Tetanus vaccination for children at the Markushka clinic

Tetanus is a disease that has an acute infectious nature and is characterized by toxicosis and severe muscle cramps. The exotoxin of tetanus bacillus (Clostridium tetani) affects the motor cells of the nervous system, causing contractions of striated muscles. This bacterium is dangerous because its spores are extremely resistant to disinfectants and antiseptics and can survive in the soil for more than a hundred years. If they get into a scratch on the skin or an open wound, it can cause infection.

Due to increased injury rates, children and adolescents are at risk.

The body does not develop natural immunity against this infection. If a person has suffered from the disease, antibodies to the pathogen are formed in the blood, but for a short time. Any organism has a fairly high susceptibility to disease. A preventive measure is the administration of tetanus toxoid, which is part of combined tetanus vaccines.

How the vaccine works

The effect of the drug is based on the body’s ability to produce antibodies to the infectious agent by introducing weakened microorganisms or inactivated toxins.
Under normal conditions, these living microorganisms can provoke the development of the disease and, at the same time, induce the production of special antibodies in the blood, which will subsequently protect the body from the effects of harmful bacteria. The injection is performed intramuscularly. The drug, which enters the muscle tissue, is localized there for a long time without being absorbed into the blood. This stimulates the body to produce antibodies to the pathogen

Why is tetanus dangerous?

Tetanus bacilli can remain in sea and fresh water for up to six months, in soil for up to several years, but it is not the bacteria themselves that are dangerous, but their toxins. When clostridia tetanus enters a wound, especially a deep one, the pathogen multiplies and produces a large amount of toxin. The development of the disease in 80% of cases develops into a generalized form, when there is a focus and subsequent areas covered, which leads to human disability or death. Even small but deep tissue damage is enough for the development of tetanus.

Madina Abdulaeva told how the onset of the disease can occur:

“The first sign of the disease may be convulsive clenching of the jaw muscles. Then the spasms move to the muscles of the face and larynx, and it becomes difficult for the child to swallow. The cramps then spread to the back muscles and other muscles of the body. Spasm of the laryngeal muscles can cause sudden death. The mortality rate for developed tetanus is from 10 to 70%, depending on the age and health of the patient. Timely medical assistance can save the patient’s life.”

Tetanus affects all age groups. In Russia, up to 35 cases of the disease are registered annually. About 70% of cases are unvaccinated people over 65 years of age.

Tetanus is rare only in countries with developed medicine. Where medical services are not widely available to the population, tetanus is a real threat, claiming the lives of not only children, but also adults.

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Preparing for vaccination

Please note the following:

Before administration:

• you need to do a urine test, a general blood test, and consult a neurologist;
• it is necessary to exclude possible diseases and allergic reactions to any drugs;
• Avoid introducing complementary foods and giving new medications;
• It is important to stock up on antipyretics based on ibuprofen or paracetamol; It is better to give preference to candles, they are the least harmful for a small organism;
• If the baby has suffered from acute respiratory viral infection, then vaccination is allowed only 30 days after complete recovery.

On the day of vaccination:

• it is important to inquire about the drug being administered, its name and purpose, composition;
• no need to give your baby new foods so as not to provoke an allergy;
• Body temperature should be measured regularly and not allowed to rise to more than 38.5C;
• You can ask your healthcare provider questions about the consequences and adverse reactions of the drug and about your actions in the event of complications.

The most common tetanus vaccines

WHO has certified several drugs. Their types are shown in the table below.

Tetanus - symptoms and treatment

Tetanus , or lockjaw (Greek tetanus - stupor, convulsion) is an acute infectious non-contagious disease caused by the tetanus bacillus (Clostridium tetani). Using a contact transmission mechanism, the bacterium enters the body and releases a toxin that affects the nervous system, leading to hypertonicity of striated muscles and generalized convulsions. It is a preventable disease.

Etiology

Taxonomy:

• domain - bacteria;
• type - Firmicutes;
• class - Clostridia;
• order - Clostridiales;
• family - Clostridiaceae;
• genus - clostridia;
• species - tetanus bacillus (Clostridium tetani).

The disease was first described by Hippocrates, who also gave it its name, although tetanus is also mentioned in the Bible. In the pre-vaccination era, the disease was called “Scourge of War” due to its frequent occurrence in the wounded. The causative agent of the disease was identified in 1883 by the Russian scientist N.D. Monastyrsky. The first morphological description of the bacterium was given by the German physician A. Nikolaier in 1884. In 1890, the Danish physician K. Faber identified tetanus toxin. In 1890, bacteriologists Sh. Kitazato and E. Bering invented anti-tetanus serum. In 1923, the French veterinarian G. Ramon obtained tetanus toxoid, which is used to prevent the disease (formalin is added to the tetanus toxin and kept at high temperature).

Cultural properties. The bacterium is an obligate anaerobe (that is, it lives only in an environment without oxygen). Has fibrinolytic activity (the ability to dissolve blood clots). Releases a toxin during the life of the bacterium (i.e. it is an exotoxin).

Morphological properties . Tetanus bacillus has two morphological forms: vegetative and spore. Does not have capsules. A vegetative cell looks like a stick with rounded ends measuring 4-8 x 0.3-0.8 microns, it is mobile, has up to 20 flagella, Gram stains positive (Gram-positive), and secretes a toxin.

The spore form resembles a drumstick in appearance and is formed under unfavorable environmental conditions (in the presence of oxygen at a temperature not lower than 4 °C). At favorable temperatures, high humidity and the absence of oxygen, spores germinate in the soil with the formation of vegetative cells, and this happens repeatedly, resulting in the accumulation of the pathogen in the external environment.

A vegetative cell grows at temperatures from 14 to 45 °C. In the laboratory, liquid nutrient media are used for cultivation, for example, Kitt-Tarozzi medium or solid nutrient media with the addition of blood (forming a hemolysis zone).

The sensitivity to the negative effects of vegetative and spore forms is different: vegetative cells are low-resistant, spore cells, on the contrary, have very high resistance: they can remain viable when heated to 80 ° C for 4-6 hours, to 90 ° C for 2 hours, when boiled die within 40-50 minutes. Complete decontamination of tetanus spores can be achieved by autoclaving (sterilization with flowing steam) at 130 °C for 20 minutes. When dried, the spores can withstand heating up to 115 °C for 20 minutes. They live in the ground for more than 10 years (this is why contamination of wounds with any soil is dangerous if the person has not been vaccinated); in sea water they can live up to six months. In a 5% phenol solution, spores remain viable for 24 hours, in 1% sublimate - 10-12 hours, in a 10% bleach solution - for 10 minutes.

Tetanus toxin is a protein with a high content of amino acids: aspartic acid, isoleucine and lysine. Consists of two fractions: tetanospasmin and tetanohemolysin:

• Tetanospasmin (neurotoxin, protein weighing 150 kDa) causes the main symptom complex of the disease - muscle spasms;
• tetanohemolysin (cardiotoxin) dissolves red blood cells, destroys tissue around the wound, and causes dysfunction of the autonomic nervous system.

A dose equal to 2 ng/kg body weight is considered lethal for humans. It is destroyed at 65 °C, sunlight for 5 minutes, enzymes of the gastrointestinal tract easily break it down [2][5][10][11]. The toxin is not absorbed through the intestinal mucosa, so if swallowed it is not dangerous.

Epidemiology

The pathogen is widespread, but is more common in hot and humid regions. Tetanus bacillus can be found in soil, street dust, gardens (including vegetables), orchards, meadows, and on objects contaminated with soil and feces (wire, nails, etc.). Normally, the bacterium lives in the intestines of herbivores, and can even be detected in the human intestines (up to 40% of cases), without causing any harm to him. From animal and human feces, tetanus enters the soil, where it accumulates (mainly in the form of spores).

WHO estimates that approximately 34,000 newborns died from tetanus in 2015 [12]. This is a 96% decrease from 1988, when 787,000 newborns died from tetanus in the first month of life. In 2021, the disease claimed the lives of 30,848 newborns [13]. There are no reliable data on adults; according to some estimates [14][15], about 300,000 people die annually in the world (mainly in the Asian, African and Latin American regions).

The incidence in the Russian Federation over the past 20 years has averaged 40 people annually [16].

The mechanism of infection of tetanus is contact, through any wound surface. The entrance gates are damaged skin and mucous membranes: abrasions, wounds (including surgical wounds), splinters, burns, frostbite, etc. In deep wounds, in the absence of oxygen, spores turn into vegetative cells producing tetanus toxin, and this is much more common than with superficial wounds.

In developed countries, among unvaccinated people who do not seek medical help, up to 98% of cases of infection occur through microtrauma, mainly of the lower extremities. In case of injuries, childbirth, criminal abortions, puncture of the leg with a nail, etc., infections are less common; in such cases, people, as a rule, immediately seek medical help.

In countries with a low level of medical development, on the contrary, morbidity as a result of more serious injuries predominates, since the majority do not go to medical institutions. It is important to note that almost 100% of cases occur in people who have not been vaccinated and have not sought medical attention.

Factors predisposing to the occurrence of the disease:

• warm climate;
• regions with developed livestock farming;
• “bare foot disease” - injuries (especially with crushing tissue) and microtraumas of the feet: scratches, splinters, abrasions with soil contamination);
• poor sanitary and hygienic conditions;
• inaccessibility of medical care, insufficient treatment of wounds;
• refusal to vaccinate, ignoring revaccination deadlines;
• insect bites that damage the integrity of the skin (for example, bites of large beetles, etc.);
• chronic ulcers and skin lesions;
• intravenous drug administration;
• severe immunodeficiency.

The seasonality of the disease is highly pronounced: in temperate and cold climates - from late April to October; in hot countries where there is no real winter, the incidence is year-round. People most often get sick are males, agricultural and livestock workers, and summer residents. In countries with developed medicine, adults are most often affected. In lagging countries, newborn morbidity may prevail: if births are performed by people with dirty hands and on dirty surfaces, if unsterile instruments and materials are used when cutting and processing the umbilical cord; if pregnant women do not receive the normal course of immunization against tetanus.

A patient with tetanus is not dangerous to others, i.e. it cannot be infected from a person. A person who has recovered from the disease does not develop natural immunity (it is either very weak or absent).

The mortality rate for tetanus reaches 40% (even with timely treatment); tetanus is especially dangerous for people over 65 years of age [1][4][8][11].

How children are vaccinated against tetanus

The World Health Organization recommends that young children be given injections exclusively in the thigh. This practice lies in the fact that the intrafemoral muscles are quite well developed, while they have few blood vessels and fatty tissue. This ensures the main principle of the vaccine’s action and the localization of the administered drug exactly in the place where the injection was made.

Starting from the age of six, the child is given an injection in the shoulder area.

Tetanus. Tetanus shot

Tetanus is an infectious bacterial disease caused by Clostridium tetani.

Since the time of Hippocrates, the connection between tetanus and previous wounds has been known.

Surprisingly, the microbe develops and lives in the intestines of many animals and humans without causing harm. With feces, the tetanus bacillus enters the soil, where, under unfavorable conditions (inappropriate temperature and humidity), it becomes covered with a capsule and “falls asleep,” forming spores. Tetanus spores can persist in the soil for years and are extremely resistant to environmental influences. Studies have shown that up to 80% of soil samples are contaminated with the tetanus pathogen, in manured soil - up to 100%.

When it becomes warm and humid, the spores turn into “blooming” vegetative forms.

In countries with limited seasons (for example, the tropics), the incidence of tetanus is year-round. In our region, tetanus is observed more often in spring and summer.

When the skin and mucous membranes are damaged, the pathogen enters the wound. The most dangerous are puncture and deep wounds, when the edges of the wound close, which stops the access of oxygen. Namely, oxygen-free conditions are most attractive to the tetanus microbe.

The incubation period is usually about 2 weeks, during which time the wound is often already closed and healing.

Tetanus is not an ordinary infection that causes an inflammatory process; rather, it is a bacterial predator that produces a powerful bacterial poison - tetanus toxin. This toxin acts primarily on the nervous system, causing generalized seizures.

Cramps are extremely painful. There is a spasm of the entire muscles, such a force that the patients bend in an arc, touching the bed only with their heads and heels.

Prolonged muscle tension leads to cardiac arrest and breathing.

Mortality from tetanus reaches 80% of the number of cases, even with the availability of modern treatment methods.

Immunity is not formed after suffering from tetanus, because While a small amount of tetanus toxin is sufficient for disease, it is absolutely insufficient for the formation of anti-infective defense.

The tetanus vaccine is based on the creation of a toxoid. Those. During special processing, tetanus toxin loses its pathogenic properties, while retaining the ability to form anti-infective defense in the human body.

The use of tetanus toxoid is considered extremely safe.

Mild systemic reactions, including fever, pain, and discomfort occur in 0.5-1% of vaccinated people. Acute allergic reactions are extremely rare, occurring in 1-6 cases per million doses administered.

Thanks to mass vaccination carried out in our country, the incidence of tetanus is reduced to isolated cases. Thus, in developed countries, the incidence of tetanus is 0.1-0.6 people per 100,000 population. However, in countries where mass vaccination is not carried out, the incidence is up to 50 people per 100,000 population.

In developing countries, where vaccine prevention is not at the proper level, the majority of cases of tetanus are newborns whose umbilical cord is tied under unsterile conditions. In such regions, WHO (World Health Organization) recommends double vaccination for pregnant women so that the fetus develops protection against tetanus in the prenatal period. The official WHO position on vaccination of pregnant women once again demonstrates the high safety profile of the vaccine.

In case of injuries, animal bites, burns, frostbite, childbirth or abortion outside of medical institutions, emergency tetanus prophylaxis is carried out. Depending on age and information about previous vaccinations, an additional dose of tetanus toxoid (tetanus vaccination) and/or tetanus immunoglobulin and tetanus serum are administered.

Routine vaccination against tetanus in the Russian Federation is recommended for children starting from 3 months of age as part of a complex vaccine.

You can read about vaccination against tetanus on our website in the article Modern tactics of vaccination against whooping cough, diphtheria, tetanus.

Normal reaction to a vaccine

Mothers often wonder whether it is possible to wet a tetanus shot. Experts say that it is worth protecting the vaccine injection site from water for at least 2 days to avoid the risk of skin irritation. The body most often reacts normally to this vaccination, although minor reactions may occur that do not require additional action or medication, namely:

• local inflammation: redness, swelling of the skin, slight compaction at the injection site;
• slight pain at the injection site;
• increase in body temperature within 37.5 C;
• general weakness, fatigue, lethargy.

These symptoms indicate that the immune system is reacting to the irritant and disappear after a few days.

Does the vaccine have side effects?

Our expert Madina Abdulaeva confirms that the tetanus vaccine can have some unpleasant consequences:

“Side effects can be of a general nature - increased body temperature, malaise, an allergic reaction to the composition of the serum. Local undesirable consequences include swelling, hardening of the tissue around the injection site, redness, and painful reaction. But in general, vaccination is well tolerated. Separately, the tetanus vaccine is given urgently in case of injury, mainly to adult patients.”

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Possible complications. What to do?

Sometimes there are side effects and negative consequences from the tetanus vaccine:

• body temperature exceeding 37.5 °C, which lasts more than 3 days;
• asthenia;
• urticaria, anaphylactic shock, Quincke's edema;
• immunosuppression;
• sepsis;
• bronchial asthma;
• serum sickness;
• convulsions;
• The tetanus shot hurts a lot.

Did you know? According to medical data, such reactions most often occur due to ballast substances included in the vaccine, without which it is ineffective and unstable (formaldehyde, aluminum hydrochloride, thimerosal).

In any of the above cases, you should immediately consult a doctor; only a specialist can decide what measures to take.

In rare cases, children developed multiple sclerosis, heart attack, renal failure, Lyell's syndrome, and rheumatism.

Possible reactions to the tetanus shot:

After vaccination, your child may experience swelling and/or redness at the injection site. There may also be pain and a slight increase in temperature in the first three days after vaccination. In this case, you can give the child an antipyretic in an age-appropriate dosage. If the tetanus vaccination technique has been violated, an infiltrate may form at the injection site. You should not massage or heat the vaccination site to prevent complications from developing. We recommend that you discuss with your doctor in advance all possible reactions to a tetanus vaccination and behavioral tactics for the development of each of them, and if the child’s condition after vaccination causes you concern, call an ambulance immediately.

Vaccination at the children's multidisciplinary clinic "Markushka" includes a mandatory examination by a pediatrician before vaccination. When carrying out vaccinations against tetanus, the following drugs can be used, which determine the cost of vaccination depending on the age of the patient (to be specified in the Registry):

• Pentaxim (made in France) for a child up to 6 months;
• Pentaxim (made in France), for a child over 6 months;
• Infanrix (made in Belgium), for a child up to 6 months;
• Infanrix (made in Belgium), for a child over 6 months.

All manipulations are carried out by experienced nurses in a special room, where proper storage conditions for vaccines and the necessary sanitary regime are provided.

Tetanus vaccination in our clinic is done by appointment, for which you just need to call the phone number: (495) 460-39-55.

Vaccination schedule

In order for the body to develop full immunity against the causative agent of the disease, a special schedule has been established (in accordance with the national vaccination calendar), according to which the vaccine is administered four times over the 14 years of the child’s life, starting from 3 months of age. How long does the tetanus shot last? After the fourth injection, revaccination is carried out every 10 years, since immunity is lost during this period. The timing of childhood vaccinations is shown in detail in the following table.

Timing of tetanus vaccination:

Tetanus vaccinations begin for children aged three months. Usually, a multicomponent DPT vaccination is immediately given, which simultaneously protects against diphtheria, tetanus and whooping cough. In order to ensure lasting immunity, vaccination is carried out three times with an interval of 45 days, and then a revaccination is carried out another year later. Then a second tetanus shot is given to children at seven and fourteen years of age.

In case of severe damage to the skin and/or mucous membranes, especially with accompanying contamination, frostbite or burns, emergency prophylaxis of tetanus is prescribed by administering anti-tetanus serum or tetanus toxoid.

Contraindications to vaccination

The main reasons why vaccination cannot be done are:

• prematurity, low birth weight;
• chronic allergic reactions;
• allergic manifestations after previous vaccination;
• acute phase of any disease;
• bronchial asthma;
• immunodeficiency;
• damage to the nervous system, kidneys, liver, heart.

It is important to know that the vaccine can be administered when a small patient is in a state of stable remission of the disease, after preliminary consultation with a family pediatrician.

Tetanus vaccination: compatibility of vaccination with alcohol

• Many people are interested in the reasons why doctors strongly recommend abstaining from drinking alcohol 3 days before tetanus vaccination, and the same amount after. The answer is obvious: to develop immunity, the patient is given a small amount of slightly modified tetanus bacilli along with the vaccine, and the body devotes all its strength to fighting this infection, weakening at its other stages.

Image 7. Compatibility of tetanus vaccine with alcohol.

• When alcohol enters the bloodstream, the body weakens even more and begins to cope worse with the artificially introduced infection. Thus, even if you have already received a booster tetanus vaccination and have not observed any side effects, if there is alcohol in your blood, these effects may occur. Moreover, both mild (fever, general weakness, headaches) and severe (convulsions, vascular and heart diseases, acute allergic reactions, loss of consciousness).
• Most often, drinking alcohol 48-72 hours before and after vaccination has a detrimental effect on the digestive system. Diarrhea may develop, gastritis may worsen, or other problems with the gastrointestinal tract may appear.
• But the most compelling reason to give up alcohol in the next few days after vaccination against tetanus is that due to the additional weakening of the body by alcohol, the chance of contracting tetanus significantly increases, since immunity to it has not yet developed. Therefore, you should set your priorities correctly and abstain from alcohol in any quantity for the next 72 hours after vaccination.

Video

If you don’t know which manufacturer to give preference to, how to monitor your baby after vaccination, and you are interested in the opinion of experts, watch the following video

There is currently a lively debate about the necessity or illogicality of administering the tetanus vaccine to children. The question is ambiguous, because even in scientific and medical circles there are doubts about the advisability of mass vaccination against this disease. It is worth keeping in mind that side effects are extremely rare and are not comparable to the number of children whose lives have been saved by vaccination. The right to choose, without a doubt, remains with the parents, but before refusing or agreeing, you need to carefully weigh the pros and cons. After all, the full development of a child is the most important task of his entire life.

If you have experience with any tetanus vaccine, please leave your comments on this matter. But it is worth considering that the data provided are only advisory in nature and do not constitute an incentive to use this or that drug. Before using it, it is important to consult a specialist.