Cases Of Neonatal Tetanus Research Articles

Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2022.

Tetanus remains a considerable cause of mortality among undervaccinated mothers and their infants following unhygienic deliveries, especially in low-income countries. Strategies of the maternal and neonatal tetanus elimination (MNTE) initiative, which targets 59 priority countries, include strengthening antenatal immunization of pregnant women with tetanus toxoid-containing vaccines (TTCVs); conducting TTCV supplementary immunization activities among women of reproductive age in high-risk districts; optimizing access to skilled birth attendants to ensure clean deliveries and umbilical cord care practices; and identifying and investigating suspected neonatal tetanus cases. This report updates a previous report and describes progress toward MNTE during 2000-2022. By December 2022, 47 (80%) of 59 priority countries were validated to have achieved MNTE. In 2022, among the 50 countries that reported coverage with ≥2 doses of TTCV among pregnant women, 16 (32%) reported coverage of ≥80%. In 2022, among 47 validated countries, 26 (55%) reported that ≥70% of births were assisted by skilled birth attendants. Reported neonatal tetanus cases worldwide decreased 89%, from 17,935 in 2000 to 1,995 in 2021; estimated neonatal tetanus deaths decreased 84%, from 46,898 to 7,719. However, the global disruption of routine immunization caused by the COVID-19 pandemic impeded MNTE progress. Since 2020, reported neonatal tetanus cases have increased in 18 (31%) priority countries. Integration of MNTE strategies into priority countries' national postpandemic immunization recovery activities is needed to achieve and sustain global elimination.

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

Delayed presentation and management approach of autonomic dysfunction associated with severe tetanus

Introduction: In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya. Case presentation: A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established. Clinical discussion: Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries. Conclusion: It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.

Reporting Case Study Results for Neonatal Tetanus Case Investigations

Developing countries are facing numerous health challenges. One of the greatest challenges in this regards is the existence of neonatal tetanus disease. Dera Ismail Khan is educationally backward, and the majority of the population lives in rural areas without proper access to health facilities. This study was aimed to intestate the neonatal tetanus cases. Literature review was undertaken, which suggested the use of case approach; therefore, the study used a case method of investigation. The case setting was District Headquarters Zanana (Women) Hospital Dera Ismail Khan, which is the only mother-child hospital in the southern districts of DIKhan, Tank, and Waziristan. The study reported that Tetanus remains a significant public health concern in the areas, with a high mortality rate and a need for improved prevention and management efforts. The majority of tetanus cases in the area occur among unvaccinated individuals, particularly among those who have not received tetanus toxoid-containing vaccine as part of routine immunization. There are significant disparities in tetanus vaccination coverage by region and socioeconomic status, which contribute to the burden of tetanus in vulnerable populations. Improving tetanus vaccination coverage and strengthening surveillance and management systems are important steps to lessen the burden of tetanus in Pakistan.

Neonatal Tetanus: case report in Saudi Arabia

Aims: This paper aims to investigate a case of neonatal tetanus in Saudi Arabia, studying the different factors leading to infection, role and protocols used in hospital in diagnosis and management of the case. Methods: A medical profile of neonatal case confirmed for neonatal tetanus was collected and studied, in addition to collecting literature reviews about epidemiology, diagnosis and management. Results: A newborn 7-day old girl with poor socioeconomical status and poor aseptic delivery had been admitted to hospital with symptoms of jerky repetitive movement and history of decreased feeding and poor sucking for one day. Laboratory tests, cranial computed tomography (CT) and lumbar puncture were performed, all of them with normal results. She was hospitalized on 12 November, 2019 in an environment free of sensorial stimuli in the Pediatric Intensive Care Unit (PICU), with assisted ventilation. The patient was treated with metronidazole 30mg/kg/day, ampicillin 150 mg/kg/day, and cefotaxime 150mg/kg/day. Sedation was maintained with midazolam 6mic/kg/min. Also, we started on muscle relaxation pancuronium 0.1 mg /kg/hr. and Magnesium sulfate. Besides that, we administered human immunoglobulin IM (500 IU), as well as one dose of tetanus toxoid. During hospital admission the condition of the patient was much improved. On 19 December 2019 the patient was extubated and started with baclofen and physiotherapy. Conclusion: This case indicates that non-sterile delivery by non-practical attendants are the biggest cause of neonatal tetanus along with mothers unimmunized against tetanus. However, in the rarest of incidence of neonatal tetanus, physicians should be prepared to suspect, diagnose and treat neonatal tetanus and ensure clear and clean delivery of newborns. A combination of antibiotics and muscular relaxants are used to manage neonatal tetanus. Key words: neonatal tetanus, case report, Saudi Arabia

The Influence of Corner Care Using Topical Breast Milk and Dry Gauge Methods on The Time of Crap Delivery

The best umbilical cord care after birth is a controversial issue. Neonatal tetanus cases in Indonesia increased from 10 cases in 2018 to 17 cases in 2019, While in Banten Province in 2019, there were 12 cases of neonatal tetanus with 8 deaths, including in Cilegon City. According to research, one of the preventions of neonatal tetanus is umbilical cord care. This study aimed to analyze the effect of umbilical cord care by using the breast milk topical method and dry gauze when removing the umbilical cord. This research is a quantitative study with a quasi-experiment research design with a control design post only, the sample is 30 respondents with a purposive sampling technique, and the research instrument is in the form of an observation sheet. The data were analyzed with an independent T-test. The results of a bivariate analysis can be concluded that there is a significant effect between differences in the acceleration of umbilical cord release. In this study, there was a significant difference between umbilical cord care using the topical method of breast milk and dry gauze on the timing of umbilical cord detachment. This can be input and evaluation for PMB in Cilegon City, regarding the importance of effective newborn umbilical cord care and does not cause infection.

Magnitude of Tetanus Toxoid Immunization and Associated Factors among Pregnant Women in Ethiopia

Background:Maternal and neonatal tetanus remains a major global health problem. Two-thirds of the cases of neonatal tetanus occur in the poorest and least developed countries, including Ethiopia.Objective:This study aimed to calculate the magnitude and identify associated factors of tetanus toxoid immunization among pregnant women in Ethiopia.Methods:The 2016 Ethiopian demographic and health survey data were accessed and used for the analysis. A total of 7193 pregnant women were included in this study. A multilevel hurdle Poisson model was conducted to identify factors associated with tetanus toxoid immunization among pregnant women.Results And Discussion:Only 41.6% of pregnant women had received at least two doses of tetanus vaccine, while 58.4% received less than two doses. The multilevel hurdle Poisson model showed that residence, wealth index, education level of women, occupation of women, education level of husbands, ANC, presence of mobile phones, region, frequency of listening radio and frequency of watching television were significantly associated with tetanus toxoid immunization.Conclusion:Tetanus toxoid immunization coverage in Ethiopia was low. The concerned governmental organization sought to resolve enumeration area variation in tetanus toxoid immunization and closely monitored its implementation. Providing quality antenatal care, enhancing women’s educational level, and involving husbands in tetanus toxoid immunization are effective strategies to increase tetanus toxoid immunization coverage. Besides, the low-income households and the rural settings should also be given special consideration.

Neonatal Tetanus: case series from Dilla univeristy referal hospital, Ethiopia

Background: Neonatal tetanus is a deadly infection leading to 7-8% of neonatal mortality in de-veloping countries. WHO defines Neonatal tetanus as an illness in a child who has the normal ability to suck in the first 2 days of life, presented with failure to suck between 3rd and 28th days of life and has rigidity and spasms? Though Ethiopia declared maternal and neonatal tetanus elimination in 2017, there has been significant number of neonates presenting with this problem in Neonatal ICU’sMethods: This review characterized clinical profile, demography and outcome of seven neona-tal tetanus cases admitted at Dilla University hospital, neonatal ICU from September 11, 2018 to September11, 2020.Results: All mothers gave birth at home with unskilled birth attendant, local blade or knife was used to cut the cord. Median age for mothers was 26 years and two out of seven had antenatal care (ANC) follow up and took Two doses of tetanus toxoid (TT) vaccine. Fever, failure to suck, spasm and convulsions were the common presenting symptoms. The overall mortality was 70%.Conclusion: Continuous emphasis on antenatal tetanus immunization and safe delivery practic-es should be maintained. Clinicians caring for neonates should be aware of the presentations of neonatal tetanus to allow them to diagnose these patients early and initiate appropriate lifesaving management.

Neonatal Tetanus in Northern Region, Ghana – A Case Report

Maternal and Neonatal Tetanus (MNT) has become a rare disease in Ghana following the intensive immunization campaigns over the last few decades. The country was certified as MNT-free by the World Health Organization (WHO) in 2013.We report on 2 cases ofNeonatal Tetanus (NT) seen in the Northern Region of Ghana. Although the mothers of both patients attended antenatal clinics, they were not vaccinated against tetanus. Both patients were successfully managed and discharged from the hospital. These cases call forpractitioners to be mindful of sporadic cases of NT that may present to our facilities.

Comparative analysis of antigenic strength and in vivo serum antibodies concentration of tetanus toxoid vaccine adsorbed in Pakistan

Clostridium tetani produce tetanospasmin, a potent exotoxin; that causes tetanus or lockjaw disease. Scientists developed an anti-tetanus toxoid to protect the body from the spasm's neurotoxic effect. In Pakistan recently, 478 cases of neonatal tetanus were reported. The study was carried out at The National Control Laboratory for Biologicals Islamabad, aiming to decipher the effectiveness of the most frequently used tetanus toxoid vaccine adsorbed in Pakistan in comparison to standard reference vaccine having earlier known consistent values. The vaccines included domestic public sector, domestic private sector, imported private sector I, and imported private sector II. The triplicate experiments on purebred Swiss albino mice were performed by immunizing with Tetanus toxoid and then tested parallel with standard reference vaccine. Various analytical tests were performed on the test organism that included flocculation test/identity test, antibody quantification using enzyme-linked immunosorbent assay (ELISA), potency test, abnormal toxicity test, osmolality, pH test, liquid sub-visible particle test, and sterility test. Results of all the vaccines were compared in comparison with the standard reference vaccine. Absorbances of test vaccines were recorded at the lowest dilution by ELISA. The domestic private sector, imported private sector I, imported private sector II and standard reference vaccine were flocculated at mean dilution (Mean: 0.24, 95% CI: 0.1903–0.2897), and the domestic public sector was flocculated at mean dilution (Mean: 0.23, 95% CI: 0.2052–0.2548). All the products were found within the normal ranges where it was concluded that the maximum average titer of 2.81 was observed at dilution 10−1.6, indicating that these vaccines were adequate/suitable for the prevention of tetanus.

Elimination of Neonatal Tetanus in Rural Central African Republic: Issues and Challenges

Like other countries in the world, the Central African Republic is committed to the fight against the elimination of neonatal tetanus (NNT). Despite the efforts made, the number of NNT cases continues to grow. The objective of this work was to describe the epidemiological profile and identify the risk factors for the occurrence of NNT in rural Central African areas in order to improve control strategies in this context. This was a case-control study of newborns with tetanus (case) or not (controls), conducted between 2014 and 2019 at the Gazi Secondary Health Center. A questionnaire collected socio-demographic and clinical data that were entered and analyzed using the Epi info 7 software. Multiple logistic regression used to establish the relationship between the occurrence of tetanus and the characteristics of the mother and the newborn, through the ORs and their 95% CI. A total of 332 newborns were included, including 166 cases of NNT and 166 controls. The average age was 7.8 ±3.6 days. The incidence of NNT was 2.7 and 5.2 cases per 1000 live births in 2014 and 2019 respectively. The main risk factors for NNT were new males (p=0.04), low maternal education (p=0.001), separation from health care (p=0.006), primiparity (p<0.001), low number of antenatal visits (p<0.003) and low tetanus vaccine coverage (p<0.001). According to newborn care practices: home birth (p=0.002), delivery by unskilled personnel (p<0.001), umbilical cord septic section (p<0.001), no cord dressing (p<0.001) and septic dressing (p=0.012) were statistically associated with the occurrence of NNT in our context. In rural Central African Africa, the incidence of neonatal tetanus remains high and the risk factors are multiple. Effective health promotion measures can contribute to the elimination of this disease.

A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome.

Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant's place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.

Neonatal and postneonatal tetanus at a referral hospital in Kamsar, Guinea: a retrospective audit of paediatric records (2014-2018).

BackgroundTetanus is a vaccine-preventable disease caused by the bacterium Clostridium tetani. In 2018, all of Guinea was considered to be at risk of the disease and the country is currently in the elimination phase.MethodsA 5-y audit (1 January 2014–31 December 2018) of all admissions to the neonatal and general paediatric units of Kamsar Hospital (Western Guinea) was undertaken to identify cases of neonatal tetanus (NNT) and postneonatal tetanus (PNNT).ResultsThere were 5670 admissions during the study period, of which 39 (0.7%) were due to tetanus (22 NNT and 17 PNNT). Among NNT patients, the bacterial entry site was the umbilical cord (n=20) or wound following circumcision (n=2). For PNNT, the entry site was surface wound (n=12), limb fracture (n=1) or could not be established (n=4). A majority of the patients (36/39, 92.3%) were born to unvaccinated mothers or those who received suboptimal vaccination during pregnancy. Overall, 21 (53.8%) children died within 7 d of admission with a higher mortality observed among neonates (16/22, 72.7%) compared with postneonates (5/17, 29.4%).ConclusionsTetanus was a rare cause of admission at Kamsar Hospital with a very high case fatality rate. The disease primarily occurred among children born to mothers who were unvaccinated/inadequately vaccinated during pregnancy.

Mortality Rate and Prognostic Factors in Neonatal Tetanus: A 3-Year Analysis of Cases Presented to Turkey-Somalia Mogadishu Training and Research Hospital

Abstract Objective The aim of this study was to evaluate mortality rate and prognostic factors in neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital. Methods A total of 35 neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital between 2014 and 2017 were included in this prospective observational study. Data on demographic, clinical and maternal obstetric characteristics, and laboratory findings including complete blood count and blood biochemistry were recorded in each patient. Study parameters were evaluated with respect to survivorship status, while multiple logistic regression analysis was performed to determine independent predictors of increased mortality risk. Results Overall, mortality occurred in 22 (62.9%) of 35 neonates diagnosed with neonatal tetanus. Tetanus prophylaxis was absent in the majority of neonates, regardless of survivorship status (100.0% in nonsurvivors vs. 84.6% in survivors, p = 0.131). In nonsurvivor versus survivor groups, significantly higher likelihood of constipation (50.0 vs. 7.7%, p = 0.002), contracture (81.8 vs. 46.2%, p = 0.035), and ventilator support (95.4 vs. 53.8%, p = 0.006) as well as significantly lower hemoglobin (14.45 ± 2.06 vs. 17.15 ± 1.77, p = 0.003) and potassium (3.50 ± 0.86 vs. 4.14 ± 0.93, p = 0.003) levels and neutrophil (3.34 ± 1.75 vs. 4.47 ± 1.08, p = 0.047, white blood cell (WBC) (5.54 ± 2.30 vs. 7.78 ± 1.70, p = 0.003) and platelet (median [min-max] 133.5 [68–332] vs. 196 [123–550], p = 0.006) counts were noted. Presence of contracture (odds ratio [OR]: 14.525, 95% confidence interval [CI]: 1.398–150.870, p = 0.025) and ventilator support (OR: 22.282, 95% CI: 1.269–391.131, p = 0.034) was the independent determinants of increased risk of mortality. Conclusion Our findings emphasize high mortality in neonatal tetanus cases in Somalia along with lack of maternal tetanus prophylaxis in majority of cases. Presence of contractures and ventilator support were significant determinants of poor survival, while factors such as constipation, lower hemoglobin, and potassium levels and lower neutrophil, WBC and platelet counts were also more common among nonsurvivors, albeit not found to be associated with mortality risk in the multivariate analysis.

Progress Toward Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2018.

Maternal and neonatal tetanus* (MNT) remains a major public health problem, with an 80%-100% case-fatality rate among neonates, especially in areas with poor immunization coverage and limited access to clean deliveries (i.e., delivery in a health facility or assisted by medically trained attendants in sanitary conditions) and umbilical cord care (1). In 1989, the World Health Assembly endorsed the elimination† of neonatal tetanus (NT), and in 1999, the initiative was relaunched and renamed the MNT elimination§ initiative, targeting 59¶ priority countries (1). Elimination strategies include 1) achieving ≥80% coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV) among women of reproductive age through routine immunization of pregnant women and supplementary immunization activities (SIAs)** in high-risk areas and districts††; 2) achieving care at ≥70% of deliveries by a skilled birth attendant (SBA)§§; and 3) enhancing surveillance for NT cases (1). This report summarizes progress toward achieving MNT elimination during 2000-2018. Coverage with ≥2 doses of TTCV (2 doses of tetanus toxoid [TT2+] or 2 doses of tetanus-diphtheria toxoid [Td2+]) among women of reproductive age increased by 16%, from 62% in 2000 to 72% in 2018. By December 2018, 52 (88%) of 59 priority countries had conducted TTCV SIAs, vaccinating 154 million (77%) of 201 million targeted women of reproductive age with TT2+/Td2+. Globally, the percentage of deliveries assisted by SBAs increased from 62% during 2000-2005 to 81% during 2013-2018, and estimated neonatal tetanus deaths decreased by 85%, from 170,829 in 2000 to 25,000 in 2018. By December 2018, 45 (76%) of 59 priority countries were validated by WHO as having achieved MNT elimination. To achieve elimination in the remaining 14 countries and sustain elimination in countries that have achieved it, implementation of MNT elimination strategies needs to be maintained and strengthened, and TTCV booster doses need to be included in country immunization schedules as recommended by the World Health Organization (WHO) (2). In addition, integration of maternal, newborn, and child health services with vaccination services is needed, as well as innovative approaches to target hard-to-reach areas for tetanus vaccination and community engagement to strengthen surveillance.

An investment case for maternal and neonatal tetanus elimination

IntroductionGlobally, 13 countries have yet to eliminate maternal and neonatal tetanus. While efforts have improved access to tetanus toxoid containing vaccines (TTCVs) and increased clean delivery practices, reaching elimination targets (<1 case of neonatal tetanus per 1000 live births per district per year) may require significant resources to reach the remaining high risk and hard-to-reach districts. MethodsWe estimated the cost to achieve maternal and neonatal tetanus elimination (MNTE) in three years in the remaining 13 countries: Afghanistan, Angola, Central African Republic, Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan, and Yemen. Costs were estimated for: (1) vaccination campaigns using standard TTCVs and TT-Uniject™ targeting women of reproductive age in high risk areas, (2) additional vaccinations delivered to pregnant women at antenatal care (ANC) clinics, (3) clean delivery and umbilical cord care promotion, (4) neonatal tetanus surveillance strengthening, and (5) validation activities. We forecasted the averted mortality to assess the cost-effectiveness of achieving MNTE. ResultsIt will cost an estimated US$197.7 million to realize MNTE over three years. These costs include $161.4 million for vaccination campaigns, $6.1 million for routine vaccination during ANC, $23.3 million for promotion of clean delivery practices, $4 million for surveillance, and $3 million for validation of MNTE. Achieving MNTE will avert approximately 70,000 neonatal deaths over ten years of vaccine protection, resulting in approximately 4.4 million life years gained. It will cost $2,900 per death averted and $45 per life year gained. ConclusionMaternal and neonatal tetanus can be eliminated with significant financial investment, high prioritization, and strong political will. While substantial costs must be incurred to reach hard-to-reach populations, MNTE should be accomplished as a matter of health equity, and will significantly contribute to reaching the United Nations' Sustainable Development Goals.

ACUTE FLACCID PARALYSIS SURVEILLANCE SYSTEM: CURRENT STATUS IN AZAD JAMMU &amp; KASHMIR- 2018

Background: The State of Azad Jammu &amp; Kashmir (AJ&amp;K) is polio free since October 2000.The objectives of our study is to review of existing Acute Flaccid Paralysis Surveillance System in Azad Jammu &amp;Kashmir, identify the strong &amp; weak points of the existing system and suggest course of action for efficient performance of the existing system. Methods: This qualitative &amp; quantitative evaluation was conducted at Provincial Disease Surveillance &amp;Response Unit (PDSRU) Muzaffarabad Azad Jammu &amp; Kashmir during March -April 2019. The database of AFP cases during 2018 was reviewed and relevant stakeholder's interviews were conducted consulting guidelines formulated by the Centre for Disease Control &amp; prevention(CDC) in 2001 for Evaluating Public Health Surveillance Systems. Results: In 2018, a total of 265 AFP cases were registered. The mean age was 65 months (range 01 - 180 months). 59 % (n=157) were male children. 58% of cases were under 05 year's age. Standardized case definition and data format with simple information flow was found. System was flexible enough to incorporate measles and neonatal tetanus cases since 2009. Data quality was excellent (100% zero and monthly reports). A close coordination was observed amongst all relevant stakeholders. Sensitivity was 200%. No polio case was identified and therefore, PPV was zero. Majority of cases were reported by public sector (93%).Sufficient financial as well as skilled human resources were available and hence system found stable. Timeliness of reporting found 90%. Conclusion: The performance of AFP surveillance system in AJ&amp;K is up to the mark. However, there is constant threat of reintroduction of polio virus from adjacent area of Punjab &amp; Khyber Pakhtunkhwa provinces. Highly vigilant AFP surveillance system with capacity of rapid response is the solution. Furthermore, it is vital to sustain the AFP Surveillance till the goal of global polio eradication is achieved.

Neonatal tetanus surveillance in Bayelsa state of Nigeria: a five-year review

ObjectiveTo assess the performance of neonatal tetanus surveillance in Bayelsa state of Nigeria.IntroductionNeonatal tetanus (NT) though a preventable disease, remains a disturbing cause of neonatal morbidity and mortality particularly in low income countries where maternal and child care are substandard and antitetanus immunization coverage is still poor. The disease, which is mostly fatal, is particularly common in hard to reach and rural areas where deliveries take place at home or with untrained attendants without adequate sterile procedures and in unclean environment. Since eliminating NT became a global target, significant reductions in NT deaths have been reported. The most recent estimates by WHO (2015) put death of newborns due to NT at 34,019, a 96% reduction from the situation in the late 1980s.All countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e., a reduction of NT incidence to below one case per 1000 live births per year in every district. A strong neonatal tetanus surveillance (NTS) is however required to achieve this. As of March 2018, only 14 countries were yet to eliminate MNT and this includes Nigeria.The different types of NTS recommended are conducted to varying degrees of efficiency and effectiveness in Nigeria under the major surveillance strategy – the Integrated Disease Surveillance and Response (IDSR). These include routine monthly surveillance, zero reporting, active surveillance and retrospective record review.Nigeria comprises six geopolitical zones, 36 states and a Federal Capital territory (FCT), and is made up of 774 Local Government areas (LGA) (districts) – an LGA being the lowest administrative level. This study was conducted in Bayelsa state – one of the six states in the south zone. It is made up of eight LGAs, more than half of which are riverine and consists of many hard-to-reach communities, where formal functional health facilities are few and far between. Health workers are in short supply and funding of health care delivery is poor in the state.MethodsThis was a retrospective review of all confirmed cases of neonatal tetanus that were managed at the two tertiary hospitals in the state - Niger Delta University Teaching Hospital Okolobiri (NDUTH), and Federal Medical Centre Yenagoa (FMC) - between January 2009 and December 2013. These were the only two public facilities that had the capacity to manage NT cases in the state. Relevant data including sociodemographics, pregnancy and birth history of patients, cord care and tetanus toxoid immunization of mothers were abstracted from the case files. The cases were traced to the office of the State Epidemiologist, where all cases were expected to be documented and investigated in line with the existing neonatal tetanus surveillance. Ethical approval was obtained from the Research and Ethics Committee of NDUTH for the research and permission was given to access case files.ResultsA total of 48 cases were managed in both facilities (36/75.0% in NDUTH and 12/25.0% in FMC) in the period under review but only 13 cases (27.1%) were reported to the office of the State Epidemiologist. Figure 1 shows the number of cases per year of review. The cases were resident in seven out of the eight LGAs. The mean age of cases was 8.98 (SD = 5.14) days and 29 (60.4%) were male while 19 (39.6%) were female. Available evidence showed that only 2.1% of the cases were protected at birth (mothers had TT2+); 91.7% of mothers did not have antenatal care and all the mothers were delivered by traditional birth attendants; 70.8% had their umbilical cord cut with new (?sterile) blade; and 43.8% had their cord treated with methylated spirit, others were treated with just water or some herbal preparation. Educational attainment of mothers of cases was primary (54.2%) and secondary (45.8%).ConclusionsThere were gaps in Neonatal Tetanus Surveillance in Bayelsa State as only 27.1% of cases were captured at the state level. Many mothers and their newborns were still not protected against tetanus, and delivery and cord care were done in unhygienic conditions. There is an urgent need to strengthen NT surveillance, improve vaccination against tetanus, and encourage skilled birth attendance in the state.

Post-operative tetanus following recto-sigmoidal carcinoma surgery: A case report

Tetanus is often seen as either neonatal tetanus or adult cases of tetanus. Rarely tetanus has been reported in postoperative patients as well. We report a case of post-operative tetanus following recto-sigmoidal carcinoma surgery in a labourer in North India. Since the diagnosis is mainly clinical, so high index of suspicion should be borne in mind regarding presentation after surgery. Early diagnosis helps in instituting treatment to neutralize the toxin thus leading to good prognosis of an otherwise fatal disease.

A study of clinical profile of childhood tetanus in south Gujarat area

Introduction: Despite the availability of cheap, safe and effective vaccine, tetanus is still a serious health problem worldwide and rural India, and a common cause of death in the new born. Community surveys have shown that only a small proportion of neonatal tetanus (NT) cases are routinely reported and under – reporting is often highest in areas at highest risk of NT. So, the objective of the study was to find out the epidemiological factors, clinical profile and outcome of childhood tetanus. Also to find out the preventable factors and prognostic factors in childhood tetanus. Methods: It was a prospective observational study. Legal guardians of all children less than 12 years old including neonates with diagnosis of tetanus admitted in pediatric department were inquired for detailed history regarding the present complaint, history of sources of infection, history of antenatal care, immunization status and detailed labor history. Grading of tetanus was done after detailed general and systemic examination. Result: Total 35 cases were included in the study with Male: Female ratio of 1.7:1. Among them 28.57% were neonatal tetanus and 28.57% were traumatic case. Among 10 neonatal tetanus cases 9 mothers were not immunized and among 25 non-neonatal cases 19 were unimmunized. Mortality was 90% in NT cases and 36% in Non-Neonatal Tetanus (NNT) cases. Common complication were septicemia [9 (25.71%)], Disseminated Intravascular Coagulation (DIC) [8 (22.85%)], Hyperpyrexia [7 (17.14%)], Pneumonia [5 (14.28%)], Bed sore [3 (8.5%)], and thrombo phlebitis [1(2.8%)] of cases. Conclusion: Although incidence of childhood tetanus has been reduced over the years, but still tetanus is more common in rural population due to illiteracy, poor socioeconomic status, poor vaccination and superstitions. The mortality by tetanus can be reduced by improving routine immunization specifically in rural and low socioeconomic population, by recognition of disease severity and providing proper management with intensive care as early as possible.