L9: Neonatal Tetanus & Diphtheria Flashcards
Neonatal Tetanus (NT) has been among the most common life-threatening consequences of β¦..
- unclean deliveries
- umbilical cord care practices.
Mortality Rate of Neonatal Tetanus
Mortality rates are extremely high > 80% especially when appropriate medical care is not available (low income countries)
International Epidemeology of Neonatal Tetanus
- Recently between 2000 & 2015, 36 countries eliminated the disease.
- It is very rare in developed countries now.
National Epidemeology of Neonatal Tetanus
Epidemic Threshold of Neonatal Tetanus
one case / 1000 live births at the level of health directorate
Suspected Case of Neonatal Tetanus
Probable Case of Neonatal Tetanus
None
Confirmed Case of Neonatal Tetanus
is a Suspected case with tetanus clinical manifestations
causative agent of Neonatal Tetanus
Clostridium Tetani
Cause of Infection bty Neonatal Tetanus
Infection results from umbilical cord contamination
during unsanitary delivery, especially those babies with a lack of maternal immunization.
Reservoir of Neonatal Tetanus
Human and Animal
(The spores are in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens).
MOT of Neonatal Tetanus
- This typically happens when the umbilical cord is cut using unsterile instruments (contaminated with spores) β> tetanus enters the body through unhealed umbilical stump where the spores change to vegetative bacteria and secrete toxins
IP of Neonatal Tetanus
from 3 to 28 days (7 days)
Infectivity Period of Neonatal Tetanus
no direct person to person transmission
Susceptibility of Neonatal Tetanus
More among neonates of non-vaccinated mothers.
Tetanus is a disease best prevented rather than cured
..
General Prevention of Neonatal Tetanus
βΆ Health education: for mothers, female relatives and companions regarding safe umbilical cord hygiene for newborns.
β· Improving maternal health services: to Increase the proportion of deliveries under medical supervision (doctors - nurses β midwives - coaches)
Specific Prevention of Neonatal Tetanus
Immunization is the only effective prevention of tetanus. Tetanus toxoid (TT) is given as follows:
- Never immunized Before Pregnant females
- Those pregnant females (who were vaccinated when they were children with
Vx for Neonatal Tetanus
Case Control Measures in Neonatal Tetanus
Notification for Neonatal Tetanus
- immediate notification of suspected cases to higher levels
- monthly zero reporting from all reporting sites nationwide upwards
TTT of Neonatal Tetanus
- NT is a medical emergency requiring hospitalization, immediate treatment (serotherapy) with human tetanus immune globulin (TIG)
- antibiotics according to treating physician(better prognosis ICU is needed)
Contact Control in Neonatal Tetanus
None
Epidemeic Measuers in Neonatal Tetanus
no epidemics occur
Interantional Measures in Neonatal Tetanus
None
Before the introduction of vaccines, diphtheria was a leading cause of childhood death around the world.
..
International Epidemeology of Diphtheria
From 1980 to 1998, the US reported <4 cases/year .
A large pandemic in Russia from 1990-1997 caused 5000 deaths .
National Epi of Diphtheria
In Egypt, no cases of diphtheria since 1998
Epidemic Threshold of Diphtheria
One CC
Suspected Case of Diphtheria
Not present
Probable Case of Diphtheria
inflammation of the upper respiratory tract with
grayish membrane covering tissues in the nose,
tonsils, and throat
Confirmed Case of Diphtheria
Probable case with one or more of the following:
βΆ bacterial isolation from nose or throat
β· positive histopathology tests
βΈ epidemiological link to a confirmed case .
Causative agent of Diphtheria
Corynebacterium Diphtheria
MOA of Diphtheria
- The bacteria make a toxin that kills healthy tissues in the respiratory system.
- The dead tissue forms a thick, gray coating called
βpseudomembraneβ covering tissues in the nose, tonsils, and throat, making it very hard to breathe and swallow .
Reservoir of Diphtheria
Human only
MOT of Diphtheria
βΆ Direct droplet
β· vehicle borne (articles contaminated with
the bacteria)
IP of Diphtheria
2-5 days
Infectivity Period of Diphtheria
βΆ β€ 2 weeks (rarely up to 4 weeks if not using antibiotics).
β· Chronic carriers may discharge bacteria 6 months or more
Susceptibility of Diphtheria
- Immunity is acquired after 3 doses of diphtheria toxoid (protective value 95%)
- Diphtheria infection doesnβt guarantee lifetime immunity.
- Person can get diphtheria more than once if not fully immunized so, a full course of diphtheria vaccine to prevent a recurrence is needed .
General Preventive Measures for Diphtheria
(according to mode of transmission as in general epidemiology lectures)
Specific Preventive Measures for Diphtheria
- Compulsary Vx
- Chemoprophylaxis
Compulsary Vx in Diphtheria
- with Diphtheria toxoid at 2, 4, 6 months, and a booster at 18months
- Other 2 booster doses can be given in primary school (grade 2,4)
Chemoprophylaxis in Diphtheria
penicillin or erythromycin
Case Control Measures for Diphtheria
Notification of Diphtheria
immediate to the ministry of health
Isolation of Diphtheria
in ICU
TTT of Diphtheria
immediate treatment with diphtheria antitoxin + antibiotics according to treating physician
Contact Control Measures in Diphtheria
βΆ Enlistment.
β· Surveillance.
βΈ Chemoprophylaxis and Booster dose of diphtheria vaccine
Epidemic Measures for Diphtheria
- no epidemics is expected in Egypt (due to the high compulsory vaccine coverage) but if occur all infants and children should be vaccinated in addition to
the cases and contacts control measures
international Measures for Diphtheria