Can pregnant women be vaccinated against tetanus?

Pregnancy is a difficult and at the same time happy period in the life of every woman. A caring expectant mother, in anticipation of the birth of her baby, closely monitors her health: after all, the normal development of the fetus depends on her condition.

Tetanus is a common dangerous pathology. The causative agent is the bacterium Clostridium tetani. You can get infected with it anywhere. The pathogen is transmitted by contact. For some women carrying a child, doctors offer vaccination against tetanus bacillus infection.

Most pregnant women have a negative attitude towards immunization, but at the same time they want to create reliable protection for the baby. Therefore, the question arises whether it is worth getting a tetanus vaccination during pregnancy.

Goals of vaccination

Immunization is a means of protecting against disease. The administered drug provides immunity against the pathogen, which makes a person invulnerable to a specific disease: diphtheria, influenza, tetanus and others.

Vaccinations for pregnant women are indicated for the following reasons:

• the expectant mother is susceptible to infections and does not tolerate them well;
• some infections directly affect the embryo, causing a variety of congenital pathologies, and vaccination protects the fetus.

Not all vaccinations are permitted during pregnancy. This issue, of course, is better to decide in advance, at the stage of pregnancy planning. But, unfortunately, we are not able to foresee all situations.

Danger of disease

Tetanus is an infectious disease. Its causative agent, the tetanus bacillus, enters the bloodstream through burns, wounds, even the smallest cuts and scratches. It multiplies quickly in tissues, releasing huge amounts of toxin. Tetanus exotoxin is a powerful bacterial poison, second only to botulinum toxin (botulism).

The substance affects the nervous system, causing paralysis of the nerve arches. A person suffers from severe frequent convulsions, paralysis, and constant muscle tension.

Tetanus develops very quickly and if severe or late diagnosis, there is a high probability of death.

A pregnant woman infected with tetanus is likely to lose her baby.

What is tetanus?

Tetanus (tetanus) is a severe infectious disease with wound transmission, manifested by damage to the motor structures of the nervous system with the subsequent development of muscle contraction uncontrollable by a person in the form of constant tonic tension and periodic clonic convulsions. Due to the severity of this infectious pathology and high mortality rate, even with modern medical capabilities, most countries carry out specific vaccination, which is included in the compulsory vaccination calendar. However, the incidence, especially in countries with poor sanitary standards and lack of vaccination, remains quite high.

Indications for vaccination

While carrying a child, the mother’s body “weakens,” since its resources, in addition to the mother’s life support, are aimed at providing for the fetus. And since any vaccination is stressful, vaccination during pregnancy is not advisable.

Immunization is performed if there are certain indications:

• the expectant mother was not vaccinated against tetanus. This is truly an excessive risk for both mother and child, so it is better to get vaccinated;
• the pregnant woman lives in an area where tetanus is common;
• if the expectant mother has an insufficient amount of antibodies to the Clostridium tetani bacterium;
• a woman is often injured, which increases the risk of infection.

If the last vaccination was given more than 10 years ago, revaccination is necessary.

Treatment of tetanus

Therapy is carried out only in a medical hospital, regardless of the form and severity of tetanus. In severe cases, treatment is carried out in an intensive care unit. Therapeutic measures for tetanus are complex and include:

• Introduction into the body of a specific immune antidote that inactivates tetanospasmin and other exotoxins of the tetanus bacterium - for this, horse immune serum or human anti-tetanus immunoglobulin is used. These biological products contain antibodies that bind and neutralize toxins in the patient's body.
• The use of muscle relaxants (myorelaxonium, ditilen), they relieve an attack of titanic convulsions for a period of 15-20 minutes.
• Intravenous administration of special buffer solutions to reduce the severity of metabolic acidosis (sodium bicarbonate solution). To prevent respiratory arrest, tracheal intubation is performed and the patient is transferred to artificial pulmonary ventilation (ALV).
• Centrally acting sedatives (phenobarbital, seduxen), which help reduce the severity of impulses in motor neurocytes of the central nervous system.
• The use of cardiac glycosides to normalize pumping function and heart rhythm.
• Antibiotics to prevent the development of secondary bacterial infections.

The patient is discharged from the hospital only after complete normalization of his general condition and the absence of re-development of cramps and tension of the striated muscles.

When is the vaccine given?

Tetanus antitoxin is allowed to be administered to expectant mothers, as it does not affect the development of the fetus. This is one of the few vaccinations that are allowed during this period.

But it is recommended to perform the procedure in the 2nd trimester of pregnancy. At this time, the fetus is maximally protected from external influences, and the mother’s body is fully adapted to its condition.

It is not recommended to vaccinate in later stages.

It is imperative to take into account the current condition of the pregnant woman. For example, with severe toxicosis, with a low level of hemoglobin, immunization is not carried out.

Causes of sunworm infection

Tetanus is caused by Clostridium tetani spores entering a wound. In the absence of oxygen, they transform into active forms. The bacterium itself is harmless. But it produces the strongest biological poison - tetanus toxin, which is second only to botulinum toxin in its toxic effect.

Routes of infection with tetanus:

• puncture, cut or laceration wounds;
• splinters, skin abrasions;
• burns/frostbite;
• fractures and animal bites;
• umbilical wound in newborns.

People who need frequent injections are also at greater risk. Any wound (including bites and burns) increases the risk of contracting tetanus.

The most common causes of death from tetanus are:

• choking as a result of prolonged spasm of the vocal cords or respiratory muscles;
• heart failure;
• spine fracture;
• pain shock.
• In children, tetanus is complicated by pneumonia, and at a later date by indigestion and anemia.

Contraindications

There are a number of factors that, if detected, should not be administered with tetanus antitoxin. The most common contraindications are:

• severe allergic reaction or high predisposition to it. In this case, there is a high probability of a violent immune response, which will lead to severe complications;
• allergy to any component of the antitetanus drug: taxoid itself, aluminum hydroxide, formalin, thiomersal;
• exacerbation of a chronic disease or acute infection is a temporary contraindication.

You need to be careful about vaccination if you have existing renal or liver failure. These organs react most sharply to the introduction of vaccines.

Complications of tetanus

Severe complications of tetanus with a high probability of death are asphyxia and cardiac arrest. In addition, tetanus can contribute to the occurrence of bone fractures, muscle ruptures, and compression deformation of the spinal column. A common complication of tetanus is pneumonia, and coronary spasm and myocardial infarction may develop.

During recovery, contractures and paralysis of the third, sixth and seventh pairs of cranial nerves are sometimes noted. In newborns, tetanus can be complicated by sepsis.

Preparations for vaccination

Adults are vaccinated with three types of vaccines:

• "Alive." They are made from pathogen microbes that are greatly weakened and cannot cause harm. Since their effect on the fetus cannot be studied for obvious reasons, pregnant women are not vaccinated with such vaccines;
• Inactivated or "dead". They are pathogens grown in laboratory conditions and then killed;
• Vaccines based on toxoids. They are made from poisons of pathogens - toxins that are previously neutralized. Such a toxin cannot cause harm to the body.

The tetanus vaccine is one of the few that can be given during pregnancy. But vaccination is prescribed for appropriate indications and preferably not in the first and third trimesters.

There are drugs both domestic and foreign made. The most famous include:

• AS – tetanus toxoid. Protects only against the causative agent of tetanus. (Planned and emergency prevention);
• ADS-M is a complex drug that includes toxoids, but in smaller quantities. Intended for protection against tetanus and diphtheria. Used for revaccination of children over 6 years of age and adults every 10 years;
• ADS is an analogue of ADS-M, but with a higher toxoid content;
• Tetracoq is a French complex drug that contains active ingredients that form immunity against whooping cough, tetanus, diphtheria, and polio. Includes aluminum hydroxide. (Mainly used by children from 2 months to 4 years old. Pending registration);
• Tritanrix is ​​a Belgian vaccine. Protects against diphtheria, tetanus, hepatitis B, whooping cough. (Mainly used for children from 6 weeks to 7 years. Pending registration)
• Adasel (Canada). Vaccine for the prevention of diphtheria (with reduced antigen content), tetanus and whooping cough (acellular), combined, adsorbed. For revaccination against tetanus, diphtheria and whooping cough in adults and children over 4 years of age.

The National Vaccination Calendar includes only mandatory free vaccines. In Russia, the ADS-M vaccination is given free of charge, and Adacel (for whooping cough, tetanus and diphtheria) is given for money and only in the third trimester.

Diagnosis of tetanus

With tetanus, laboratory diagnostics are practically meaningless, since at the onset of the disease the toxin is not detected in the blood, antibody titers do not increase (even a lethal dose of the toxin is an insignificant antigenic irritant and does not cause an immune response). The detection of antitoxic antibodies can only indicate a history of vaccinations. Sometimes bacteriological methods are used (histological examination of tissues obtained during surgical treatment of wounds, microscopy of fingerprint smears, inoculation of wound discharge under anaerobic conditions in nutrient media).

However, early diagnosis of this disease is possible only with a careful collection of epidemiological history (injuries, burns, wound infections, surgical interventions received within a time frame that corresponds to the incubation period) and with the active detection of symptoms of the prodromal period. At the height of the disease, there are no problems with diagnosis due to the presence of pathognomonic symptoms. At the same time, there are no deviations from the internal organs, meninges, cerebrospinal fluid, blood and urine.

In some cases, wound examinations are carried out using a bacteriological method:

• histological examination;
• smear microscopy;
• inoculating samples from the wound under conditions similar to the human body.

Based on the signs of the disease during the clinical course of the disease, the diagnosis is made without difficulty or doubt. Despite the fact that the symptoms may be similar to diseases such as rabies, strychnine poisoning and hypofunction of the thyroid glands, lockjaw and a painful smile are unique to tetanus.

Meningitis and meningoencephalitis, traumatic brain injuries, hysterical and epileptic seizures, exacerbations of osteochondrosis also require study when diagnosing tetanus.

How is vaccination carried out?

Immunization is performed in the medical office of a medical institution (clinic) in compliance with sanitary standards.

Preparation includes:

• examination – identification of contraindications;
• diet - 2-3 days before vaccination, it is advisable to exclude highly allergenic foods from the menu, such as chocolate, eggs, citrus fruits;
• rest - especially good sleep;
• taking antihistamines, if there is a tendency to develop allergies, 2-3 days before the procedure;
• measuring temperature and pressure before vaccination.

After vaccination, you need to monitor your temperature and blood pressure for at least a week. If complications occur, you should immediately consult a doctor.

Tetanus symptoms

The first symptoms of tetanus appear several days or weeks after contracting tetanus. The average incubation period is seven to eight days. Typically, tetanus bacteria enter the body through a break in the skin.

The most common symptoms of tetanus are the following (in order of appearance):

• Cramps and tension in the jaw muscles
• Neck muscle tension
• Difficulty swallowing
• Abdominal muscle tension

Painful generalized (affecting all muscles of the body) tonic convulsions, which are provoked by a loud sound, bright light, touching the patient, etc. Such convulsions are called opisthotonus.

In addition to these main symptoms, general infectious symptoms of tetanus may occur:

• Fever;
• Increased sweating;
• High blood pressure;
• Heartbeat.