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  Treatment and control

Treatment and control:

The patient is aware and needs sedation and constant nursing. Intravenous injection of large initial dosage of antitoxin (30,000 - 200,000 units) followed by intramuscular injection, are suggested instantly. The wound is cleaned and left open with a loose pack. Surgical elimination of necrotic tissue is necessary.

The patient is specified 10,000 units of human tetanus immunoglobin (i.e., HTIG) in saline by slow intravenous infusion. Penicillin or metronidazole is specified for as long as considered essential. Previously immunized individual whenever wounded must be specified booster dose of tetanus toxoid to stimulate the antitoxin production.

Epidemiology:

Tetanus comes under the main lethal infections. There are approximately 1 million deaths annually from tetanus of which 400,000 are due to the neonatal tetanus. Therefore the disease differs from country to country, and is universally proportional to socio-economic growth and standard of living, preventive medicine and organization of wound. Treatment of the umbilical cord with cow dung, tying of umbilical cord with primitive lygatures and ear piercing through unsterile instruments might cause tetanus.

Prevention and Control:

Wound management is of the primary and foremost significance. Or else tetanus spores will germinate in the unclean wounds. Active immunization: Universal active immunization with tetanus toxoid is obligatory. All persons must be actively immunized against tetanus in childhood and their immunity is sustained by booster doses of toxoid at intervals of 5 to 10 years. Tetanus toxoid is a preparation of refined toxin which has been rendered non-toxic by treatment with formaldehyde (i.e., formal toxoid). A soluble toxoid is made more efficient by absorption on to an aluminium hydroxide carrier (i.e., absorbed toxoid). Tetanus toxoid is given all along with Diphtheria and pertussis as a triple vaccine in babyhood.

A course of three 0.5 ml doses of tetanus toxoid with intervals of 6-12 weeks among the first two, and 6-12 months among the second and third injections. A booster dosage of 0.5 ml might be specified at intervals of 5 to 10 years to sustain immunity. A careful record must be kept of all prophylactic injections.

Passive Immunization:

Tetanus antitoxin is frequently termed as anti-tetanus serum or ATS can be acquired by immunizing horses with toxoid. This serum is of value in the prophylaxis of tetanus when provided instantly after wounding. Its utilization as a curative agent after development of tetanus is less efficient.

Combined Active and Passive Immunization:

Patients getting passive protection with antitoxin after injury must also be given tetanus toxoid. An injured non-immune patient might get from separate syringes, 1500 units of equine tetanus antitoxin or 250 units of homologous ATG intra muscularly in one arm and 0.5 ml of the adsorbed toxoid in another. The patient is recommended to have a second injection of 0.5 ml of absorbed toxoid 6-12 weeks afterward.

 

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