Neonatal Tetanus is a severe disease with high fatality. It should no longer be present in a country with the development status of Malaysia. However, sporadic cases still occur and the disease has not been eradicated. This editorial summarises the disease pattern, incidence and suggests reasons for the continued persistence of the condition locally.
This study aims to study the demographics, clinical presentation, treatment and outcome of neonatal tetanus patients managed at Hospital Duchess of Kent from January 1st 2006 to December 31st 2006. Five neonates were studied. All presented with fever, poor sucking and limb stiffness, with a history of unsterile delivery and uncertain maternal tetanus immunity status. All were nursed in a minimal-stimuli environment and were given IV penicillin G, IM tetanus immunoglobulin and sedatives to control spasms. Nutrition and chest physiotherapy were rendered. Three patients required artificial ventilation. Duration of treatment ranged from 25 to 44 days. All survived. Inadequate maternal immunization, unsterile delivery and inappropriate umbilical cord care are major contributing factors of neonatal tetanus in our study. Supportive measures are the mainstay of treatment in our setting with very limited resources.
Matched MeSH terms: Tetanus/complications; Tetanus/diagnosis; Tetanus/drug therapy*; Tetanus/prevention & control
Objective: To study the demographic, clinical features, management and outcome of neonatal tetanus treated at Tawau Hospital.
Method: A retrospective study of neonatal tetanus admitted to a district hospital in Sabah was conducted.
Results: In 2015, the hospital handled 18 cases of babies with neonatal tetanus in the Tawau Hospital. This implies an occurrence of 1.5 cases per month. All the mothers were non-citizens and did not have any proper antenatal follow up. All the tetanus babies required invasive mechanical ventilation with a median of 20 days (range, 5 to 32 days). The survival rate was 94.4%.
Conclusion: Despite the promotion of maternal and childhood vaccination along with hygienic practices of delivery, neonatal tetanus still remains a threat to babies born in Sabah.
A newly developed fully liquid hexavalent vaccine that comprises six antigens for Diphtheria, Tetanus, acellular Pertussis, Inactivated Poliomyelitis, Haemophilus Influenza type b., and Hepatitis B, is proposed to be introduced in the Malaysian national immunization program, instead of the non-fully liquid pentavalent vaccine and monovalent Hepatitis B vaccine that is currently employed in the immunization schedule. Although the introduction of new vaccines is a necessary intervention, it still needs to be accepted by parents and healthcare professionals. Hence, this study aimed to develop three structured questionnaires and to investigate the participants' perception and acceptability toward the incorporation of the new fully liquid hexavalent vaccine. A cross-sectional study was conducted among a sample of 346 parents, 100 nurses, and 50 physicians attending twenty-two primary health care centers in the states of Selangor and the Federal Territory of Kuala Lumpur and Putrajaya during 2019-2020. The study found that Cronbach's alpha coefficients for the study instruments ranged from 0.825 to 0.918. Principal components analysis produced a good fit with KMO>0.6. For the parents' perception questionnaire, the only extracted factor explained 73.9 % of the total variance; for the nurses' perception toward a non-fully and fully liquid combined vaccine, there was a sole extracted factor that explained 65.2 % and 79.2% of the total variance, respectively. Whereas for the physicians' perception, there was one factor extracted that explains 71.8 % of the total variance. The median score for all the questionnaire items ranged from 4 to 5 (Q1 and Q3 vary between 3-5). Parents' ethnicity was significantly associated (P-value ≤ 0.05) with the perception that the new hexavalent vaccine would reduce their transportation expenses. Moreover, a significant association (P-value ≤ 0.05) was found between physicians' age and the perception of the hexavalent vaccine's ability to decrease patient overcrowding in primary healthcare centers. The instruments used in this study were valid and reliable. Parents of Malay ethnicity were the most concerned about transportation expenses since they have the lowest income and are more concentrated in rural areas compared to other races. Younger physicians were concerned about reducing patient crowding and hence reducing their workload and burnout.
Tetanus is an acute, potentially fatal disease caused by Clostridium tetani. It is characterized by generalized, painful spasms and rigidity of skeletal muscles. We present two fatal cases and discuss the potential causes that lead to mortality in cases of tetanus infection
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.
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.
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.
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.
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.
Tetanus is still widely prevalent in many parts of the world especially in the developing countries. This study was conducted to assess the demographic and clinical features, treatment and outcome of tetanus in adults with a special emphasis on identification of predictors of mortality. This was a retrospective study of all adult patients admitted with tetanus over a three-year period from 1998 to 2000 at Lok Nayak Hospital, New Delhi, India. The demography, clinical features, treatment and complications of the patients were assessed and were evaluated against two possible outcomes- survival or death, to identify the predictors of mortality. There were 217 adults (148 males, 69 females) admitted with generalized tetanus during the study period. The mean age of the patients was 36.08 +/- 18.84 years. In most instances (63.5%), wounds / injuries served as the source of infection. Overall 31.8% had mild, 21.7% had moderate and 46.5% had severe disease at presentation. Respiratory failure and dysautonomia were the frequently observed complications. Of the 217 patients, 82 died - a mortality rate of 37.78%. Parameters that were significantly associated with increased mortality were: age (especially > 60 years); shorter duration of symptoms - trismus, rigidity and dysphagia; severe disease at presentation and shorter period of onset. Tetanus is a preventable disease associated with a high fatality rate. Universal coverage of immunization programme and appropriate wound prophylaxis is the corner stone of tetanus eradication. The treatment of tetanus is difficult and requires specialized and intensive care. The presence of parameters indicating an adverse outcome at the beginning in the patients will help identify the subset of patients that need more intensive management especially in resource poor nations.