An epidemiological study of Tetanus cases in a tertiary care hospital of Jaipur, Rajasthan
Abstract
In developing countries like India tetanus is still a public health problem as compared to developed countries. Although TT vaccination in pregnant women has given its dividends then also people are having tetanus even now. So this hospital based study was conducted to find out epidemiological factors in tetanus patients; admitted in a tertiary care hospital, Jaipur. This study was conducted on 192 tetanus patients above one year of age, who were admitted in Infectious disease hospital SMS, Jaipur Rajasthan during March 2017 to august 2018. Patient’ s detailed history was obtained and findings entered in proforma. Scoring was done by modified scoring system for grading of tetanus. Out of 192 cases 77.6% were below 40 years; out of these 60% were in age range of 1 to 20 years and median age was 17.6 year. In the study 73.4% were male and 27% were female and 83.9% of the cases were from rural and 16% from urban area. The completely immunized cases against tetanus were only 2%. The most common cause of tetanus was injury (54.6%) and the foot (42%) was commonest site of injury. The case fatality rate was 16.1%; which was more in above 40 year of age, in partial/non immunized cases and in severe cases. It can be concluded that tetanus cases were seen more in male and from rural area. Trauma was the most common cause of tetanus and among trauma Foot injury was commonest. Immunization status was significantly associated with fatality of cases, there was big lack of immunization which contributed in case fatality of tetanus.
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Introduction
Tetanus is an acute fatal disease caused by an exotoxin- tetanospasmin which is produced by Clostridium tetani, an anaerobic bacillus, whose spores survive in soil and cause infection by contaminating wounds. It is characterised by painful muscular spasms especially of jaw, facial and neck muscles.1 It is a vaccine preventable disease.1
The global incidence of tetanus has been estimated at approximately one million cases annually.1,2 In Developed countries with effective implementation of immunization programme, prompt wound management, incidence of tetanus is rare now. It was reported that in UK since 1947 tetanus cases and deaths from tetanus have been declined by >95% and >99% respectively.3
India has also achieved maternal neonatal tetanus elimination i.e. < 1 cases per 1000 live birth in May 2015.4 It became possible due to improved childbirth practices and increased levels of maternal immunity resulting from tetanus toxoid immunization during antenatal period.
But still tetanus is a public health problem especially in rural areas due to incomplete immunization, lack of health education and poor hygiene. The present study was conducted to study the epidemiologic factors associated with tetanus with their fatality.
Conclusion
This present study concluded that tetanus cases were seen more in male and from rural area. Trauma was the most common cause of tetanus and among trauma Foot injury was commonest. Immunization status and severity of disease were significantly associated with fatality of cases, there was big lack of immunization which contributed in case fatality of tetanus.