Tetanus

Tetanus Remains a Threat to Unvaccinated

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A recent case of tetanus in an unvaccinated child highlights the continued threat of this rare but dangerous disease among the unvaccinated individuals in the United States.

“Unvaccinated or inadequately vaccinated persons are at risk for tetanus, irrespective of age, and recovery from tetanus disease does not confer immunity,” write Judith A. Guzman-Cottrill, DO, from the Oregon Health and Science University, Portland, and colleagues. The case report was published online March 7 in Morbidity and Mortality Weekly Report.

The case involved a 6-year-old boy who suffered a scalp laceration while playing outdoors. Although his wound was cleaned and sutured at home, the boy was unvaccinated.

After 6 days, he developed symptoms of jaw clenching, involuntary upper extremity muscle spasms, opisthotonus, generalized spasms, and breathing difficulty. He was airlifted to a hospital, where a clinical diagnosis of tetanus was made.

He underwent 8 weeks of inpatient care, including administration of tetanus immune globulin, as well as diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). His wound was irrigated and debrided, and he received intravenous metronidazole.

He required neuromuscular blockade to manage his muscle spasms, continuous intravenous medication infusions to control his pain and blood pressure, and a tracheostomy for ventilator support.

After 8 weeks, his condition improved enough for transfer to an inpatient rehabilitation center, where he remained for 17 days. One month later, he was able to resume his normal active lifestyle. His family refused the second dose of DTaP and other vaccinations recommended by clinicians.

Because of continued use of tetanus immune globulin for wound management and widespread vaccination with tetanus toxoid, tetanus cases have dropped in the United States by 95% since the 1940s, and the number of tetanus-related deaths have dropped by 99%.

In this case, the boys inpatient care alone cost $811,929, which is about 72 times the mean cost of $11,143 for a child’s hospital stay, according to a 2012 study.

This is the first case of tetanus in a child in Oregon in more than 30 years, the authors emphasize, but it highlights the importance of vaccination for this preventable disease.

The Advisory Committee on Immunization Practices recommends a five-dose DTaP series for all eligible children at 2, 4, and 6 months of age, followed by a fourth dose at 15 to 18 months of age, and a fifth at 4 to 6 years of age.

“Booster doses of diphtheria and tetanus toxoids are recommended every 10 years throughout life,” the authors stress.

Tetanus, Diphtheria, and Pertussis Vaccination during Pregnancy .

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Tetanus, diphtheria and pertussis can be very serious diseases, even for adolescents and adults. These diseases are caused by bacteria. Diphtheria and pertussis are spread from person to person through coughing or sneezing. Tetanus enters the body through cuts, scratches, or wounds.

Tetanus, Diphtheria, and Pertussis Vaccination during Pregnancy

TETANUS (Lockjaw) causes painful muscle tightening and stiffness, usually all over the body. It can lead to tightening of muscles in the head and neck so you can’t open your mouth, swallow, or sometimes even breathe. Tetanus kills about 1 out of 5 people who are infected.

DIPHTHERIA can cause a thick coating to form in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and death.

PERTUSSIS (Whooping Cough) causes severe coughing spells, which can cause difficulty breathing, vomiting and disturbed sleep. It can also lead to weight loss, incontinence, and rib fractures. Up to 2 in 100 adolescents and 5 in 100 adults with pertussis are hospitalized or have complications, which could include pneumonia or death.

The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs in infants who are less than or equal to 3 months of age. Infants do not begin their own vaccine series against pertussis (with the diphtheria, tetanus and acellular pertussis vaccine [DTaP]) until 2 months of age. This situation leaves a window of significant vulnerability for newborns, many of whom appear to contract serious pertussis infections from family members and caregivers, including the mother.

Advisory Committee on Immunization Practices (ACIP) Recommendations

The ACIP of the Centers for Disease Control and Prevention (CDC) published its updated recommendation in February 2013, which recommends that health care personnel administer a dose of Tdap during each pregnancy, irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, optimal timing for Tdap administration is between 27 weeks and 36 weeks of gestation, although Tdap may be given at any time during pregnancy. Receipt of Tdap at some point during pregnancy is critical, and there may be compelling reasons to vaccinate earlier in pregnancy (e.g., under “Special Situations During Pregnancy” [Click to follow link]).

For women who previously have not received Tdap, if Tdap was not administered during pregnancy, it should be administered immediately postpartum to the mother in order to reduce the risk of transmission to the newborn.

The ACIP recommends that all adolescents and adults who have or who anticipate having close contact with an infant younger than 12 months (e.g., siblings, parents, grandparents, child care providers, and health care providers) who previously have not received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission. Ideally, these adolescents and adults should receive Tdap at least 2 weeks before they have close contact with the infant.

American College of Obstetricians and Gynecologists (ACOG) Recommendations

(a) General Considerations Surrounding Immunization during Pregnancy:

ACOG recommends routine assessment of each pregnant woman’s immunization status and administration of indicated immunizations. The benefits of nonlive vaccines outweigh any unproven potential concerns. There is no evidence of adverse fetal effects from vaccinating pregnant women with an inactivated virus or bacterial vaccines or toxoids, and a growing body of robust data demonstrates safety of such use. Co-administration of indicated inactivated vaccines during pregnancy (i.e., Tdap and influenza) is also acceptable, safe, and may optimize effectiveness of immunization efforts. It should be remembered, however, that live attenuated vaccines (e.g., measles-mumps-rubella [MMR], varicella, and live attenuated influenza vaccine) do pose a theoretical risk (although never documented or proved) to the fetus and generally should be avoided during pregnancy. All vaccines administered during pregnancy as well as health care provider-driven discussions about the indications and benefits of immunization during pregnancy should be fully documented in the patient’s prenatal record. In addition, if a patient declines vaccination, this should be documented in the patient’s prenatal record, and the health care provider is advised to revisit the issue of vaccination at subsequent visits.

(b) Special Situations During Pregnancy:

  • Ongoing Epidemics

Pregnant women who live in geographic regions with epidemics of pertussis should be immunized as soon as feasibly possible for their own protection in accordance with local recommendations for nonpregnant adults. Less emphasis should be given to targeting the proposed optimal gestation window (between 27 weeks and 36 weeks of gestation) in these situations given the imperative to protect the mother from locally prevalent disease. Newborn protection will still be garnered from vaccination earlier in the same pregnancy. Importantly, a pregnant woman should not be re-vaccinated later in the same pregnancy if she already received the vaccine in the first or second trimester.

  • Wound Management

As part of standard wound management care to prevent tetanus, a tetanus toxoid-containing vaccine is recommended in a pregnant woman if 5 years or more have elapsed since her previous tetanus and diphtheria (Td) vaccination. If a Td booster vaccination is indicated in a pregnant woman for acute wound management, health care providers should administer Tdap irrespective of gestational age. A pregnant woman should not be re-vaccinated with Tdap in the same pregnancy if she received the vaccine in the first or second trimester.

  • Due for Tetanus and Diphtheria Booster Vaccination

If a Td booster vaccination is indicated during pregnancy (i.e., more than 10 years since the previous Td vaccination) then health care providers should administer Tdap during pregnancy, preferably between 27 weeks and 36 weeks of gestation. Because of the nonurgent nature of this indication, waiting until 27–36 weeks of gestation appears to be the appropriate management plan to obtain maternal immunity and maximize antibody transfer to the newborn.

  • Unknown or Incomplete Tetanus Vaccination

To ensure protection against maternal and neonatal tetanus, pregnant women who have never been vaccinated against tetanus should begin the three-vaccination series, containing tetanus and reduced diphtheria toxoids, during pregnancy. The recommended schedule for this vaccine series is 0, 4 weeks, and 6–12 months; Tdap should replace one dose of Td, preferably given between 27 weeks and 36 weeks of gestation.

India Virtually Eliminates Tetanus as a Killer

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A year after eliminating polio, India has scored another public health victory. Following a 15-year campaign, the country has virtually eliminatedtetanus as a killer of newborns and mothers.

Tetanus, caused by a bacterium common in soil and animal dung, usually infects newborns when the umbilical cord is cut with a dirty blade. Mothers often receive the infection by giving birth on dirty surfaces or being aided by midwives with unwashed hands.

The disease — also known as lockjaw, after its muscle spasms — usually sets in about a week after a birth and is invariably fatal if not promptly treated. Fifteen years ago, the World Health Organization estimated that almost 800,000 newborns died of tetanus each year; now fewer than 50,000 do.

But the effort to reduce tetanus has gone slowly. The World Health Assembly — the annual gathering of the world’s health ministers in Geneva — originally set 1995 as the target date for its global elimination as a health threat.

Unlike polio or smallpox, tetanus can never be eradicated because bacterial spores exist in soil everywhere, said Dr. Poonam Khetrapal Singh, the director of the W.H.O.’s Southeast Asia region.

India has reduced cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem.” The country succeeded through a combination of efforts.

In immunization drives, millions of mothers received tetanus shots, which also protect babies for weeks.

Mothers who insisted on giving birth at home, per local tradition, were given kits containing antibacterial soap, a clean plastic sheet, and a sterile scalpel and plastic clamp for cutting and clamping the cord.

The country also created a program under which mothers were paid up to $21 to give birth in a clinic or hospital. “Lady health workers” from their neighborhoods were paid up to $9 per mother and up to $4 for bus or taxi fare to make sure women in labor went to clinics. The workers earned the full amount only after visiting each baby at home and giving tuberculosis shots.

The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments — including some to a 60-year-old woman registered as having been pregnant five times in 10 months.

Whooping Cough Vaccine Can Cause Brain Damage And Death.

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 In July, the state of Missouri began offering for free a vaccine aimed at preventing, among other ailments, whooping cough. According to officials, the TDap vaccine, which reportedly prevents tetanus, diphtheria and pertussis, was necessary because “of the rising incidence of whooping cough is reported to be related to the vaccine wearing off if given more than ten years earlier,” says an online report.

Citing a St. Louis Post Dispatch article, Michelle Goldstein of VacTruth.com says some 41,000 cases of pertussis occurred in the U.S. in 2012, compared to less than 19,000 cases in the previous year – thus the need for the new vaccine.

“The news story emphasized that whooping cough is highly dangerous and can lead to vomiting and death, especially in children. The report indicates that diphtheria is a bacterial disease that is highly contagious and can also lead to death,” Goldstein writes, adding that tetanus can cause severe muscle spasms.

Natural remedies, treatments can work without risk

What the paper failed to report, however, is that there are serious health risks associated with the Tdap vaccines. Also, there are relatively benign health implications that are commonly associated with the diseases the vaccine is intended to prevent – “along with the important fact that vaccines have never been proven to prevent any disease,” Goldstein said.

She adds:
The risks that WHOOPING COUGH, diphtheria and tetanus pose to health are low compared to the potential, serious dangers reported as a result of this vaccine. Whooping cough can be treated successfully through a vitamin C protocol developed by Dr. Suzanne Humphries which has been shown to greatly reduce symptoms. In contrast, antibiotic treatments, given routinely by conventional, allopathic physicians to treat whooping COUGH, have never been shown to positively impact the course of the illness.
Whatever the standard medical treatments, most people fully recover from whooping cough, which then gives them lifetime immunity from it. If they should become re-infected, Goldstein writes, subsequent episodes are generally “quite mild.”

Meanwhile, tetanus can be prevented in a number of ways without ever receiving a VACCINE. For instance, simply thoroughly washing and cleaning cuts can prevent the disease. And in actuality, contracting the disease in the first place is rare; just “233 cases of tetanus were reported to the Center for Disease Control between 2001 and 2008,” Goldstein points out, citing the federal agency’s own figures. “The incidence of tetanus declined by more than 95% between 1947 and 2008.”

Finally, diphtheria is also a low-risk disease, and one that is not seen widely in the U.S. since an outbreak in the 1970s. Over the 30-year period between 1980 and 2010, just 55 cases of the disease were reported to the CDC.

Vaccine dangers outweigh risk of actually getting the disease

The dangers of getting a Tdap vaccine can also be significant. According to Goldstein:

Health consequences resulting from the Tdap vaccine include encephalitis, BRAIN DAMAGE and death. A comprehensive report made by the National Vaccine Information Center (NVIC) documents clearly the widespread health dangers associated with the Tdap vaccine. Tdap and DTap vaccines are currently used in the United States, replacing the DTP vaccine in 1996, but all three vaccines contain the dangerous pertussis toxin with unsafe additives.

Furthermore, experts note, the fact that whooping cough even occurs in “vaccinated” populations is a sign that vaccines are not effective at preventing the disease.

Sources: Raw For Beauty

 

Pertussis Immunity Drops Soon After the Last Vaccine Dose Is Given.

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The incidence of pertussis in children rises steadily in the years immediately following receipt of the fifth dose of the diphtheria–tetanus–acellular pertussis (DTaP) vaccine, according to a study in Pediatrics.

Researchers examined the incidence of pertussis among more than 400,000 children in Minnesota and Oregon who’d received all five doses of DTaP, with the fifth dose given between ages 4 and 6 years. In the 6 years after the last dose was received, some 550 pertussis cases were identified. The incidence rose steadily with each passing year.

The authors say their findings “strongly [suggest] waning of vaccine-induced immunity,” which “helps to explain the emergence of an increased burden of disease among 7- to 10-year-olds.” (Currently, the adolescent booster is recommended at ages 11 to 12 years.)

Source: Pediatrics

Vaccines for adults: Which do you need?

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Vaccines offer protection from various types of infections and diseases, from seasonal flu to diphtheria. Understand which vaccines adults need and when to get them.

Wonder which vaccines you need? It can be confusing, especially if you thought vaccines were just for kids. Use the list below to find out which vaccines you need now and which vaccines might be coming up — based on recommendations from the Centers for Disease Control and Prevention.

Seasonal influenza (flu)

Seasonal flu is a viral infection that affects the respiratory system. Potentially serious — even life-threatening — complications of the flu are possible.

Who needs it
The flu vaccine is recommended for all adults — unless you had a severe reaction to a previous flu vaccine or you’re currently ill. The flu vaccine is available as a shot or a nasal spray.

If you’re pregnant, choose the flu shot vaccine — not the nasal spray vaccine. If you’re age 65 or older, ask your doctor about a high-dose flu shot. Consult your doctor before getting a flu vaccine if you’ve had Guillain-Barre syndrome or you have a severe allergy to eggs.

When to have it
Get one dose of the flu vaccine every year, ideally in September or as soon as the vaccine is available.

Pneumococcal disease

Pneumococcal disease is a potentially serious infection caused by a type of bacteria called pneumococcus. Pneumococcal disease can take various forms, including pneumococcal pneumonia and pneumococcal meningitis. Pneumococcus also causes infections in the bloodstream.

Who needs it
Get the pneumococcal polysaccharide vaccine — the type of pneumococcal vaccine available for adults — if:

  • You’re age 65 or older
  • You have a weak immune system
  • You have a chronic illness, including asthma, lung disease, liver disease or diabetes
  • You’ve had your spleen removed
  • You live in a long term care facility
  • You smoke

Don’t get the vaccine if you had a severe reaction to a previous dose of the vaccine or you’re currently ill.

When to have it
Get one dose of the pneumococcal vaccine at any time. Ask your doctor if you need a second dose.

Tetanus, diphtheria and pertussis

Tetanus, diphtheria and pertussis are bacterial infections. Tetanus, sometimes called lockjaw, affects the nervous system, leading to painful muscle contractions — especially in the jaw and neck. Diphtheria is a respiratory disease that can lead to difficulty breathing. Whooping cough (pertussis) causes cold-like signs and symptoms and a persistent hacking cough.

Who needs it
Get the combined tetanus toxoid, reduced diphtheria and acellular pertussis (Tdap) vaccine if you haven’t received the vaccine in the past or don’t know if you’ve received the vaccine.

The Tdap vaccine isn’t recommended if you had a severe reaction to a previous dose of the tetanus-diphtheria (Td) series or Tdap vaccine, you experienced a coma or seizures within seven days of a previous dose of the vaccine or you’re currently ill. Consult your doctor before getting the Tdap vaccine if you have epilepsy or you’ve had Guillain-Barre syndrome.

When to have it
Get one dose of the Tdap vaccine if you didn’t finish the Td series as a child or don’t know if you ever had the Td vaccine. Get a second dose four weeks after the first dose. Get a third dose six to 12 months after the second dose.If you’re due for a Td booster — recommended every 10 years — but haven’t previously received Tdap, get one dose of the Tdap vaccine at any time followed by a Td booster every 10 years.

Meningitis

Meningitis is an inflammation of the membranes surrounding the brain and spinal cord.

Who needs it
Get the meningitis (meningococcal) vaccine if:

  • You didn’t have the vaccine as a child or adolescent and you’re living in a dormitory for the first time
  • You travel to or work in parts of the world where meningitis is common
  • You’re joining the military
  • You had your spleen removed
  • A meningitis outbreak occurs in your community

The meningitis vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine or you’re currently ill.

When to have it
Get one dose of the meningitis vaccine at any time — or a booster dose if you’re a first-year college student up to age 21 and first had the vaccine before age 16. Get a second dose eight weeks later if you have certain health conditions, such as HIV.

Chickenpox (varicella)

Chickenpox is a highly contagious infection that causes a red, itchy rash. Complications can include a bacterial infection of the skin, an infection in the bloodstream, pneumonia or inflammation of the brain (encephalitis).

Who needs it
Get the chickenpox vaccine if:

  • You didn’t have the vaccine as a child or adolescent or you’ve never hadchickenpox — especially if you live with someone who has a weak immune system
  • You aren’t sure whether you’ve had chickenpox
  • You’re considering pregnancy and don’t know if you’re immune to chickenpox

The chickenpox vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine or to gelatin or the antibiotic neomycin, you’re currently ill, you’re pregnant or you have a weak immune system.

When to have it
Get one dose of the chickenpox vaccine at any time. Get a second dose at least four weeks after the first dose.

Measles, mumps and rubella

Measles, mumps and rubella are viral infections. Measles causes a red, blotchy skin rash. Complications can include ear infection, pneumonia and inflammation of the brain (encephalitis). Mumps causes swelling in the salivary glands, located below and in front of your ears. Rubella, also called German measles, causes a distinctive red rash. Rubella is most serious if it develops during pregnancy.

Who needs it
Get the combined measles-mumps-rubella (MMR) vaccine if you were born during or after 1957 and didn’t have the vaccine as a child or adolescent.

The MMR vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine or to gelatin or the antibiotic neomycin, you’re currently ill, you’re pregnant, you have a weak immune system, or you recently had a blood transfusion.

When to have it
Get one dose of the MMR vaccine at any time. Get a second dose at least four weeks after the first dose if you’re a health care worker, you travel internationally, you’re a college student, or you had a rubella blood test that shows no immunity.

Human papillomavirus

Genital human papillomavirus (HPV) is a common sexually transmitted infection. Most people who have HPV don’t develop symptoms. For some people, however, an HPV infection can lead to genital warts or, for women, cervical cancer.

Who needs it
Get the human papillomavirus (HPV) vaccine if:

  • You’re a woman age 26 or younger and didn’t have the vaccine as an adolescent
  • You’re a man age 21 or younger and didn’t have the vaccine as an adolescent — although men can get the vaccine through age 26, if desired

The HPV vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine, you have a severe allergy to yeast or latex, you’re pregnant, or you’re currently ill.

When to have it
Get one dose of the HPV vaccine at any time. Get a second dose one to two months after the first dose, and a third dose six months after the first dose.

Hepatitis A

Hepatitis A is a potentially serious liver infection.

Who needs it
Get the hepatitis A vaccine if:

  • You want to protect yourself from hepatitis A
  • You have a clotting-factor disorder or chronic liver disease
  • You’re a man who has sex with men
  • You inject illicit drugs
  • You’re a health care worker who might be exposed to hepatitis A in a lab setting
  • You travel to or work in parts of the world where hepatitis A is common

The hepatitis A vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine, you have a severe allergy to latex or you’re currently ill.

When to have it
Get one dose of the hepatitis A vaccine at any time. Get a second dose six at least six months after the first dose.

Hepatitis B

Hepatitis B is another type of liver infection. For some people, hepatitis B becomes chronic — leading to long-term liver problems.

Who needs it
Get the hepatitis B vaccine if:

  • You want to protect yourself from hepatitis B
  • You’re sexually active but not in a mutually monogamous relationship
  • You’re a man who has sex with men
  • You have close contact or sex with a person infected with hepatitis B
  • You inject illicit drugs
  • You’re receiving hemodialysis
  • You’re a health care or public safety worker who might be exposed to infected blood or body fluids
  • You live with someone who has a chronic hepatitis B infection
  • You travel to or work in parts of the world where hepatitis B is common
  • You’re age 59 or younger and have type 1 or type 2 diabetes and haven’t received the hepatitis B vaccine

If you’re age 60 or older and have diabetes, ask your doctor if the hepatitis B vaccine is right for you. The hepatitis B vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine, you have a severe allergy to yeast or you’re currently ill.

When to have it
Get one dose of the hepatitis B vaccine at any time. Get a second dose one month after the first dose. Get a third dose at least two months after the second dose and at least four months after the first dose.

Shingles (herpes zoster)

Shingles is a viral infection that causes a painful rash. Anyone who has recovered from chickenpox might eventually develop shingles.

Who needs it
Get the shingles vaccine if you’re age 60 or older.

The shingles vaccine isn’t recommended if you’re currently ill, you had a severe reaction to gelatin or the antibiotic neomycin, you have a weak immune system or you’re pregnant.

When to have it
Get one dose of the shingles vaccine at any time.

Haemophilus influenzae type b (Hib)

Hib is a bacterium that causes potentially serious infections, including pneumonia, meningitis and swelling of the piece of cartilage that covers the windpipe (epiglottitis).

Who needs it
Get one dose of the Haemophilus influenzae type b (Hib) vaccine if:

  • You have certain health conditions, such as sickle cell disease, leukemia or HIV
  • You had your spleen removed

The Hib vaccine isn’t recommended if you had a severe reaction to a previous dose of the vaccine or you’re currently ill.

When to have it
Get one dose of the Hib vaccine at any time.

Source: Mayo Clinic.