Chijioke Iremeka
Maternal health experts have urged pregnant women to take at least a dose of anti-tetanus injections to protect their newborns from diseases.
The gynaecologists said tetanus continues to be a significant public health issue in many regions, particularly in low-income countries or areas with low vaccination coverage.
The physicians emphasised that most reported cases of tetanus occur in newborns and mothers who have not received full vaccination coverage.
According to the World Health Organisation, tetanus is an acute infectious disease caused by spores of the bacterium Clostridium tetani.
The WHO notes that these spores are everywhere in the environment, particularly in soil, ash, and the intestinal tracts or faeces of animals and humans, saying that they can also be found on surfaces such as skin and rusty tools like nails, needles, and barbed wire.
The global health body noted that due to their high resistance to heat and most antiseptics, the spores can persist for years. The
Anyone can get tetanus, the WHO noted, but the disease is particularly common and serious in newborn babies as well as pregnant women who have not been sufficiently immunised with tetanus-toxoid-containing vaccines.
“Tetanus during pregnancy or within six weeks after the end of pregnancy is known as maternal tetanus, while tetanus occurring within the first 28 days of life is referred to as neonatal tetanus.
“Neonatal tetanus can arise when non-sterile instruments are used to cut the umbilical cord, or when contaminated materials are used to cover the umbilical stump. Also, deliveries conducted by individuals with unclean hands or on contaminated surfaces are also risk factors.
“In 2018, approximately 25,000 newborns died from neonatal tetanus, representing a 97 per cent reduction from 1988, when an estimated 787,000 newborns died from tetanus within their first month of life.
“However, there is an increased risk of tetanus in adolescent and adult males who undergo circumcision due to waning immunity and limited opportunities for receiving booster doses in many countries,” it added.
A Consultant Obstetrician and Gynaecologist as well as the Chief Medical Director of the State Specialist Hospital, Ikole, Ado Ekiti, Ekiti State, Babatunde Rosiji, highlighted that while immunising mothers is crucial for protecting their babies, not all women complete their full course of tetanus vaccinations during pregnancy.
Rosiji explained that the purpose of vaccination during pregnancy is to protect the baby from contracting tetanus, but many women do not complete their full course of vaccinations, which is essential for providing long-term protection for their babies.
He said, “We have observed that some women receive only one dose of the vaccine, which does not provide adequate protection against tetanus throughout pregnancy.
“At a minimum, two doses are required to protect both the mother and child, but we aim to administer four doses to ensure long-term protection for the baby.
“Unfortunately, some expectant mothers are unaware of this and act out of ignorance, while others, particularly those who give birth at home, may not perceive the necessity of completing the full vaccination course.”
Rosiji, who is also the Chairman of the Nigerian Medical Association, Southwest Zone, noted that the experience with COVID-19, where vaccination was presented as a choice rather than a requirement, has influenced some antenatal women to view tetanus vaccination similarly as an option rather than a necessity.
“We need to raise awareness that vaccination is crucial for protecting both the mother and the baby. The anti-tetanus vaccine not only safeguards the mother but also provides protection to the baby,” he said.
Rosiji added that tetanus is both deadly and fatal, emphasising that once a neonate, a newborn within the first 28 days of life contracts tetanus, the mortality rate is extremely high.
Corroborating his points, a Family Physician at the Anambra State Ministry of Health, Dr. Chidumeje Okafor, emphasised that tetanus can be effectively prevented through immunisation with tetanus-toxoid-containing vaccines, which are included in routine antenatal care programmes.
Okafor explained that to ensure lifelong protection, an individual should receive six doses of the tetanus-toxoid-containing vaccine: three primary doses and three booster doses.
He noted that the three-dose primary series should start as early as six weeks of age, with subsequent doses administered at a minimum interval of four weeks between each.
Okafor emphasised that the three booster doses should ideally be given during the second year of life (between 12 and 23 months), at four to seven years of age, and again at nine to 15 years.
“Ideally, there should be at least four years between booster doses. Neonatal tetanus can be prevented by immunising women of reproductive age with TTCV, either during pregnancy or outside of it.
“Robust medical practices, such as clean delivery and cord care during childbirth, as well as proper wound care for surgical and dental procedures, can prevent tetanus disease,” he said.
Supporting these points, a study published in the National Library of Medicine by Ana Faria et al titled, ‘Factors associated with tetanus vaccination in pregnant women living in Minas Gerais State: A cross-sectional study,’ affirms that most tetanus cases are associated with lack of vaccination in pregnant women.
The authors noted that several countries have successfully eliminated tetanus, but lamented that many cases are still linked to inadequate vaccination among pregnant women.
The study estimated that 47 million women worldwide remain unprotected from tetanus, highlighting that despite advances in vaccination coverage, significant challenges remain in fully eradicating the disease.
It added that in the absence of vaccination records, pregnant women should receive three vaccine doses, adhering to the recommended intervals between doses to ensure that antibody levels stay above the protection threshold.
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