Tetanus: still a public health problem in India — observations in an infectious diseases hospital in Kolkata

Abstract

Background: Tetanus is a major health problem in many developing countries,including India, with significant morbidity and mortality due to lack of environmentalhygiene and health education, incomplete vaccination, high case prevalence andinadequate intensive care facilities.Objectives: To observe the demography, clinical profile and outcomes of tetanuspatients.Materials and methods: A total of 282 tetanus patients were screened and closelyobserved prospectively from January 2010 to December 2011.Results: The mean age of the study patients was 31.15 years (‎± 14.26)‎ and themajority were unvaccinated or incompletely vaccinated against tetanus. Patientswere mainly farmers (‎140, 49.64%)‎ and children (‎102, 36.17%)‎. The sources ofinfection identified were mainly thorn/pin prick in 129 cases (‎45.7%)‎, cut/laceratedinjury in 83 cases (‎29.4%)‎ and ear infection in 47 cases (‎16.7%)‎, while definiteinjury was not detected/remembered in 42 cases (‎14.8%)‎. The average duration ofhospital stay was 17.2 ± (‎4.7)‎ days and autonomic nervous system dysfunction wasthe most common complication observed in this study. Death was the outcome ina total of 58 patients (‎20.6%)‎ mostly due to aspiration pneumonia-induced sepsis,respiratory failure or cardiac complications.Conclusion: Environmental hygiene, basic health education, increased inimmunization coverage, proper wound care – even following minor injuries – andmore facilities for intensive care units, may reduce the overall incidence of tetanusand mortality following onset of the disease