Neonatal tetanus (''trismus nascentium'') is a form of generalised

tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...

that occurs in newborns. Infants who have not acquired

passive immunity Passive immunity is the transfer of active humoral immunity of ready-made antibodies. Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta, and it can also be induced artificially, when ...

from an immunized mother are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in

developing countries A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...

, particularly those with the least developed health infrastructure. It is rare in

developed countries A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...

. The

WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...

recommend that unimmunized pregnant women receive tetanus toxoid in the pregnancy to prevent the disease in their baby once born. Globally, deaths from neonatal tetanus was 787,000 in the early 1980s. In 1989, the WHO launched a programme to vaccinate all pregnant women, and deaths from neonatal tetanus dropped to 25,000 in 2018.

Signs and symptoms

In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. The fatality rate for infants has been estimated as 70% to 100%; death usually occurs by the age of 2 weeks. On the basis of clinical findings, four different forms of tetanus have been described. The time from exposure to symptoms may be up to several months. The neonate is unable to suck and cry, is rigid, and develops spasms.

Prevention

The spores which cause tetanus are present everywhere, so the only prevention is immunization. Three properly spaced doses of tetanus toxoid vaccine are recommended for women of childbearing age, either before or during pregnancy; this will protect their future babies from neonatal tetanus after delivery.

Public health campaigns

In 1989, the World Health Congress called for the elimination of neonatal tetanus.

UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing humanitarian and developmental aid to ...

took the lead, assisted by other United Nations agencies, individual governments, and non-profit organisations. By 2000, the disease was declared as eliminated from 104 of 161

. "Elimination" is defined as less than 1 case per 1,000 live births in every district of the country. Since tetanus can also strike postpartum mothers, the campaign has been expanded to target both maternal and neonatal tetanus. In many affected countries, there was a lack of awareness of maternal and neonatal tetanus and how to prevent it. Education and immunisation campaigns have been launched in the remaining countries at risk and are targeted particularly at pregnant women. Education focuses on hygienic birth practices and infant cord care as well as the need for immunisation. In Egypt, the number of cases of neonatal tetanus dropped from 4,000 to fewer than 500 annually as the result of an immunisation campaign. In Morocco, neonatal tetanus accounted for 20% of neonatal deaths in 1987 but only 2% in 1992. In 1998 in

Uganda }), is a landlocked country in East Africa. The country is bordered to the east by Kenya, to the north by South Sudan, to the west by the Democratic Republic of the Congo, to the south-west by Rwanda, and to the south by Tanzania. The sou ...

, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda in 2011 was certified as having eliminated tetanus. In 2011,

Pampers Pampers is a brand of baby and toddler products marketed by Procter & Gamble. History In 1961, P&G researcher Victor Mills disliked changing the cloth diapers of his newborn grandchild. He assigned fellow researchers in P&G's Exploratory Divi ...

joined with UNICEF to target maternal and neonatal tetanus in

Yemen Yemen (; ar, ٱلْيَمَن, al-Yaman), officially the Republic of Yemen,, ) is a country in Western Asia. It is situated on the southern end of the Arabian Peninsula, and borders Saudi Arabia to the Saudi Arabia–Yemen border, north and ...

. In 2010,

Kiwanis International Kiwanis International ( ) is an international service club founded in 1915 in Detroit, Michigan. It is headquartered in Indianapolis, Indiana, United States, and is found in more than 80 nations and geographic areas. Since 1987, the organizati ...

pledged to raise $110 million to eliminate maternal and neonatal tetanus throughout the world in partnership with UNICEF. On 15May 2015, the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...

(WHO) declared India free from maternal and neonatal tetanus. India has reduced its

infant mortality rate Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

(IMR) from 380 per 1000 live births in 1990, to 40 in 2015, and its

maternal mortality rate Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to p ...

(MMR) from 540 per 100,000 to 167 in the same years. The national health programme was started in 1983 by the

Government of India The Government of India (ISO: ; often abbreviated as GoI), known as the Union Government or Central Government but often simply as the Centre, is the national government of the Republic of India, a federal democracy located in South Asia, ...

, when all pregnant women were given two doses of tetanus vaccine. The number of deaths from tetanus dropped from 79,000 in 1990, to less than 500 in 2013 and 2014.

Epidemiology

Year of Maternal Neonatal Tetanus (MNT) elimination, OWID

In 2000, neonatal tetanus was responsible for about 14% (215,000) of all neonatal deaths. In 2008, 59,000 newborns worldwide died as a result of neonatal tetanus. In 2005, 57 countries were identified as still at risk, with 27 countries accounting for 90% of cases. As of December 2013 the number of countries at risk was reduced to 25.

References

External links

{{commons category, Neonatal tetanus
Tetanus – Immunization, Vaccines and Biologicals

Neonatal Tetanus D7341 Insert

Maternal/Neonatal Tetanus (MNT)

Maternal and neonatal tetanus-Immunization

Neonatal tetanus
RightDiagnosis.com Animal bacterial diseases Tetanus Neonatology