Neonatal tetanus is a form of generalized tetanus that occurs in newborns. Infants who have not acquired passive immunity because the mother has never been immunised 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, particularly those with the least developed health infrastructure. It is rare in developed countries.
The incubation period of tetanus may be up to several months, but is usually about eight days. 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 spores which cause tetanus are present everywhere, so the only prevention is immunisation. 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.
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 number of countries at risk was reduced to 25.
Public health campaigns
In 1989 the World Health Congress called for the elimination of neonatal tetanus. UNICEF took the lead, assisted by other United Nations agencies, individual governments, and nonprofit organizations. By 2000 the disease was declared as eliminated from 104 of 161 developing countries. "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, 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 joined with UNICEF to target maternal and neonatal tetanus in Yemen. In 2010, Kiwanis International pledged to raise $110 million to eliminate maternal and neonatal tetanus throughout the world in partnership with UNICEF.
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