by epidemiological point of view also covering a glance to its prevalence in India and world. showing introduction to disease, causes, signs and symptoms, epidemiological triad and epidemiological factors affecting it, at last having prevention to that disease.

1. z
TETANUS
& TRACHOMA
CLASS PRESENTATION ON
SUBMITTED BY:
AAYUSHI SAJWAN
(25)

2. z TETANUS
• Also called LOCKJAW.
• It is a bacterial infection caused by exotoxin of
Clostridium tetani.
• It is characterised by muscular rigidity which
persist throughout illness punctuated by painful
paroxysmal (trismus or lock jaw), the facial
muscles, the muscles of back and neck and those
of lower limb and abdomen.
• The mortality tends to be very high, varying from
40 to 80%.

3. z
 It’s vaccine is a easy way to
prevent tetanus, as it has no
cure.
 Tetanus during pregnancy or
within 6weeks of pregnancy is
called MATERNAL TETANUS
and tetanus within the first
28days of life is called
NEONATAL TETANUS.

4. z
EPIDEMIOLOGY
IN WORLD
 Now tetanus is comparatively rare disease in developed countries.
 Neonatal tetanus is deadly disease, after measles. Even, with
treatment, the case fatality rate is as high as 80-90%.
 It tends to occur in areas with poor access to health care, hence it
remains quite often to remain in community.

5. z
 According to community surveys, only
small proportion of NT cases are
routinely reported to notifiable disease
reporting system in most developing
countries, because of this, WHO makes
estimates of annual neonatal tetanus
morbidity and mortality.
 During 2012, a total of 10,392 cases of
tetanus and 4,650 cases of neonatal
tetanus were reported to WHO
worldwide

6. z Showing prevalence in world

7. z
IN INDIA
 It is an important endemic infection in India.
 Behaviors such as hand-washing, delivery practices, traditional
birth customs and interest in immunization, are all important
factors affecting the disease incidence.
 Medically under-served areas and livestock raising regions are
two environments particularly associated with behavior
conducive to neonatal tetanus.
 Since 1983 in India, the nationwide EPI has recommended the
provision of 2 doses of tetanus toxoid to all pregnant women
during each pregnancy (or one booster dose if <3 years have
passed since the previous pregnancy) to prevent neonatal and
maternal tetanus.

8. z
 More recently, under the National Rural Health Mission launched in 2005,
the Government of India has provided training to health workers. The
mission also actively encourages institutional deliveries through
interventions such as the “Janani Suraksha Yojana”.
 These measures have contributed to reducing the burden of neonatal tetanus
(NT) in India considerably. In 2013, about 528 cases of neonatal tetanus
were reported in India compared to 11,000 in 1989.
 By the end of 2008, India had validated NT elimination in 15 states/UT's.
 Hospital records show a major male preponderance of cases. Since there is no
biological reason why male infants should be more susceptible.

9. z
EPIDEMIOLOGICAL TRIAD
AGENT
• Cl. Tetani
• Reservoir-soil
• exotoxin
HOST
• Age
• Sex
• Occupation
• Rural or urban
• immunity
ENVIRONMENT
• Poverty
• Custom
• Habit
• Poor health care
facilities

10. z
EPIDEMIOLOGICALDETERMINANTS
AGENT FACTORS
 AGENT- Cl. tetani which is gram positive, anaerobic, spore bearing organism.
Spore are resistant to heat. The spore can be destroyed by steam under pressure
at 120 degree Celsius for 20 minutes or by gamma irradiation.
 RESERVOIR OF INFECTION- the natural habitat for organism is soil and dust.
This can also found in intestine of many herbivores animal which makes their
faeces infected as well. Spores can survive for years in nature,.

11. z
 EXOTOXIN- it is lethal for human e.g. for 70kG man 0.1mg
will be enough. This toxin acts on 4 areas of nervous system
i.e. motor end plates in skeletal system, the spinal cord, the
brain and the sympathetic system. Its principle action is to
block inhibition of spinal reflexes.
 PERIOD OF COMMUNICABILITY- none. It does not transmit
from person to person.

12. z
HOST FACTORS
 AGE- tetanus is a disease of the active age (5 to 40 years). This period
predisposes to all kinds of trauma and therefore, the risk of acquiring the
disease is pretty high. Tetanus occurring in the new-born is known as
"neonatal tetanus". Infants typically contact the disease at birth, when
delivered in non-aseptic conditions.
 SEX- Although a higher incidence is found in males, females are more
exposed to the risk of tetanus, especially during delivery or abortion leading
to "puerperal tetanus".

13. z
 OCCUPATION- Agricultural workers are at special risk because of their
contact with soil
 RURAL-URBAN DIFFEENCES- The incidence of tetanus is much lower in
urban than in rural areas due to poor education.
 IMMUNITY- No age is immune unless protected by previous immunization.
The immunity resulting from 2 injections of tetanus toxoid is highly effective
and lasts for several years.

14. zENVIRONMENTAL AND SOCIAL FACTOR
 Tetanus is a positive environmental hazard .
 Its occurrence depends upon man's physical and ecological surroundings -
the soil, agriculture, animal husbandry – and not on the presence or absence
of infection in the population.
 The environmental factors are compounded by social factors such as
unhygienic customs and habits (e.g.:, application of dust or animal dung to
wounds), unhygienic delivery practices (e.g., using unsterilized instruments
for cutting the umbilical cord), ignorance of infection and lack of primary
health care services.

15. zMODE OF TRANSMISSON
 Infection is acquired by contamination of wounds with tetanus spores.
 The range of injuries and accidents which may lead to tetanus comprise a
trivial pin prick, skin abrasion, puncture wounds, burns, human bites,
animal bites and stings, unsterile surgery, intra-uterine death, bowel
surgery, dental extractions, injections, unsterile division of umbilical cord,
compound fractures, otitis media, chronic skin ulcers, eye infections, and
gangrenous limbs.

16. z
TRANSMISSIONCYCLE
Tetanus
bacteria in
soil, faeces,
etc.
Enters human
flora through
injury
Secrets
tetanosporin
Toxin attacks
on
intramuscular
junction
It blocks
release of
inhibitory
transmitters

17. z

18. zINCUBATION PERIOD
 The incubation period is usually 6
to 10 days.
 However, it may be as short as one
day or as long as several months. It
depends on favorable period or
host.

19. z
CLINICALFEATURES
 GENERAL- fever, high blood pressure, sweating
 MUSCULAR- muscle spasms, cramping, muscle
stiffness
 RESPIRATORY-shortness of breath
 SPECIFIC SYMTPOMS- abdominal rigidity,
lockjaw, difficulty swallowing, drooling, fast
heart rate, irritability, stiff neck

20. z

21. z
DIAGNOSIS
 Physical examination
 Medical and immunisation history
 Culture of wound site (may be negative even if
tetanus is present)
 Tetanus antibody test

22. z
PREVENTION
ACTIVE IMMUNISATION
 Tetanus is best prevented by active immunization with tetanus toxoid. It
stimulates the production of the protective antitoxin. The aim should be to
vaccinate the entire community and ensure a protective level of antitoxin
approximately 0.01 IU/ml serum throughout life. All persons should be
immunized regardless of age.
 Two preparations are available for active immunization
 a. Combined vaccine - DPT
 b. Monovalent vaccines – plain and tetanus vaccine

23. z
COMBINEDVACCINE
 Primary dose –given in combination with Diphtheria and Pertussis
as DPT vaccine. The DPT vaccine is, typically given in arm or thigh
to children of age. group:
2months
4months
6months
 Booster dose –it is given with combination of Diphtheria as Td for
children of age group:
15-18months.
4-6years
10 years

24. z
MONOVALENT VACCINE
 Purified tetanus toxoid (adsorbed) has largely supplanted plain toxoid because
it stimulates a higher and longer lasting immunity response than plain toxoid.
 The primary course of immunization consists of two doses(each of 0.5ml)
given at: 1-2months
 The booster dose should be given after 1year of third booster dose i.e. around
7-8years

25. z

26. zPASSIVE IMMUINIZATION
 Temporary protection against tetanus can be provided by an injection of
human tetanus hyperimmunoglobulin (TIG) or anti-tetanus serum (ATS).
 It gives a longer passive protection upto 30 days or more compared with 7-
10 days for horse ATS.
 The standard dose is 1500 IU, injected subcutaneously after sensitivity testing.
ANTIBIOTICS
PENICILLIN- IM injection of 1.2 mega units will be provided and sustained upto
3-4weeks.

27. z
SUMMARY OF TETANUS

28. z TRACHOMA
 It is a bacterial infection caused by Chlamydia trachomatis.
 It is infection of conjunctiva and cornea.
 Trachoma inflammation may undergo spontaneous resolution or
may progress to conjunctiva, scarring which can cause inward
deviation of eyelashes (trichiasis) or of the lid margin (entropion).
 The abrasion of the cornea by eyelashes frequently result in
corneal ulceration, followed by scarring and visual loss.

29. z
EPIDEMIOLOGY
 Trachoma is a major preventable cause of blindness in developing
countries.
 According to recent estimates, about 2.2 million people currently
suffer from visual impairment due to trachoma, of these 1.2
million are irreversibly blind, and about 324.85 million are at
risk of infection.
 Woman are three time more at risk of this compared to male.
 Australia is only developed country with trachoma
 India has become free from trachoma with an overall prevalence
found to be only 0.7% in National Trachoma Survey Report.

30. SHOWING ACTIVE TETANUS IN WORLD

31. z
EPIDEMIOLOGICAL TRIAD
AGENT
• C.Trachomatis
• Reservoir
• Source of
infection
• communicabilit
y
HOST
• Age
• Sex
• Pre-disposing factors
ENVIRONMENT
• Season
• Quality of life
• custom

32. z EPIDEMIOLOGICAL
DETERMINANTS
AGENT FACTORS
 AGENT- it is caused by C. trachomatis. Its milder case are usually called
“inclusion conjunctivitis”. These strains rarely produce permanent visual loss
but they cause respiratory infections (pneumonia) in infants and genital
tract infections in adults.
 RESERVOIR- Children with active disease, chronically infected older
children and adults.

33. z
 SOURCE OF INFECTION- Ocular discharges of infected persons and
fomites
 COMMUNICABILITY- Trachoma is a disease of low infectivity. It is
infective as long as active lesions are present in the conjunctiva, but not
after complete cicatrization.

34. zHOST FACTORS
 AGE- children from the age of two to five years are the most infected.
 SEX- females have been found to be affected more than males, as they act as
primary care provider in home.
 PRE-DISPOSING FACTORS-Direct sunlight, dust, smoke and irritants such as
kajal or surma may predispose to infection.

35. z
ENVIRONMENTAL FACTORS
 SEASON- The higher temperature and rainfall favors the increase in fly
population.
 QUALITY OF LIFE- The disease thrives in conditions of poverty, crowding,
ignorance, poor personal hygiene, squalor, illiteracy and poor housing.
 CUSTOMS- The custom of applying kajal or surma to the eyes is a
positive risk factor.

36. z
MODE OF TRANSMISSION
 In communities where trachoma is endemic, eye-to-eye transmission can
be considered as a rule.
 This may occur by direct or indirect contact with ocular discharges of
infected persons or fomites, e.g., infected fingers, towels, kajal or surma.
Eye-seeking flies (e.g., Musca spp. ) play some role in spreading the
infection by mechanical transmission.
INCUBATION PERIOD
 5-12DAYS

37. z
TRANSMISSIONCYCLE

38. z

39. z
CLINICALMANIFESTATIONS
Bacteria has incubation period of 6-12
days.
 Conjunctivitis or irritation
 White lumps in upper eyelids and
non specific inflammation and
thickening
 Watery discharge
In severe cases

40. z
 Scarring of eyelid
 Distortion of eyelid with buckling of lid
 Misdirected eyelashes (trichiasis)
 Blindness
Further symptoms include
 Swollen eyelids
 Swelling lymph nodes in front of ear
 Gritty sensation of sand

41. z
 Mucupurulent discharge
 Watery eye
 Redness
 Photophobia
 Blurring
 Mild pain
 Increase heart

42. z
DIAGNOSIS
 Physical examination
 Sample culture of eye discharge

43. z
PREVENTION
Environmental measure
 Use of clean water for drinking and cooking purpose
 Fly control and use of insecticide
 Use of latrine and other sanitary measures
 Health education

44. z
Antibiotics
 Among 1-9 years old children in area having active trachoma prevalence-by
WHO
Frequent washing of face
Mantling personal hygiene ANTIBIOTICS

45. z

46. z
SUMMARY OF TRACHOMA

47. z
B I B L I O G R A P H Y
Name of book Author Publication Page number
Preventive and
Promotive measures
for disease in
community
K.Park BANOT (23rd edition) 312-317
www.cdc.com
www.wikepidia.com
www.who.com
www.slideshare.com