elimination and eradication of tetanus
TRANSCRIPT
• Throughout these years, many scientists and researchers are trying to find the ways to eliminate and eradicate the one called disease ‘tetanus’. Many control and preventive measures are planned to ensure this objective can be achieved.
• As the science world knows that this disease that caused by anaerobic organism, Clostridium tetani, is a global disease that brings fatal and worse complication to the infected person. It is characterized by painful muscular contractions due to the neurotoxin released by this organism that blocked the inhibition of spinal reflexes. Mainly respiratory failure is the cause of death underlying by this tetanus disease.
• Based on the definition provided by the Centre of Disease Control and Prevention (CDC), we can compare the definition between control, elimination, eradication and extinction to study and understand the processes being run.
• Control : The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts. Continued intervention measures are required to maintain the reduction. Example diarrheal diseases.
• Elimination of disease : Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts. Continued intervention measures are required. Example neonatal tetanus.
• Elimination of infections : Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts. Continued measures to prevent re-establishment of transmission are required. Examples poliomyelitis, measles.
• Eradication : Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts. Intervention measures are no longer needed. Example smallpox.
• Extinction : The specific infectious agent no longer exists in nature or in the laboratory. Example none.
• For the process of elimination and eradication, there are some criteria should be followed to ensure the process can be aimed and accomplished.
Criteria for diseases suitable for elimination or eradication Tetanus
1. Causative agent is antigenically potent and stable. Antigenically potent and stable.
2. Man is the only reservoir. Soil and gastrointestinal tract of animals. *
3. Disease occur in clinically apparent form that can be detected. Clinically apparent form can be detected.
4. Disease has long incubation period. Incubation period for 4-21 days.
5. Modes of transmission are limited. Not certainly limited.*
6. Post infection immunity is life lasting. Long lasting immunity after 5 doses. Booster dose required.
7. Availability of effective control measures and resources to implement program for elimination and eradication.
Available.
• Based on the criterias listed above, this disease can only be control for the meantime and still ongoing process towards its elimination and eradication. Despite of this limitation, still there are some steps that had been conducted to control and limit its occurrence to the world.
• There are some control and preventive measures conducted:
- Vaccination program.- Increase effectiveness in reporting cases.- Health education towards women community
regarding the danger and consequences of unclean practice of delivery.
- Improving the surveilance system on detecting and identifying the high risk areas for the implementation of corrective action.
Age Vaccine Dose
Infant Diphteria Pertussis Tetanus vaccine (DPT)
Given at the end of 2nd, 4th, and 6th month of age.
Pre-school DPT Booster dose. Given 18-24 months of age.
School Tetanus diphteria (Td) Given at the 4th primary.
Adult Td Booster dose. Every 10 years.
Risk group( exposed to the infection ) previously unvaccinated
TD First 2 doses are given at 4-8 weeks interval and the third dose at 6-12 months after the 2nd dose.
Primary series of 3 doses TD is given.
Reproductive period of woman ( for prevention of neonatal tetanus )
Tetanus toxoid (TT) Five doses 1 : as early as possible during pregnancy2 : at least 4 weeks after TT13 : at least 6 weeks after TT24 : at least 1 year after TT35 : at least 1 year after TT4
Vaccination Program
• The vaccine will starts it reaction two weeks after the administration of the second dose. Any subsequent dose administered after the first dose will counts as a dose towards the five doses schedule even if it administered after a long interval than recommended minimum interval.
• Until now, there is no evidence proven on the contraindications of this tetanus toxoid immunization of pregnant women at any time during pregnancy. It is recommended by the Centre for Disease Control (CDC) for the women who received the last tetanus toxoid vaccine less than 10 years ago to receive Tdap in the post partum period.
• Up till now, this vaccination program can be concluded that it has been in a good progress all over the world. Many countries implemented this program and succeed to decrease the incidence of tetanus in their country.
• Other than vaccine, there is also another chemoprophyaxis for the treatment of tetanus. This type of immunity is a passive artificial type which is tetanus immunoglobulin (TIG) or tetanus antitoxin. This immunity is indicated for the person that previously unimmunized and required an urgent protection due to injury with a risk of getting infected with tetanus.
• In Malaysia, with concern and role of responsibility towards the nation, the government supported this vaccination program and participated in it thus implemented it all over the country. It was a successful in decreasing tetanus cases in Malaysia. By the order from ministry of health, there is a mandatory list of vaccine that should be taken by every newborn in this country after taking consideration and consent from the parents and guardian of the newborn.
Increase effectiveness in reporting cases.
• Not only in the case of tetanus, other than this disease also need to be improve in aspect of reporting to the local and legal authorities. Statistics showed that in every disease that having the good reporting and surveilance system will result in a good feedback and outcomes.
• People should be awaken and aware about the importance of knowing the dangerous and consequences of getting infected with tetanus. This will be conducted in a health community program. After getting the community to realise about this matter, it should improve in the reporting the incidence and prevalence of this disease. Thus, it can be success towards achieving the aim of elimination and eradication.
Health education towards women community.
• In cases of neonatal tetanus, many of it resulted from unclean and unsterile practice of delivery. This occurred especially to those who are going to deliver in homes in the practice of strict asepsis of umbilical stump of newborn infants. Usually this incidence can be seen in less developed and educated areas where contaminated substances are traditionally applied.
• Health officers and authorities should aware and concern about this matter and construct a plan of health program to ensure this women community being educated and realised to practice a safe baby delivery even doing it at home.
Example of messages that should be included in the women health program
• Advise the mother on the importance of practicing clean and sterile baby delivery at home.
• Inform the dangerous of getting tetanus infection and the factors of risk to get infected.
• Educate them on how to practicing healthy and clean baby delivery at home.
• Explain to them about the control and prevention measures of tetanus and the advantages of getting immunized.
Improving the surveilance system on detecting and identifying the high risk areas for the
implementation of corrective action.
• By improving the mechanism of running the surveilance system itself, it should help in increasing the reported cases. Thus from here, this improvement can help in identifying the high risk areas that can be focus on for the implementation of corrective program such vaccination administration and health education.
