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MARCH-APRIL , 2023 | THE HEALTH
23
SEPSIS ALERT
BY ASSOC PROF DR TAN TOH LEONG
AND DR SUSAN LOO POOI SAN
TETANUS is one of the world ’ s most forgotten and yet deadly infections . According to the World Health Organisation ( WHO ), there were only 64 cases reported in Malaysia in 2019 .
Tetanus is an acute bacterial infection caused by Clostridium tetani sp . The disease is acquired by direct contact with clostridium tetani spore from the soil , excreta from animals or humans to an open wound . One of the biggest worries about tetanus infection is that it can cause serious muscle spasms , ultimately affecting respiratory function and leading to potential death .
Tetanus cannot be eradicated but it can be prevented through vaccination . The vaccine is a substance that triggers the body ’ s immunity to a particular infectious disease . It can be in a form of killed germs ( killed vaccine ), weakened germs ( lived attenuated vaccine ), specific structure of the germs ( conjugated , subunit , recombinant , polysaccharide , and conjugate vaccines ) or piece of mRNA that instruct the human body to produce part of germ ’ s protein ( mRNA vaccine ).
Tetanus is a toxoid vaccine which
The forgotten enemy : Tetanus
A tetanus infection can cause serious spasm of muscles which ultimately affect respiratory function and lead to potential death
contains the toxin ( Tetanospasmin ) produced by Clostridium tetani sp . The Malaysian healthcare system has a systemic approach in combating tetanus infection . Tetanus vaccination is provided to all children and adolescents via the national scheduled vaccination .
HIGH FATALITIES AMONG SENIORS AND INFANTS
The primary doses of tetanus vaccination are given as a combination vaccine ( Diphtheria , Tetanus , Pertussis , Polio , Hepatitis B , Haemophilus Influenza type b ) at two , three , five and 18 months old . Additional booster doses using a combination vaccine of
Diphtheria and tetanus will be given at seven and 15 years old , respectively .
Tetanus toxoid has an efficacy rate of more than 95 per cent and after
Assoc Prof Dr Tan Toh Leong is a Senior Lecturer and Consultant Emergency Physician in Hospital Canselor Tuanku Muhriz , Universiti Kebangsaan Malaysia and President and Founder of Malaysian Sepsis Alliance ( MySepsis ) while Dr Susan Loo Pooi San is Emergency Physician , Teluk Intan Hospital and member of MySepsis completion of the primary doses , it confers at least five years of protection . Immunity will last 10 years after the fourth dose and up to 20 years after the fifth dose .
Therefore , adults are recommended to have a tetanus booster every 10 years after completion of a primary course and booster dose . According to the Malaysian Society of Infectious Disease and Chemotherapy ( MSIDC ), the fatality to case ratio is highest among those over 65 years old and also infants which is about 10-20 per cent .
To reduce the incidence of congenital tetanus , a dose of adsorbed tetanus toxoid booster is given to all expecting mother around 27 weeks to 36 weeks gestation to optimise maternal antibody response and passive transfer of antibody to the baby . Other targeted approach includes tetanus booster or immunoglobulin administration to adult with recent injuries .
PREVENTION BETTER THAN CURE
Tetanus booster or immunoglobulin administration in such cases depends on the immunisation status of the patient and the type of wounds . Examples of tetanus prone wounds include compound fracture , wounds that are heavily contaminated with soil , wounds that contain foreign body ( such as wood ) and wounds with extensive tissue damage .
Based on the recommendation by the MSIDC , for those who have competed three primary doses , in which time since last dose is less than five years , both tetanus booster and immunoglobulin administration are not required for all types of wounds . However , if the last dose is more than five years after completion of primary doses , the booster is only given to those with wounds other than a clean wound .
If more than 10 years , then a booster is recommended for all the wounds . However , if someone has not completed the primary doses or is unsure of their vaccination status , they should be given all primary doses of vaccine containing Tetanus and Diptheria and immunoglobulin should be given for wounds other than a clean wound . Immunoglobulin administration will provide immediate response to the bacterial .
Well , prevention is always better than cure especially for diseases with a high mortality rate like tetanus . Therefore , get your tetanus vaccination before it is too late . – The Health
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