Tetanus- Once a Vaccination Success Story: Now Making a Comeback?

A 7-year old child is in critical condition after contracting tetanus. She was unvaccinated. Can this child survive the illness itself? No one knows, but if she does, this horrific disease can cause all of her muscles to become rigid, including those required for swallowing and breathing.

Tetanus occurs when a bacterium, Clostridium tetani, enters the body through an open wound or puncture. The bacterial spores are ubiquitous — they live in the soil, in animal dung, and in feces. More than one million people died each year from tetanus in the 1980s, about three-quarters of them, infants in the first month of life. Today, neonatal deaths have been reduced by over 90%, and maternal and neonatal tetanus has been eliminated from all but 22 countries. There are still 58 countries where tetanus is a public health problem, and there are plans to eliminate it in every one of them, except two. However, with the rise of anti-vaccination sentiment, this vaccine success story could easily

Once tetanus spores become active, the bacteria begin producing a toxin (a poisonous substance) called tetanospasmin, which attaches to the nerves around the area of the wound. The tetanus toxin also can spread and attach to the ends of nerves of the spinal cord and at neuromuscular junctions (where nerves meet muscles). The toxin blocks the release of a neurotransmitter, a chemical that carries a signal from nerves to other nerves or muscles. This affects the messages that the muscles receive, resulting in severe muscle spasms * that can be powerful enough to LITERALLY tear muscles apart and break bones.

Tetanus has been known to humans for a long time- it is referred to in the Old Testament as the “seventh-day death.” If contracted during delivery, neonatal tetanus strikes rapidly, killing newborns soon after birth. There are two great opportunities to prevent tetanus in humans 1. During pregnancy and 2. During childhood. During childhood in the USA, the 5–dose series of DTaP vaccine occurs at ages 2, 4, 6, 15 through 18 months.

Birth and delivery is a particularly dangerous time for women and infants as there are ALWAYS open wounds (cutting the umbilical cord for example, or the dreaded episiotomy or tear between the vagina and anus) and fecal contamination occurs frequently, unsanitary and unhygienic conditions occur in many places women deliver babies around the world!

In the USA, the Tdap booster is indeed recommended for pregnant women, to maximize the “maternal antibody response” and transfer across the placenta to the infant. Optimal timing for Tdap administration is between 27 and 36 weeks of gestation. This is an “evidence based” recommendation, it was not arbitrary!

Please. Vaccinate. I can not imagine the unbelievable suffering this child is enduring for her parent’s terrible decisions.

The latest study involved 123,494 live births at two California sites involved in the Vaccine Safety Datalink. Among mothers who got the Tdap during pregnancy, 6.3% had preterm delivery, compared to 7.8% among unvaccinated mothers. Further, 8.4% of vaccinated mothers and 8.3% of unvaccinated mothers had underweight (small-for-gestational-age) babies. There was no higher risk of preterm delivery, underweight babies or hypertensive disorders of pregnancy in vaccinated mothers.
Additionally, a large observational study published this past July in BMJ Open looked at wide range of pregnancy outcomes in more than 20,000 pregnant women who received the Tdap during pregnancy. That study found no increased risk of stillbirth in the two weeks after the vaccination or throughout the rest of the pregnancy in vaccinated women, compared to historical rates. There was also no evidence that vaccinated women gave birth earlier or had any increased risk of maternal death, newborn death, pre-eclampsia or eclampsia, hemorrhage, fetal distress, uterine rupture, placenta or vasa previa, C-section, low birth weight or neonatal kidney failure.

Preventing infant pertussis: a decision analysis comparing prenatal vaccination to cocooning. Terranella A, Asay G, Messonnier M, Clark T, Liang J. Presented at the 49th Infectious Diseases Society of America Annual Meeting, Boston, MA; October 20–23, 2011.

Neonatal tetanus in New Guinea. Effect of active immunization in pregnancy. Schofield FD, Tucker VM, Westbrook GR. Br Med J 1961;2:785–9.

Newell, KW, Dueñas Lehmann, Leblanc DR, Garces Osoria N. The use of toxoid for the prevention of tetanus neonatorum. Final report of a double-blind controlled field trial. Bull World Health Organ 1966;35:863–71.

Evaluation of the Association of Maternal Pertussis Vaccination With Obstetric Events and Birth Outcomes, JAMA, November 12, 2014, Vol 312, №18

Safety of pertussis vaccination in pregnant women in UK: observational study, BMJ 2014; 349 doi (Published 11 July 2014), BMJ 2014;349:g4219