Tetanus – a Review of Current Concepts in Management *o

Tetanus is a vaccinepreventable disease that yearly causes a total of 309,000 deaths. Reports showed up to 1 million cases annually, mostly in underdeveloped countries. Clostridium tetani, the causative organism, is widespread in the faeces of domestic animals and humans, while spores of C. tetani are abundant in soil and in the environment surrounding the habitation of humans and animals. In developing countries, mortality rates are as high as 28 per 100,000; in North America the rate is less than 0.1 per 100,000. Immunization programs clearly decreased neonatal tetanus deaths, and some recent evidence suggests progress in prevention throughout the World. Tetanus remains a great public health problem in developing countries such as Nigeria and it is associated with high mortality, but the understanding of the epidemiological aspects of this disease forms the basis of preventive strategies in any community. This paper reviewed the history, epidemiology and clinical diagnosis of tetanus and emphasized the current opinions in the management of tetanus outlining the various suggested treatment plans from experts in developing countries which form the basis for World Health Organization recommendations. INTRODUCTION Tetanus, an infective intoxication of the nervous system by clostridium tetani, is an ancient disease – as old as humans. It is currently responsible for 1.2 million deaths in the developing world. Despite the widespread availability of a safe and effective vaccine against this disease, it remains a major health problem in developing countries, and also occurs in countries with good standard of medical practice. It is a disease associated with a high mortality rate and a major cause of death among neonates in developing African countries. It typically presents with trismus, difficulty in swallowing and more ominously difficulty in breathing or opisthotonus. The incidence of tetanus has been on gradual and continuous decline in developed countries due to organized mass tetanus immunization campaigns. The widespread use of tetanus toxoids (formulated as diphteria, whole-cell pertusis vaccine and tetanus toxoid-DPT) for infants and children, the use of both tetanus toxoids and tetanus immune globulin (TIG) for post-exposure prophylaxis in wound treatment and improved care Vol. 11 No. 1 December, 2009 Tetanus – A review of current concepts in management