Professional Documents
Culture Documents
Muhammad Saaiq*
The Scourge of Tetanus: Time for Khaleeq-uz-Zaman**
* Senior Registrar,
Critical Re-appraisal of the Issue in a Department of Surgery.
Effective immunization programme has almost key players in the maternal and child health in a
eradicated tetanus in the developed world. In the United larger segment of our population still exercise unsafe
States, there has been a steady decline in the incidence and unhealthy practices.15 Not surprisingly, we do come
of tetanus since 1940s. An annual average of 43 across instances in which our miserable patients have
tetanus cases were reported in the United States contracted tetanus purely because of the ignorant
between 1998 and 20001. An all time low of 20 cases medical practices of our quacks e.g. excision of mole
(0.01 cases per 100,000) were reported in 2003. Only with horse hair.16 The pathetic state of affairs is best
two cases of neonatal tetanus have been reported reflected by the fact that cow dung, desi ghee and
in US since 19891, 2. surma etc. still continue to be applied to the umbilical
While the developed world and most developing wound stumps of the newborn babies in our villages.12
countries are winning their battle against both neonatal All these key issues are compounded by the prevalent
as well as non-neonatal tetanus, the killer disease environment of public apathy, political expedience and
still continues to play havoc with precious human professional dominance. Hence the dream of tetanus
lives in our country. Ours is among the countries with eradication is not coming true.
highest incidence of tetanus. In fact each dying Tetanus is in fact not a new entity, with its
Pakistani tetanus patient reminds and re-emphasizes earliest descriptions being found in the writings of
the importance of primary tetanus immunization and ancient Egyptians as well as those of the Hippocrates.
follow- up boosters for all at risk patients. At national Tetanus toxoid was developed by Descombey in
level tetanus is reported from all parts of the country. 1924 and was first widely used during World War II
The locally reported mortality is disconcertingly high, while passive immunization was successfully employed
ranging from 19.3% to 57.69% for non-neonatal for the treatment and prophylaxis of tetanus during
tetanus3-9 while 22% to 36.58% for neonatal World War I. Because of the extreme potency of
tetanus10-12. tetanospasmin, tetanus disease does not confer any
Why are we losing our battle against immunity and even a small dose of the toxin can trigger
tetanus? In fact a multitude of issues are operative. the disease in a person who has previously suffered
There is lack of a broad based, realistic and an an attack17-19. Hence proper antitetanus vaccination is
all-encompassing antitetanus programme at national mandatory even among those who have suffered from
level. The ongoing antitetanus vaccination programme tetanus.
which is part of the expanded programme on Almost all cases of tetanus occur in persons
immunization (EPI) is presently focusing on children and who have either never have been vaccinated or
women of child bearing age and that too has pathetically competed a primary series but have not had a
failed to ensure adequate antitetanus immunization of its booster in the preceding 10 years. Routine boosters are
target groups13. Even our doctor community at the recommended every 10 years because the antitoxin
gross root level still continues to be largely ignorant levels gradually decline with time and by the time of 10
regarding antitetanus coverage to the patients at years it reaches the minimum protective level. To
their disposal14. Traditional birth attendants (TBAs) or ensure protective antitoxin levels, individuals sustaining
dais who continue to enjoy the status of being the wound that is otherwise clean and minor should receive