Tetanus Booster -A missed opportunity

Abstract

Tetanus a known childhood killer is an entirely preventable disease with tetanus toxoid (TT). Most of the research today is on neonatal tetanus owing to its high case fatality rate. Though the reported mortality with tetanus is lower in older age groups, the management of tetanus is still a challenge in resource constraint settings of developing countries like India. On this background the present study was designed to know the status of tetanus immunization among school going age group children. This was an OPD based survey targeting school going children (age of 5 to 18 years) attending Pediatric out-patient department (OPD) of a tertiary care teaching hospital. It was observed that out of 636, 299 (47%) children were vaccinated for diphtheria, pertusis and tetanus (DPT) booster at 5 years of age. Out of 374 children eligible for TT (10 to 16 years) only 37 (9.8 %) were immunized with TT at age 10 years. Out of 44 children at age of 16 years only 6 (13.6%) were immunized. Though there are strategies to immunize school going children under routine immunization programme, official records documented that the immunization coverage for TT was 68% in school going age group. Majority of (80%) the cases of tetanus were in non-neonatal age group (mainly school going group) in Madhya Pradesh, India. Based on these observations it can be concluded that the tetanus immunization coverage among children of school going age was poor in the given setting.  Tetanus is an acute, spastic paralytic illness historically called lockjaw that is caused by the neurotoxin produced by Clostridium tetani. Tetanus occurs worldwide and is endemic in approximately 90 developing countries. Tetanus is an entirely preventable disease with active immunization with tetanus toxoid. A serum antibody titer of ?0.01 U/mL is considered protective. [1] In India, according to National immunization schedule, active immunization against tetanus is done with administration of tetanus toxoid as trivalent vaccine of diphtheria, pertusis and tetanus (DPT)  at 6, 10, 14 weeks and boosters at 16-24 months and 5-6 years of age. Afterwards only tetanus toxoid (TT) is given at 10 and 16 years of age. [2] The active immunization with tetanus toxoid has an estimated failure rate of less than 4 per 100 million immune-competent persons. [3] The reports of department of health and family welfare, Govt. of Madhya Pradesh (MP) revealed that the number of non-neonatal tetanus were higher than the neonatal cases. [4]  On this background we have done an OPD based survey targeting to know the status  of tetanus immunization among school going age group children (age of 5 to 18 years) attending Pediatric out-patient department (OPD) of a  tertiary care teaching hospital, R. D. Gardi Medical college located in district Ujjain, of Madhya Pradesh (MP) Province of India. Prior approval from institutional Ethics committee was taken for the study. Total of 636 children were screened during the period of June – August 2013 for their routine immunization with DPT booster at age of 5 years. Among these 374 children were aged between 10 and 16 years and were asked for tetanus toxoid (TT) vaccination as per the National Immunization Schedule (NIS). Our findings revealed that out of 636, 299 (47%) children were vaccinated for DPT booster at 5 years of age. Out of 374 children eligible for TT (10 to 16 years) only 37 (9.8%) were immunized with TT at age 10 years. Out of 44 children at age of 16 years only 6 (13.6%) were immunized.