Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India
Background: Despite being a vaccine-preventable disease, tetanus continues to cause considerable morbidity and mortality, especially among children. In India, the incidence of non-neonatal tetanus has decreased from 23,356 cases in 1990 to 4,946 cases in 2017. Yet, it continues to pose a threat in b...
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Jaypee Brothers Medical Publisher
2025-06-01
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| Online Access: | https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1473 |
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| author | Rajesh N Pankhaniya Nili Mehta Kapil Jetha Krutika R Tandon |
| author_facet | Rajesh N Pankhaniya Nili Mehta Kapil Jetha Krutika R Tandon |
| author_sort | Rajesh N Pankhaniya |
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| description | Background: Despite being a vaccine-preventable disease, tetanus continues to cause considerable morbidity and mortality, especially among children. In India, the incidence of non-neonatal tetanus has decreased from 23,356 cases in 1990 to 4,946 cases in 2017. Yet, it continues to pose a threat in both urban and rural settings, and it remains a public health issue in regions with low immunization coverage. Here, we are reporting a 10-year chart review of postneonatal tetanus for its clinical profile and outcome.
Materials and methods: After Institutional Ethics Committee approval with waiver of consent, this retrospective study reviewed the data of all indoor pediatric patients between 1 month and 18 years from 2014 to 2023 (10 years) who had a diagnosis of tetanus from hospital records. A record of 26 patients with tetanus was retrieved from the Hospital Management Information System (HMIS) and patient files. All pertinent details were collected and analyzed using STATA 14.2.
Results: Out of all 26 cases of tetanus, males were 18 (69.2%). Twenty-two (84.6%) patients were between 5 and 18 years, and only four (15.4%) were under 5 years of age. Successful discharge occurred in 19 patients, mortality in three patients, and discharge against medical advice/abscond in four patients. Twenty-two (84.6%) patients were from rural areas, and 18 (69.2%) were postinjury cases. Ten patients (38.46%) were unimmunized, whereas 15 (57.69%) were partly immunized with tetanus toxoid (TT). Seven from the unimmunized and eight from the partly immunized category had severe tetanus. The incubation period ranged from 1 to 15 days, with a median (Q1, Q3) of 4.52, 7 days. The duration of the hospital stay ranged from 1 to 78 days, with a median (Q1, Q3) of 17.5 (8.5, 32) days. Trismus and spasms were present in all patients.
Among other symptoms, difficulty in swallowing, fever, autonomic instability, and retention of urine/oliguria were present in 10, 8, 7, and 3 patients, respectively. Among expired patients, cellulitis with septic shock, pneumonia, and acute kidney injury (AKI) were major issues. A mechanical ventilator was needed in 14 (53.85%) patients. Fifteen patients (57.7%) were tracheostomized. No association of mortality and severity was found when compared to age, gender, mode of infection, need for a mechanical ventilator, duration of spasms, immunization status, tetanus immunoglobulins, etc., in this limited sample size.
Conclusion: Posttraumatic severe tetanus is still prevalent in older and unimmunized/partially immunized children, though it is preventable 100%. Mortality was also high in severe tetanus requiring mechanical ventilation and pediatric intensive care unit (PICU) management. |
| format | Article |
| id | doaj-art-8da96abd18d64e75a8c1d196cf00edae |
| institution | Kabale University |
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| series | Pediatric Infectious Disease |
| spelling | doaj-art-8da96abd18d64e75a8c1d196cf00edae2025-08-20T04:02:27ZengJaypee Brothers Medical PublisherPediatric Infectious Disease2582-49882025-06-0173778110.5005/jp-journals-10081-14731Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western IndiaRajesh N Pankhaniya0https://orcid.org/0000-0001-8590-7813Nili Mehta1Kapil Jetha2https://orcid.org/0000-0002-9978-0275Krutika R Tandon3https://orcid.org/0000-0001-6572-9917Department of Pediatrics, Gujarat Medical Education and Research Society, Vadnagar, Gujarat, IndiaDepartment of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, IndiaDepartment of Pediatrics, All India Institute of Medical Sciences, Rajkot, Gujarat, IndiaKrutika R Tandon, Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India, Phone: +91 9879531972Background: Despite being a vaccine-preventable disease, tetanus continues to cause considerable morbidity and mortality, especially among children. In India, the incidence of non-neonatal tetanus has decreased from 23,356 cases in 1990 to 4,946 cases in 2017. Yet, it continues to pose a threat in both urban and rural settings, and it remains a public health issue in regions with low immunization coverage. Here, we are reporting a 10-year chart review of postneonatal tetanus for its clinical profile and outcome. Materials and methods: After Institutional Ethics Committee approval with waiver of consent, this retrospective study reviewed the data of all indoor pediatric patients between 1 month and 18 years from 2014 to 2023 (10 years) who had a diagnosis of tetanus from hospital records. A record of 26 patients with tetanus was retrieved from the Hospital Management Information System (HMIS) and patient files. All pertinent details were collected and analyzed using STATA 14.2. Results: Out of all 26 cases of tetanus, males were 18 (69.2%). Twenty-two (84.6%) patients were between 5 and 18 years, and only four (15.4%) were under 5 years of age. Successful discharge occurred in 19 patients, mortality in three patients, and discharge against medical advice/abscond in four patients. Twenty-two (84.6%) patients were from rural areas, and 18 (69.2%) were postinjury cases. Ten patients (38.46%) were unimmunized, whereas 15 (57.69%) were partly immunized with tetanus toxoid (TT). Seven from the unimmunized and eight from the partly immunized category had severe tetanus. The incubation period ranged from 1 to 15 days, with a median (Q1, Q3) of 4.52, 7 days. The duration of the hospital stay ranged from 1 to 78 days, with a median (Q1, Q3) of 17.5 (8.5, 32) days. Trismus and spasms were present in all patients. Among other symptoms, difficulty in swallowing, fever, autonomic instability, and retention of urine/oliguria were present in 10, 8, 7, and 3 patients, respectively. Among expired patients, cellulitis with septic shock, pneumonia, and acute kidney injury (AKI) were major issues. A mechanical ventilator was needed in 14 (53.85%) patients. Fifteen patients (57.7%) were tracheostomized. No association of mortality and severity was found when compared to age, gender, mode of infection, need for a mechanical ventilator, duration of spasms, immunization status, tetanus immunoglobulins, etc., in this limited sample size. Conclusion: Posttraumatic severe tetanus is still prevalent in older and unimmunized/partially immunized children, though it is preventable 100%. Mortality was also high in severe tetanus requiring mechanical ventilation and pediatric intensive care unit (PICU) management.https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1473complicationsimmunizationotogenic tetanuspediatric intensive care unitposttraumatic tetanusspasmstetanus immunoglobulin |
| spellingShingle | Rajesh N Pankhaniya Nili Mehta Kapil Jetha Krutika R Tandon Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India Pediatric Infectious Disease complications immunization otogenic tetanus pediatric intensive care unit posttraumatic tetanus spasms tetanus immunoglobulin |
| title | Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India |
| title_full | Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India |
| title_fullStr | Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India |
| title_full_unstemmed | Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India |
| title_short | Ten-year Retrospective Chart Review of Postneonatal Tetanus at Semiurban Tertiary Care Teaching Hospital of Gujarat, Western India |
| title_sort | ten year retrospective chart review of postneonatal tetanus at semiurban tertiary care teaching hospital of gujarat western india |
| topic | complications immunization otogenic tetanus pediatric intensive care unit posttraumatic tetanus spasms tetanus immunoglobulin |
| url | https://www.pidjournal.com/doi/PID/pdf/10.5005/jp-journals-10081-1473 |
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