Picking her teeth with a twig while out in the field had become a habit for senior citizen Doddathayamma from Akkur Hosahalli of Channapatna taluk. Little did she know she would get tetanus.
Her family members were shocked when she had sudden nerve spasms (similar to convulsions) and tightness in the neck. She was unable to swallow anything. They took her to the nearby government hospital and was referred to NIMHANS, where doctors asked her to go to a general hospital. She was taken to a private hospital and finally diagnosed with tetanus. She was then referred to Epidemic Diseases Hospital on Old Madras Road in a critical condition.
Another patient Sharfunnissa, 57, who accidentally stepped on an injection needle in the garbage dump near her house in Tippunagar, Hassan, was also brought to the hospital in a critical condition.
These are not isolated cases. Doctors, who are seeing an average of at least six cases a month, said tetanus remains a difficult disease to treat with high morbidity and mortality.
This is mainly because most cases are either reported late or are not vaccinated.
Although tetanus is a vaccine preventable illness and the WHO has declared that India has reached an elimination stage, its prevalence is still a major concern in Karnataka.
“Although these patients were brought in a critical condition, we were able to save them. We have seen patients who have died within 24 hours of getting admitted,” Ansar Ahmed, Medical Superintendent of Epidemic Diseases Hospital, told The Hindu . Of the 52 cases in 2017 in this hospital, 20 patients, who were brought in a critical condition, died. Most of them were adults, the doctor said.
While tetanus was earlier seen mainly in newborns, it has become a major concern among adults, especially farm labourers and workers from rural areas. “We see at least five adult cases a month, most of which are from neighbouring villages in and around Sira, Tumakuru, Raidurg, and even Kurnool and Hindupura,” he said.
Attributing the spread of tetanus to the general attitude among people to ignore micro injuries or apply cow dung or mud to the injury, Dr. Ahmed said: “Minor injuries suffered by farmers while harvesting or working in the fields are the entry point for tetanus bacteria into the body.”
A few paediatric cases last year
Doctors at the State-run Indira Gandhi Institute of Child Health have seen only four cases of tetanus in children in 2017. Vykuntaraju K., paediatric neurologist at the hospital, who along with a team of doctors had last year published a study titled “Re-emergence of Tetanus: Epidemiological Features, Clinical Profile and Outcome from South India”, said the cases had considerably reduced.
The study that recommended that the incidence of tetanus can be reduced with an effective immunisation program was published in the Indian Journal of Paediatrics.
Maternal and neonatal tetanus
Officials in the Health Department claimed that Karnataka had reached an elimination stage in terms of maternal and neonatal tetanus. Tetanus cases were seen earlier among newborns, and the cause was mainly unhealthy practices in rural areas.
There were unhygienic practices like application of cow dung and mud to the umbilical cord of the newborn when the mother delivered the baby at home.
“Now, owing to increased institutional deliveries, there are hardly any maternal and neonatal tetanus cases. Childhood immunisation is also effectively carried out,” said an official in charge of immunisation.
What is tetanus?
Tetanus, also known as Lockjaw, is an infection characterised by muscle spasms. It is called Lockjaw because the infection often causes muscle contractions in the jaw and neck.
It is caused by bacterium clostridium tetani which is found in soil, saliva and dust.
The tetanus bacteria often enters the body through a puncture wound, which can be caused by nails, splinters, insect bites, burns, skin break, and injection-drug sites. They produce staph toxins that interfere with muscle contractions resulting in symptoms like spasms, fever, headache, trouble in swallowing, high blood pressure, and sweating. The onset of symptoms is typically 3 to 21 days following the infection.
