Look Before You Step

Tetanus is one of those diseases, which though is non-communicable in nature (does not spread from person to person), is still a public health threat. The rate of tetanus affected patients is high, especially in a developing country like ours, where farming is a major occupation. Plus it is also one of the main causes of neonatal deaths, as here most of the births take place at home in a non-sterile environment.
Tetanus is a disease of the nervous system caused by the bacteria called Clostridium tetani. The bacteria are usually found in soil, dust and manure and enter the body through breaks in the skin - usually cuts or puncture wounds caused by contaminated objects.
It may seem frightening, as how easily the organism can get into our body. Any sort of dirty wound, starting from crashing injury to a simple puncture from a rusty nail or a barbed wire can lead to tetanus. Hence one has to be very careful during such events.

Symptoms
A person affected with Tetanus usually shows symptoms within 5-10 days. Stiffness of the jaw (lockjaw) is the most common symptom of tetanus. A person with tetanus has difficulty opening his or her mouth. Other muscles may also include stiffness (at the back, abdomen, face). The patient may also have a fever, headache, perspire heavily, have a rapid pulse, feel restless, and have muscle spasms. Noise and light may cause seizures in a person with tetanus. Infants with tetanus can't be fed as they lose their ability to suck.
Sometimes symptoms are localised near the injury site, known as localized tetanus, which is rare in nature but is completely curable.

Self-Care at Home
Any wound that causes break of skin or bleeding should be cleaned thoroughly with antiseptic (savlon) and running water. If one is vaccinated, usual dressing of the wound is good enough. But if someone is unsure of their tetanus vaccine status or whether the injury has dirt in it, they should visit the nearest emergency centre. No chances should be taken regarding this deadly disease.

Prevention
Luckily, most of us are vaccinated in our childhood, as Tetanus vaccine is included in EPI (Extended Programme on Immunisation) schedule in Bangladesh. Children are provided with Tetanus vaccine along with Diptheria and Whooping cough vaccines as part of the government initiative, and its coverage is more than 90 percent of the population. But this vaccine loses its efficacy after 10 years. Hence every adult should get a booster dose once in every 10 years.
Now, if a person has taken a booster shot within the last 10 years, a minor cut or an apparently clean wound won't be any concern. But if the wound is dirty or if the case was of a road traffic accident then he/she should get the booster dose, if not taken in the last five years. This shot will help in the passive immunisation of the patient.
This was the preventive part. The curative part for such victims lies with the immunoglobulin. TIG, (tetanus immunoglobulin) though a bit expensive, is required to be injected as soon possible. This will prevent spreading of the bacteria and resist against its toxins. Along with TIG, physicians will provide some regular antibiotics and some medications for pain relief.

Take Away
Tetanus Toxoid (TT) vaccine is safe and highly recommended in pregnancy. Caesarean-section and normal delivery both require handling of equipments, which may not be sterile. Plus neonatal tetanus is extremely fatal and nearly irreversible. Hence knowledge and awareness regarding this deadly disease is massively necessary in a developing country like ours.
The writer is a doctor of ICDDR,B.