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Fulltext Tetanus after induced abortion--a case report

bin Misiran K

Med J Malaysia, 1990 Dec;45(4):349-52.
PMID: 2152060

A case of tetanus occurring after induced abortion is reported. The patient gave a history of low grade fever with chill and rigors, headache, neck pain and Trismus. She subsequently developed respiratory distress. However, incorrect information from the patient resulted in the delay to locate and eradicate the source of infection. Early referral to an intensive care unit for ventilatory assistance was the most appropriate step to save the patient. Complications which occurred during the course of the disease were sometimes difficult to overcome. These complications were probably related to the duration of stay in the intensive care unit. Their incidence could be reduced by more meticulous patient care.

Matched MeSH terms: Tetanus/diagnosis; Tetanus/etiology*; Tetanus/therapy
Fulltext Treatment of tetanus neonatorum in a rural setting

Yong YF

Med J Malaysia, 1983 Mar;38(1):74-6.
PMID: 6688850

Tetanus, especially tetanus neonatorum (T.N.) continues to be a significant medical and social problem in the developing countries. The case mortality rate remains very high even in the 'developed' countries, varying from 60-80 percent in various reports, and even higher in the case of tetanus neonatorum. Sanders et al had introduced the method of intrathecal injection of antitetanus serum (ATS) in 1976 and have achieved very encouraging results. As the conventional treatment of tetanus neonatorum had achieved very poor result, even in the very sophisticated centres, a case of tetanus neonatorum admitted to Cottage Hospital Semporna in Sabah had been treated with intrathecal ATS since June 1982. This paper reviews the results of this new approach to tetanus neonatorum treatment as compared to cases treated conventionally.

Matched MeSH terms: Tetanus/therapy*; Tetanus Antitoxin/administration & dosage
Oxygen therapy and pulmonary fibroplasia: a review and case reports

Chew DT, Yin AL

Med J Malaya, 1971 Dec;26(2):122-8.
PMID: 4260858
Matched MeSH terms: Tetanus/therapy
Fulltext Antenatal care (ANC) services utilization in maternal and child health (MCH) clinics of Kinabatangan (rural) and Sandakan (urban) of Sabah, Malaysia

Win SS, Aung S, Tha TO, Myint T, Awang Besar J, Yayaha Z

Malaysian Journal of Public Health Medicine, 2017;17(2):42-51.

This paper investigates the antenatal care (ANC) services utilization in currently pregnant women during their visits to maternal and child health (MCH) clinics of rural (Kinabatangan) and urban (Sandakan), Sabah. A community clinic based, cross-sectional descriptive study was performed. In total, 800 currently pregnant women attending two MCH clinics, from April to September 2012, were participated using tested set questionnaires. Descriptive analysis was used for background characteristics and chi-square analysis was applied to identify the rural-urban differences among the variables.In both study areas, previous births delivered by skilled birth personnel were same. In pregnant women from rural, less income, more grand-multiparity, earlier antenatal care booking, more frequent post-natal care, more use of contraception compared to those in urban. In comparison, urban pregnant women had more anti-tetanus toxoid injection in their previous pregnancies, past history of antenatal care for at least four times, increase in household members. As this study found the differences in ANC services utilization at Rural and Urban, further study is needed to explore concrete reasons for above findings. By delivering services according to the needs of all clients, irrespective of their place of residence, it will improve ANC services utilization in both areas of Sabah and hence will improve more on existing health status of the Nation.
Study site: Klinik Kesihatan, Kinabatangan and Sandakan, Sabah, Malaysia

Matched MeSH terms: Tetanus Toxoid
Witch doctors

Williams C

Pediatrics, 1970 Sep;46(3):448-55.
PMID: 5454800
Matched MeSH terms: Tetanus
Case Report: A Challenging Case of Tetanus Presenting with Headache

Rahim AIA, Azlan EAM, Rahman MR, Pathi NM, Ismail M, Sulaiman WAW

Am J Trop Med Hyg, 2023 Dec 06;109(6):1242-1244.
PMID: 37955309 DOI: 10.4269/ajtmh.23-0035

Tetanus is a life-threatening infectious neurological condition that has become uncommon due to large-scale immunization campaigns. We describe a rare instance of generalized tetanus presenting with a headache on a tropical island in Malaysia. A 43-year-old woman presenting with headaches and generalized body weakness, which progressed into trismus and neck stiffness. Her medical history indicated a wound on the sole of her foot caused by shattered glass in an unhygienic area, but no tetanus prophylaxis had been administered. The patient was subsequently given immunoglobulin, tetanus toxoid, metronidazole, and sedatives in the recommended dosages. Her neurological condition improved remarkably, but she suffered blood pressure fluctuations due to dysautonomia. She was successfully discharged with complete recovery after 6 months of follow-up. The case demonstrates the significance of appropriate identification and care of tetanus, as well as the lethal effects of untreated wounds in vulnerable patients.

Matched MeSH terms: Tetanus Toxoid
Case of traumatic tetanus cured by inhalation of ether

Smith GH

Lancet, 1849;54:667-668.
DOI: 10.1016/S0140-6736(02)71261-0
Matched MeSH terms: Tetanus
Fulltext Timing of antenatal tetanus immunization for effective protection of the neonate

Chen ST, Edsall G, Peel MM, Sinnathuray TA

Bull World Health Organ, 1983;61(1):159-65.
PMID: 6601539

The relationship between the timing of maternal tetanus toxoid immunization and the presence of protective antitoxin in placental cord blood was investigated among women admitted to the obstetrical service of the University Hospital in Kuala Lumpur, Malaysia. The 1st dose was given between 13-39 weeks of gestation, with a median of 29 weeks. The 2nd dose was given an average of 4 weeks later. Protection was conferred on 80% or more of newborns whose mothers received their 1st tetanus toxoid injection 60 days or more before delivery. Protective levels were seen in all cord blood samples from infants whose mothers had received their 1st injection 90 days before delivery. Similarly,protective titers were found in 100% of cord blood samples when the 2nd maternal injection was give 60 days or more before delivery. There was no significant degree of protection when immunization was carried out less than 20 days before delivery. A single-dose schedule provided no protection when less than 70 days before delivery. Cord and maternal antiotoxin titers differed by no more than 1 2-fold dilution for almost all of the individual paired sera. A cord: maternal antitoxin ratio of 2 was more likely to occur with increasing time between the 2nd injection and delivery. Overall, these findings indicate that the 1st injection of a 2-dose maternal tetanus toxoid schedule should be given at least 60 days and preferably 90 days before delivery.

Matched MeSH terms: Tetanus/prevention & control*; Tetanus Antitoxin/analysis; Tetanus Toxoid/administration & dosage*
Total paralysis regime in severe tetanus

Alhady SMA, Bowler DP, Reid HA, Scott LT

Br Med J, 1960;1:540-545.

Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.

Matched MeSH terms: Tetanus
Fulltext Acute disseminated encephalomyelitis (ADEM) presenting with seizures secondary to anti-tetanus toxin vaccination

Hamidon BB, Raymond AA

Med J Malaysia, 2003 Dec;58(5):780-2.
PMID: 15190671

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system (CNS) that is known to occur spontaneously in association with specific and non-specific viral illnesses and after vaccination against various pathogens. Although it is often a self-limited monophasic illness, the fatality rate is estimated to be as high as 20%, and many patients suffer residual neurologic impairment 1. The diagnosis is mainly based on clinical and radiological findings. The clinical presentation varies from merely, an asymptomatic condition to loss of consciousness, seizures, ataxia, optic neuropathy, cranial nerve palsies, and motor dysfunction. MRI of the brain is the single most important diagnostic radiological investigation and can facilitate early diagnosis and prompt treatment. This case report describes a patient with ADEM presenting with only seizures after vaccination with anti-tetanus toxin.

Matched MeSH terms: Tetanus Antitoxin/adverse effects*
Effect of Spirulina (Arthrospira) supplementation on the immune response to tetanus toxoid vaccination in a mouse model

Chu WL, Quynh le V, Radhakrishnan AK

J Diet Suppl, 2013 Sep;10(3):229-40.
PMID: 23927690 DOI: 10.3109/19390211.2013.822452

The aim of this study was to investigate whether Spirulina (Arthrospira) supplementation could enhance the immune response to tetanus toxoid (TT) vaccine in a mouse model. Vaccination of TT was performed on day 7 and 21 in mice fed daily with Spirulina (50 and 150 mg/kg body weight). Both Spirulina supplementation and TT vaccination did not significantly affect body weight gain of the mice. Supplementation of Spirulina significantly enhanced IgG level (p = .01) after the first but not after the second TT vaccination. The anti-TT IgG levels of the groups that received low dose and high dose of Spirulina were not significantly different. Spirulina supplementation did not show significant effects on in vitro splenocyte proliferation and cytokine (IFN-γ and IL-4) production induced by Con A and TT. This study showed that Spirulina supplementation could enhance primary immune response in terms of antibody production, but not secondary immune response following TT vaccination in a mouse model.

Matched MeSH terms: Tetanus Toxoid/immunology; Tetanus Toxoid/pharmacology*
Fulltext Economic impact of switching from partially combined vaccine "Pentaxim® and hepatitis B" to fully combined vaccine "Hexaxim®" in the Malaysian National Immunization Program

Aljunid SM, Al Bashir L, Ismail AB, Aizuddin AN, Rashid SAZA, Nur AM

BMC Health Serv Res, 2022 Jan 05;22(1):34.
PMID: 34986870 DOI: 10.1186/s12913-021-07428-7

BACKGROUND: The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)' and parents'/caregivers' perceptions.
METHODS: In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents'/caregivers' questionnaire. Also, HCPs' and parent's/caregivers' perceptions were investigated using structured questionnaires.
RESULTS: The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects.
CONCLUSIONS: Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B.
TRIAL REGISTRATION: Not applicable.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine*
Fulltext Social expectations and government incentives in Malaysia's COVID-19 vaccine uptake

Abdul Aziz NI, Flanders S, Nungsari M

PLoS One, 2022;17(9):e0275010.
PMID: 36156604 DOI: 10.1371/journal.pone.0275010

High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals' expectations of others in their social groups towards vaccination predicts those individuals' vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual's reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine
Fulltext Severe tetanus--in spite of tetanus toxoid

Nivedita N

Med J Malaysia, 1994 Mar;49(1):105-7.
PMID: 8057983

A 66-year-old man sustained an injury to his right foot while gardening. Despite receiving tetanus toxoid one hour later and adequate wound toilet, he developed severe tetanus complicated with autonomic dysfunction six days later. He died 20 days after admission. This case shows that tetanus toxoid alone may not be sufficient to prevent tetanus in wounded patients. Careful consideration must be given to the immune status of the patient and to the nature of the wound sustained. Incompletely immunised patients or patients with unknown immune status who sustain a tetanus prone wound should be protected with both tetanus toxoid and tetanus immunoglobulin.

Matched MeSH terms: Tetanus/drug therapy*; Tetanus/etiology*; Tetanus/immunology; Tetanus/epidemiology; Tetanus Toxoid/therapeutic use*
Fulltext Supplementation with natural forms of vitamin E augments antigen-specific TH1-type immune response to tetanus toxoid

Radhakrishnan AK, Mahalingam D, Selvaduray KR, Nesaretnam K

Biomed Res Int, 2013;2013:782067.
PMID: 23936847 DOI: 10.1155/2013/782067

This study compared the ability of three forms of vitamin E [tocotrienol-rich fraction (TRF), alpha-tocopherol (α-T), and delta-tocotrienol (δ-T3)] to enhance immune response to tetanus toxoid (TT) immunisation in a mouse model. Twenty BALB/c mice were divided into four groups of five mice each. The mice were fed with the different forms of vitamin E (1 mg) or vehicle daily for two weeks before they were given the TT vaccine [4 Lf] intramuscularly (i.m.). Booster vaccinations were given on days 28 and 42. Serum was collected (days 0, 28, and 56) to quantify anti-TT levels. At autopsy, splenocytes harvested were cultured with TT or mitogens. The production of anti-TT antibodies was augmented (P < 0.05) in mice that were fed with δ-T3 or TRF compared to controls. The production of IFN-γ and IL-4 by splenocytes from the vitamin E treated mice was significantly (P < 0.05) higher than that from controls. The IFN-γ production was the highest in animals supplemented with δ-T3 followed by TRF and finally α-T. Production of TNF-α was suppressed in the vitamin E treated group compared to vehicle-supplemented controls. Supplementation with δ-T3 or TRF can enhance immune response to TT immunisation and production of cytokines that promote cell-mediated (TH1) immune response.

Matched MeSH terms: Tetanus Toxoid/administration & dosage*
Effects of supplementation with tocotrienol-rich fraction on immune response to tetanus toxoid immunization in normal healthy volunteers

Mahalingam D, Radhakrishnan AK, Amom Z, Ibrahim N, Nesaretnam K

Eur J Clin Nutr, 2011 Jan;65(1):63-9.
PMID: 20859299 DOI: 10.1038/ejcn.2010.184

Vitamin E is an essential fat-soluble vitamin that has been shown to induce favorable effects on animal and human immune systems. The objective of this study was to assess the effects of tocotrienol-rich fraction (TRF) supplementation on immune response following tetanus toxoid (TT) vaccine challenge in healthy female volunteers.

Matched MeSH terms: Tetanus Toxoid/administration & dosage; Tetanus Toxoid/immunology*
Control of vitamin a deficiency for reducing morbidity and mortality in children

Muhilal

Malaysian Journal of Child Health, 1997;9(1):49-52.
MyJurnal

Various studies conducted in Indonesia have shown that administration of Vitamin A to pre-school children had decreased the mortality and morbidity rates among them. In the first study conducted in the province of Acheh in North Sumatra, a twice yearly high dose of vitamin A led to a 34% decrease in mortality. In a second study in Bogor, conducted by fortifying the nutritional additive MSG with vitamin A and distributing the product in a designated area, the mortality rate among preschool children was 45% less than in a control area. In the third study also conducted in Bogor, where vitamin A was given to lactating women 2 weeks after giving birth and then directly to the infants themselves after 5 months of age, the mortality rate was 38% lower. The prevalences of respiratory and diarrhoeal infections were statistically lower than in the control gorups. Another study on preschool children showed a two-fold increase of anti TT IgG on primary immunisation against tetanus when compared to a control group and a four-fold increase with a secondary immunisation. Other studies conducted in Bogor and other parts of the world have showed that smaller doses given more often are more effective than bigger doses given less often.

Matched MeSH terms: Tetanus; Tetanus Toxoid
Current trends in morbidity and mortality of children in Malaysia

Lin, Hai Peng, Mohd Sham Kasim

Malaysian Journal of Child Health, 1997;9(2):104-132.
MyJurnal

Malaysia is a rapidly developing country with a very young population, about 36% of which are below the age of 15 years. The standard of child health has improved greatly. However, there are great changes in the morbidity and mortality patterns of childhood diseases relating mainly to an improved standard of living; availability of safe water supply and adequate sanitary latrines; a higher literacy rate; rapid industrialisation and urban migration. The infant mortality rate has droppedfrom 50.1 per 1,000 livebirths in 1986 to 10.4 in 1995, and similar trends apply also to neonatal, perinatal and toddler mortality rates. Nevertheless, current major child health problems are those relating to events in the perinatal period and to infections. Despite improvements in the standard of neonatal care with the use ofhigh technology, the commonest cause of certified deaths still occur in the neonatal period. A rapid and inexpensive screening test for G6PD deficiency, a disease present in 2-3% of the population, is now widely available and, together with the use of phototherapy is largely responsible for the declining incidence of kernicterus in the country. Infections remain an important cause of morbidity and mortality although their patterns have changed. The very high (>95%) WHO-EPI-vaccines coverage rate is linked to the great reduction in the incidence of diphtheria, pertussis, tetanus, poliomyelitis and measles. Childhood tuberculosis is less common now, with about 250 - 300 reported cases per year and TB meningitis is rare with about 30-40 reported cases/year. The hepatitis B carrier rate is high (5%) and the introduction of routine newborn hepatitis B vaccination in 1989 is expected to have a positive impact as is the immunisation of young girls against rubella introduced in 1985 in reducing the incidence of congenital rubella syndrome. The incidence of malaria has declined but remains prevalent in the interiors of PeninsularMalaysia and in Sabah and Sarawak. Filariasis is largely under control. Unfortunately, despite great efforts at mosquito control, dengue virus infection remains a major problem with thousands of cases reported every year. Children are most susceptible to dengue haemorrhagic fever with many dying from the shock syndrome. The incidence of acute gastroenteritis has also dropped with most cases being due to a viral aetiology. Acute respiratory infections, mostly viral in origin, account for most attendances at paediatric outpatient services. Although staphylococcal and streptococcal impetigo and pneumonia are common, the incidence of streptococcal related diseases like rheumatic fever and acute glomendonephritis is rapidly declining. The nutritional status of children has improved in tandem with the rise in the standard of living, but subclinical malnutrition is prevalent, particularly among urban squatters and the rural poor. There is a disturbing decline in breastfeeding among urban working mothers. Poor weaning practices and food habits are responsible for the common occurrence of nutritional anaemia (5%) among infants and young children. Greater prosperity, rapid industrialisation and urbanisation have resulted in changes in the childhood disease pattern where non-communicable diseases assume greater importance as the problems of malnutrition and infection are gradually overcome. Road traffic accidents are a major killer and home accidents, largely preventable, are an important cause of morbidity and mortality. Childhood cancer, with about 550 new cases a year, is an important cause of death beyond infancy. Major congenital malformations, with a 1% prevalence rate, cause much ill-health. Thalassaemia is a particularly common genetic disease with fl thalassaemia gene frequency of about 5%. The prevalence of asthma is increasing, with a rate of 13.9% in the Kiang Valley but the prevalence of asthma-related symptoms is much higher. Physical, sexual child abuse and neglect, abandoned babies, substance abuse are but signs of stress of modern city living and peoples inability to cope with it. Although the general standard of child health has greatly improved, there are several states where it is still not satisfactory. In Sabah where there is a large illegal immigrant population, the infant mortality and infection rates are relatively high. In Kelantan and Trengganu, it is common for parents to refuse permission for a lumbar puncture required to treat meningitis. Other still deeply entrenched, culturally-related adverse health practices include : a fatalistic attitude to illness; a preference for traditional practitioners of medicine resulting in late treatment; and 'doctor-hopping' with unrealistic expectations of 'instant cure'. Childhood illnesses that are uncommon in Malaysia include: cystic fibrosis, coeliac disease, ulcerative colitis, Crohns disease, Sudden Infant Death Syndrome, Encopresis, enuresis and epiglottitis due to Haemophilus Influen:ae.

Matched MeSH terms: Tetanus; Tetanus Toxoid
Maternal education and tetanus immunisation in Indonesia

Mohamed WN

Sains Malaysiana, 1996;25(4):19-29.

This paper examines the influence of maternal education on the acceptance of tetanus toxoid vaccine, using data from two villages in rural Yogyakarta, Indonesia. Maternal education results in increased tetanus toxoid uptake. Irrespective of the level of formal education, correct knowledge of the function of tetanus toxoid is positively associated with the probability of using the vaccine. It is therefore recommended that health education campaign be run to provide correct information on the importance of tetanus toxoid. This study can be used as a model for health programmes in other population with low levels of women education.
Key words: Neonatal tetanus, maternal education, tetanus toxoid, binomial logistic regression, multinomial logistic regression.
Kertas ini mengkaji pengaruh pendidikan ibu ke atas penerimaan vaksin tetanus toxoid, dengan menggunakan data daripada dua buah kampung di pendalaman Yogyakarta, Indonesia. Kajian ini mendapati pendidikan ibu dapat meningkatkan kadar pengambilan tetanus toxiod. Pengetahuan yang tepat tentang kepentingan vaksin tersebut didapati mempunyai hubungan yang positif dengan pengambilannya, tanpa mengira tahap pendidikan wanita. Dengan itu dicadangkan agar kempen pendidikan kesihatan dijalankan untuk menyebarkan maklumat yang jelas ten tang kepentingan tetanus toxoid. Kajian ini boleh dijadikan model bagi program kesihatan untuk populasi lain yang mempunyai tahap pendidikan wanita yang rendah.
Kata kunci: Tetanus neonatal, pendidikan ibu, tetanus toxoid, regresi logistik binomial, regresi logistik multinomial.

Matched MeSH terms: Tetanus; Tetanus Toxoid
Fulltext Tetanus and immunization: a six-year study

Miranda AF, Miranda S

Med J Malaysia, 1986 Dec;41(4):305-9.
PMID: 3670152

There is a high incidence of tetanus in the Malaysian state of Kelantan. Out of 162 reported cases of tetanus in Peninsular Malaysia during 1979 - 1984, 62 cases were from Kelantan, i.e. 38% of the total reported cases in Peninsular Malaysia. Thus a retrospective study was carried out to analyse the possible factors responsible for this high incidence. 62 cases of tetanus admitted to the General Hospital, Kota Bharu, over a period of 1979 - 1984 were studied.
Neonatal tetanus, though still existing, had been considerably reduced compared to the preceding five-year period (1975-1979). There was notable absence of cases in the two months to four-year age group, 24% of the cases occurred in the 10 - 20 years, and 29% in the age group 25 - 40 years. Since tetanus is a disease preventable by active immunization. l every effort must be taken to improve immunization coverage and increase the public awareness to prevent unnecessary loss of lives.

Matched MeSH terms: Tetanus/epidemiology*; Tetanus/prevention & control; Tetanus Toxoid*

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