Pt BDS PGIMS, Community Medicine, Rohtak, Haryana, India.
Hum Vaccin Immunother. 2012 Oct;8(10):1439-42. doi: 10.4161/hv.21145. Epub 2012 Aug 16.
Tetanus is caused by a neurotoxin produced by Clostridium tetani (C. tetani), a spore-forming bacterium. Infection begins when tetanus spores are introduced into damaged tissue. Tetanus is characterized by muscle rigidity and painful muscle spasms caused by tetanus toxin's blockade of inhibitory neurons that normally oppose and modulate the action of excitatory motor neurons. Maternal and neonatal tetanus (MNT) are caused by unhygienic methods of delivery, abortion, or umbilical-cord care. Maternal and neonatal tetanus are both forms of generalized tetanus and have similar clinical courses. About 90% of neonates with tetanus develop symptoms in the first 3-14 d of life, mostly on days 6-8, distinguishing neonatal tetanus from other causes of neonatal mortality which typically occur during the first two days of life. Overall case fatality rates for patients admitted to the hospital with neonatal tetanus in developing countries are 8-50%, while the fatality rate can be as high as 100% without hospital care. Tetanus toxoid (TT) vaccination of pregnant women to prevent neonatal tetanus was included in WHO's Expanded Program on Immunization (EPI) a few years after its inception in 1974. In 2000, WHO, UNICEF, and UNFPA formed a partnership to relaunch efforts toward this goal, adding the elimination of maternal tetanus as a program objective, and setting a new target date of 2005. By February 2007, 40 countries had implemented tetanus vaccination campaigns in high-risk areas, targeting more than 94 million women, and protecting more than 70 million subjects with at least two doses of TT. In 2011, 653 NT cases were reported in India compared with 9313 in 1990. As of February 2012, 25 countries and 15 States and Union Territories of India, all of Ethiopia except Somaliland, and almost 29 of 34 provinces in Indonesia have been validated to have eliminated MNT.
破伤风是由梭状芽孢杆菌（C. tetani）产生的神经毒素引起的，梭状芽孢杆菌是一种形成孢子的细菌。当破伤风孢子被引入受损组织时，感染就开始了。破伤风的特征是肌肉僵硬和疼痛性肌肉痉挛，这是由破伤风毒素阻断抑制神经元引起的，而抑制神经元通常会对抗并调节兴奋性运动神经元的作用。孕产妇和新生儿破伤风（MNT）是由不卫生的分娩、流产或脐带护理方式引起的。孕产妇和新生儿破伤风都是全身性破伤风的形式，具有相似的临床过程。大约 90%的新生儿破伤风患者在生命的前 3-14 天出现症状，大多在第 6-8 天，这将新生儿破伤风与其他导致新生儿死亡的原因区分开来，后者通常发生在生命的头两天。在发展中国家，因新生儿破伤风住院的患者总病死率为 8-50%，而如果没有医院治疗，病死率可能高达 100%。1974 年扩大免疫规划（EPI）成立几年后，孕妇接种破伤风类毒素（TT）以预防新生儿破伤风被纳入世卫组织的计划。2000 年，世卫组织、儿基会和人口基金结成伙伴关系，重新启动这一目标的努力，将消除孕产妇破伤风作为一个规划目标，并设定了 2005 年的新目标日期。截至 2007 年 2 月，40 个国家在高危地区开展了破伤风疫苗接种运动，目标人群超过 9400 万妇女，并为 7000 多万人接种了至少两剂 TT。2011 年，印度报告了 653 例新生儿破伤风病例，而 1990 年为 9313 例。截至 2012 年 2 月，25 个国家和印度的 15 个邦和联邦属地、除索马里兰以外的埃塞俄比亚全部地区以及印度尼西亚 34 个省份中的近 29 个省份已被证实消除了孕产妇和新生儿破伤风。
