live births in every district of the country. High coverage with tetanus toxoid among pregnant women and in.
Tetanus is today a rare disease in europe and in 2007 a total of 144 cases of tetanus cases, of which 125 were confirmed, were reported by 25 eu countriesi. Visit our research pages for current research about neonatal tetanus treatments. Prevention information for neonatal tetanus has been compiled from various data sources and may be inaccurate or incomplete. New jersey department of health and senior services njdhss case definitions 1. Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. The rate of decline of neonatal tetanus incidence and case fatality was consistent with the impact of routine and supplementary immunization activities. To estimate the incidence of neonatal tetanus nt and to study the factors associated with nt mortality in dadu district, pakistan. The who definition of a confirmed neonatal tetanus case is an illness occurring in an infant who has the normal ability to suck and cry in the first 2 days of life, but who loses this ability between days 3 and 28 of life and becomes rigid or has spasms. Immunization to prevent maternal and neonatal tetanus givewell. In many countries neonatal tetanus is responsible for half of all neonatal deaths due to vaccinepreventable diseases and for almost 14% of all infant deaths. The mnte initiative aims to target areas with more than 1 neonatal tetanus case per 1,000 live births, or about 1 neonatal tetanus death per 1,000 live births without hospital care, the case fatality rate is very high. These may be observed in figure 1 which depicts a decrease in the reported suspect nt cases overtime from 20.
By 1995, 63 countries had not yet eliminated the disease, 3 including nepal. The last reported case of neonatal tetanus in the united states occurred in 1998 in montana in a newborn whose umbilical stump had been treated with nonsterile clay. Neonatal tetanus symptoms, diagnosis, treatments and. Presenting symptoms include irritability, excessive crying, grimaces, intense rigidity, and opisthotonos. A case that is classified as confirmed for reporting purposes. Controls were selected from neonates with diseases other than tetanus who were admitted to the same facility during the same period. Neonatal tetanus nt is targeted by unicef, unfpa and who for elimination as a major public health burden along with maternal tetanus. Unlike in resourcelimited nations, neonatal tetanus is extremely rare in the united states. Who and its partners the united nations childrens fund unicef and the united nations population fund are committed to eliminating maternal and neonatal tetanus. Neonatal tetanus definition of neonatal tetanus by medical. Infants who have not acquired passive immunity from the mother having been immunised are at risk. A total of 24 cases of nnt according to the who case definition were identified from hospital records, and 96 community controls children who survived the neonatal period were selected. Generalized tetanus is the most common form, accounting for approximately 80% of cases. Tetanus clostridium tetani 2010 case definition recommend on facebook tweet share compartir note.
Neonatal tetatnus or tetatnus neonatorum is a tetanus infection of the newborn baby. The number of neonatal tetanus nt cases in a given year, in a defined population, including both suspected and confirmed cases. Feb 22, 2019 tetanus is a serious disease caused by a bacterial toxin that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. In 2000, nepal developed a strategy to eliminate maternal and neonatal tetanus mnt by 2005. Of the estimated 28 countries with highest numbers of mnt cases, 16 of them are in the african region accounting for 90% global neonatal. The inclusion criteria were 1 only infants born within the neonatal period, that is, first 28 days of life, 2 all cases that had met the who case definition of nnt, 3 all nnt cases treated in health facilities, and, 4 all nnt cases treated from january 01, 2010, to december 31, 2014. Neonatal definition of neonatal by medical dictionary. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus case definition was taken as an acute illness with muscle spasms or hypertonia in the absence of a more likely diagnosis, and diagnosis of tetanus by a health care provider. Risk factors of neonatal tetanus in wenzhou, china. The case that was the exception was considered outbreak associated in 2010 a haitian patient who was transported to the u. Fifteen percent of patients with tetanus had diabetes mellitus, which is three times the estimated prevalence of.
On the basis of clinical findings, four different forms of tetanus have been described. Apr 08, 2016 a confirmed case of neonatal tetanus is defined by world health organization who as a child with a history of all three of the following. Who maternal and neonatal tetanus elimination mnte. Maternal and neonatal tetanus mnt has been among the most common life threatening consequences of unclean deliveries and umbilical cord care practices, and are indicators of inequity in access to immunization and other maternal, newborn, and child health services. Apr 06, 2006 a case was defined as confirmed nnt according to the who case definition i. Neonatal tetanus elimination was defined in 1993 as fewer than 1 case of neonatal tetanus for every 1,000 live births per year in each administrative district of a given country. Neonatal purpura fulminans, a rare genetic disorder due to protein c deficiency. Any neonatal death between 328 days of age in which the cause of death is unknown. Neonatal tetanus, caused by clostridium tetani, is the second leading cause of death from vaccinepreventable diseases among children worldwide. Surveillance manual tetanus vaccine preventable diseases. In 20, a new neonatal tetanus case definition and classification was introduced retaining only clinically confirmed nt. It usually gets transmitted from an unvaccinated mother and enters the body through infection of unhealed umbilical stump. High coverage with tetanus toxoid among pregnant women and in high. Elimination is defined as less than one nt case per live births at district level per year.
We summarize fours cases of neonatal tetanus as a result of the failure of the clean chain during delivery andor no tetanus toxoid vaccination during pregnancy. In addition to strengthening maternal tetanus toxoid. The mortality rate for neonatal tetanus exceeds 90%, with apnea and sepsis being the leading causes of death. Tetanus in the first 28 days of life, known as neonatal tetanus nt, develops when clostridium tetani spores, omnipresent in nature, are introduced via the umbilical cord during an unhygienic delivery or after delivery through improper umbilical stump care. The maternal and neonatal tetanus elimination initiative was launched by unicef, who and unfpa the united nations population fund agency in 1999, revitalizing the goal of mnt elimination as a public health problem defined as less than one case of neonatal tetanus per live births in every district of every country. For reporting purposes, a standardized clinical case definition.
Process of neonatal tetanus elimination in nepal journal. Unlike polio and smallpox, tetanus cannot be eradicated tetanus spores are present in the environment worldwide, but through immunization of children, mothers, other women of reproductive age wra and promotion of more hygienic deliveries and cord care practices, mnt can be eliminated defined as less than one case of neonatal tetanus per. Generalized tetanus is the most common type of tetanus, representing about 80% of cases. Only two cases of neonatal tetanus have been reported in the united states since 1989, both in infants born. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Jul 06, 2015 the who case definition for neonatal tetanus was used. Clinical case definition and case classification suspected case.
The key objective of nt surveillance is to detect cases of nt towards monitoring achievement and maintenance of mnte, defined as less than one nt case per. The case definition for confirmed neonatal tetanus is a neonate with the normal ability to suck and cry during the first two days of life, and between 3 and 28 days of age cannot suck normally and becomes stiff or has spasms ie, jerking of the muscles. Risk factors for neonatal tetanus busoga region, uganda. Neonatal tetanus is a severe, often fatal disease caused by the toxin clostridium tetani. Verification of neonatal tetanus surveillance systems in katsina. Number of neonatal tetanus cases measure evaluation. Tetanus, also known as lockjaw, is a bacterial infection characterized by muscle spasms. In many affected countries, there was a lack of awareness of maternal and neonatal tetanus and how to prevent it. The surveillance case definition of neonatal tetanus is straightforwardthe ability of a newborn to suck at birth and for the first few days of life, followed by. Methods data were collected from 107 cases of neonatal tetanus. In newborns, tetanus usually presents with generalized weakness and failure to nurse that progresses to rigidity and spasms. Tetanus definition is an acute infectious bacterial disease characterized by tonic spasm of voluntary muscles especially of the jaw and caused by an exotoxin of a clostridium clostridium tetani which is usually introduced through a wound.
Of 330 neonatal deaths, 112 met the case definition for tetanus. Infant usually presents with generalized weakness and failure to nurse that progress to rigidity and spasms. Neonatal tetanus is a form of generalised tetanus that occurs in newborns. The surveillance case definition of neonatal tetanus is straightforwardthe ability of a newborn to suck at birth and for the first few days of life, followed by inability to suck starting between 3 and 10 days of age, spasms, stiffness, convulsions, and death 14. Tetanus disease has been known to man since the 14th century when john of arderne, an english surgeon, described a case of tetanus following a gardening injury. At the end of the first week of life, infected infants become irritable, feed. Tetanus is a vaccinepreventable disease that is caused by a potent neurotoxin produced by the sporeforming bacterium clostridium tetani. Demographic survey and management outcome of postneonatal. Neonatal tetanus presents with an inability to suck 310 days after birth.
Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. Tetanus is a serious disease caused by a bacterial toxin that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Hygienic delivery and cord care practices can easily prevent nt, as can immunization. Tetanus definition of tetanus by medical dictionary.
Neonatal tetanus symptoms, diagnosis, treatments and causes. A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Infection results from umbilical cord contamination during unsanitary delivery, coupled with a lack of maternal immunization. Neonatal tetanus is a common cause of neonatal death in areas where mothers are not immune and where nonsterile umbilical cordcare practices are followed. Typically, cases in florida are classified as generalized tetanus 53% and have at least one dose of vaccine for tetanus 41%. The incidence and mortality rates of neonatal tetanus nnt remain. Verification of neonatal tetanus surveillance systems in. Any record that did not meet the who nnt case definition was termed as. Surveillance manual tetanus vaccine preventable diseases cdc.
Neonatal tetanus has been eliminated from europe and the overall number of tetanus cases has declined sharply since the 1950s. Poor feeding,rigidity and spasms it is easily preventable by 2 tetanus toxoidinjections and 5 cleans while conductingdeliveries. Another 15 percent of patients were injection drug users. Case report all four neonatal cases were managed at a tertiary care neonatal intensive care unit of shree krishna hospital attached to pramukhswami medical college of karamsad, gujarat. Neonatal tetanus definition of neonatal tetanus by. Need for developing case definitions and guidelines for data collection, analysis, and presentation for neonatal death as an adverse event following immunization classification of a childs life into welldefined periods has become an important standardization to determine the care and interventions necessary to increase the chances of child. Tetanus clinical case definition in the absence of a more likely diagnosis, an acute illness with muscle spasms or hypertonia and diagnosis of tetanus by a health care provider. Who whorecommended surveillance standard of neonatal tetanus. Whorecommended surveillance standard of neonatal tetanus. A case report she said the first 28 days of life the neonatal period was the most vulnerable time for a childs survival, and noted that nigeria ranked high in neonatal deaths. Neonatal tetanus is a generalized tetanus infection of the newborn. The spores of c tetani are present in the environment throughout the world and can contaminate wounds, minor abrasions, and, in neonatal tetanus, the umbilical stump. This study is a retrospective analysis of surveillance data.
A tracheotomy can be lifesaving if performed when appropriately indicated. Pdf epidemiology of neonatal tetanus in rural pakistan. Thanks to the tetanus vaccine, cases of tetanus are. A neonatal seizure is defined as a transient electrographic change in the brain due to an abnormal, excessive or synchronous neuronal activity either with the occurrence of clinical signs electroclinical or without them electrographiconly, in the first 28 days of life in full. There were eleven cases of neonatal tetanus reported in malaysia in 20065. Bivariate analysis indicated that neonates with nnt were more likely to have been delivered outside a health facility, on an unclean surface. We write about two observations in two teaching hospitals at the same period. Neonatal tetanus tetanus neonatorum is a major cause of infant mortality in underdeveloped countries but is rare in the united states. To recall practitioner about the existing danger of neonatal tetanus despite efforts made by immunization in the country and worldwide. Or death, with tetanus listed on the death certificate as the cause of death or a significant.
The infection is usually caught from another infected person e. Neonatal tetanus is a generalized tetanus, which occurs in a neonate between 328 days of life. Process of neonatal tetanus elimination in nepal journal of. Neonatal tetanus field guide, 2005 iris paho home pan. Clinical features on admission were analyzed against mortality and a combined endpoint of death or prolonged hospital stay. Neonatal tetanus is prevented by immunization andor as. Laboratory tests for probable cases are specified only for some diseases. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a nonsterile instrument. Poor information about neonatal tetanus cases are assembled in gabon. It is estimated that in the 1970s more than 10,000 newborns died annually from neonatal tetanus in the americas. Since tetanus can also strike postpartum mothers, the campaign has been expanded to target both maternal and neonatal tetanus. This typically happens when the umbilical cord is cut using unsterile instruments. It should be reclassified as probable or discarded within 48. Maternal and neonatal tetanus who regional office for.
The number of neonatal tetanus nt cases in a given year, in a defined population, including both suspected and confirmed cases a suspected case. Tetanus definition tetanus is a rare but often fatal disease that affects the central nervous system by causing painful muscular contractions. It is estimated that fewer than 5% of neonatal tetanus cases are actually reported, even from welldeveloped surveillance systems. Because the case fatality is very high in most developing countries, the number of neonatal tetanus cases is often based on actual or estimated numbers of nt deaths. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Original article epidemiology of neonatal tetanus in rural. Case report 1 a woman was hospitalized at agondje teaching hospital at day 12 of life for vomiting and fever. The case definition for confirmed neonatal tetanus is a neonate with the normal ability to suck and cry during the first two days of life, and. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. Neonatal tetanus tetanus neonatorum 8thday disease usually fatal if untreated children born to inadequately immunizedmothers, after unsterile treatment of umbilicalstump during first 2 weeks of life. Risk was increased with a history of neonatal tetanus in a previous child, application of coconut oil to the vagina, and use of. Nt elimination at country level is defined as having less than 1 case of nt per live births in every district. The maternal and neonatal tetanus elimination initiative, launched by who and its partners, has made substantial progress in eliminating maternal and.