Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital.

Nighat Sultana,Mehwish Faizan,Attia Bari,Muhammad Sarwar

doi:10.12669/pjms.35.5.656

Abstract

Objective:To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital.Methods:This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20.Results:Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively.Conclusion:Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option.

Highlights

Tetanus is a vaccine preventable disease but even in this era of effective vaccines against most preventable diseases tetanus is still considered a common public health problem in developing countries causing huge morbidity and mortality
In our study the children were in post neonatal age and we found that mean age of presentation was 7.5±3.4 years consistent with 8 years in a study from Ethiopia and a study by Alhaji et al showing mean age of 6.9±3.87 years.[2,7]
We found that only one third of children who presented with tetanus had received three doses of tetanus toxoid but none of the children received booster dose

Summary

Introduction

Tetanus is a vaccine preventable disease but even in this era of effective vaccines against most preventable diseases tetanus is still considered a common public health problem in developing countries causing huge morbidity and mortality. In resource rich countries with the help of a good immunization coverage the disease incidence is decreased with very low mortality rates.[1]. Tetanus is caused by a potent exotoxin called tetanospasmin produced by gram positive organism Clostridium tetani.[2] Tetanus is the only vaccinepreventable disease which is not communicable and is acquired through environmental exposure to the spores of Clostridium tetani.[3] It is an acute. Pak J Med Sci September - October 2019 Vol 35 No 5 www.pjms.org.pk 1233 neuromuscular disorder diagnosed clinically and is characterized by increased muscle tone, rigidity and spasms caused by neurotoxin. There may be autonomic dysfunction and in severe forms patients with tetanus requires respiratory and hemodynamic support.[4]

Methods

Discussion

Conclusion