Our Global Voices Posts

Tetanus: Eliminating the Forgotten, Deadly Disease

Posted on by Dr. Rebecca Casey, EIS Officer, Global Immunization Division
Working with FETP colleagues at the Uganda Ministry of Health. Left to right: Joyce Nguna, Rebecca Casey and Doreen Birungi
Working with FETP colleagues at the Uganda Ministry of Health. Left to right: Joyce Nguna, Rebecca Casey and Doreen Birungi

As a clinician, seeing a patient with a preventable disease like tetanus is heartbreaking. The most common signs are painful spasms of the muscles of the jaw (lockjaw) and spine. But, in the worst cases, tetanus impairs breathing, and without medical intervention, nearly 100% of patients die. Tetanus rarely occurs in the U.S. because we’ve offered vaccines since the 1940s, but not everybody around the world is so lucky.

The World Health Organization (WHO) recommends that we get at least six tetanus vaccine shots to protect us against tetanus. According to WHO, the first three shots should be given before one year of age, followed by at least three booster shots before adolescence. In the United States, we get three shots before one year of age, two booster shots before adolescence and then a booster shot every 10 years. If a person does not stay up-to-date with the booster shots, they will not be protected through adolescence and adulthood. Women will not be protected in childbirth or be able to pass on protective antibodies to their newborn baby. The germs causing tetanus are present all around us in soil and dust, so they can enter the body at any time through wounds, like a skin puncture, or through the umbilical cord stump of a newborn.

Uganda is one of many countries in the African Region that does not yet offer six shots of tetanus vaccine to everybody. About 80% of infants in Uganda get the first three tetanus shots, and women are additionally offered the vaccine during pregnancy for the protection of mothers and newborns during birth. Older children and adult men do not receive booster shots. Uganda successfully eliminated tetanus in mothers and newborns related to childbirth (also known as Maternal and Neonatal Tetanus Elimination, or MNTE) in 2011. However, more than 8,000 cases of tetanus have been reported in adults and children after the newborn period since 2012, making it one of the countries with the highest tetanus numbers worldwide.

FETP Resident Pheobe Hilda Alitubeera searching for tetanus cases in health facility registers.
FETP Resident Pheobe Hilda Alitubeera searching for tetanus cases in health facility registers.

During November–December 2017, I had the opportunity to work with a remarkable team of staff from the Uganda Ministry of Health and the Field Epidemiology Training Program (FETP) to examine whether the high number of reported tetanus cases was reflective of true tetanus cases or not. We visited 26 health facilities that collect and report data on patients suspected of being infected with tetanus across the country’s four regions.

Our field investigation revealed that:

  • For tetanus after the newborn period, 96% of cases reported from the hospitals were true cases of tetanus and more than one half of the patients died.
  • Most of these tetanus cases were in males (81%) and in persons aged 10 years or more (80%),– which showed us the immunity gaps in older children and adult men because of the lack of booster dose vaccination.
  • At the health facilities, we found 78 newborns infected by tetanus, which was far more than the three newborn tetanus cases that had been investigated and reported to the national level.
Tetanus patients need to be isolated because light and noise make the muscle spasms worse. We saw many tetanus isolation areas like this one during our visits to health facilities.

Our review showed that, sadly, a significant number of tetanus cases and deaths continue to occur in Uganda, including among newborns. CDC and its partners are therefore advocating for strengthening efforts to protect mothers and their newborns at childbirth, and for including tetanus booster shots in all countries in order to ensure that everyone, including older children and adult men, are protected from this deadly disease throughout their life. Furthermore, our work highlighted the need to ensure that the public health information collected is of high quality to best inform decision-making and to save lives. It was a real privilege to be part of this project, and I feel positive that our work can really make a difference for improving tetanus control in Uganda.

Posted on by Dr. Rebecca Casey, EIS Officer, Global Immunization DivisionTags , , , ,

Preventing Cervical Cancer in Cambodia: Evaluating the HPV Vaccination Demonstration Project

A nine-year old girl and her grandmother being interviewed in Svay Rieng province about her knowledge on HPV vaccine

Cervical cancer claims the lives of a quarter of a million women every year with almost nine out of ten deaths occurring in developing countries.   Cervical cancer is caused by human papillomavirus (HPV), a virus that can cause cancers in the mouth, throat, and reproductive tract, as well as genital warts. Safe and effective vaccines Read More >

Posted on by Julie Garon, MPH - Vaccine Introduction Team, GIDTags , , ,

Proud to Protect Burkinabè from Meningitis

A child lines up to get her routine MACV vaccination in Burkina Faso in 2017. © Evelyn Hockstein/CDC Foundation

Isaïe Medah, MD, MSc, is a physician and director general of public health in Burkina Faso. Previously he was director of the country’s routine immunization program from 2015–2017 and director of disease control from 2011–2015. Proud to Protect Burkinabè from Meningitis By Isaïe Medah, MD, MSc In a remote village of Burkina Faso, a woman Read More >

Posted on by By Isaïe Medah, MD, MScTags , , , , ,

Message from Hank Tomlinson, PhD, Acting Director of CDC’s Division of Global HIV & TB.

CDC's innovative efforts to find, cure, and prevent TB are creating a safer America and a safer world.

“We are at a key moment in the global fight against tuberculosis. Tremendous progress has been made and, yet, this preventable, curable infection still claims more lives than any other infectious disease or epidemic. As leaders come together on World TB Day and again at the United Nations High Level Meeting on TB in September, Read More >

Posted on by Dr. Hank Tomlinson

Global Health Security Agenda Programs Protect Americans from Infectious Disease Threats

Today’s world of increasing interconnectivity and mobility accelerates the shared global risk to human health and well-being. The United States cannot effectively protect the health of its citizens without addressing infectious disease threats around the world. A pathogen that begins in a remote town can reach major cities on all six continents in 36 hours[1]. Read More >

Posted on by Anne Schuchat, MD (RADM, USPHS)

World Birth Defects Day 2018 Raises Global Awareness of Birth Defects

Every year, millions of babies around the world are born with a serious birth defect. In many countries, birth defects are one of the leading causes of death in babies and young children. Babies who survive and live with these conditions are at an increased risk for long-term disabilities and other health problems. The fourth Read More >

Posted on by Margaret A. Honein, Ph.D, M.P.H., Acting Director, Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental DisabilitiesLeave a commentTags ,

Continuing the Fight Against Zika

Zika virus continues to spread in many countries and territories around the globe. Because there is no vaccine or medicine for Zika, the virus and its associated health outcomes will remain a significant and enduring public health challenge. The Danger from Zika Although many people infected with Zika experience mild or no symptoms, infection during Read More >

Posted on by Olga L. Henao, MPH, PhD, Epidemiologist2 CommentsTags , , , ,

IMPACT Program in Kenya: A Fellow’s Experience

Oren (right) with some of his colleagues Dr. Vincent Yator (center) and Athanasio Omondi (left) engage with a International Union Against Tuberculosis and Lung Disease facilitator, Dr. Gihan El-Nehas (standing) during a group session.

Many doctors and other health workers in my country have limited background or training in leadership and management, yet they often find themselves in leadership positions. This was my case when I was appointed Sub-County Medical Officer in February 2014. Starting out was no easy task, considering I was more used to clinical work. Here, Read More >

Posted on by Dr. Oren Nyambane Ombiro4 CommentsTags , , ,

Creating Strength in Numbers to End Violence Against Women & Girls

Dr. Daniela Ligiero

The 16 Days of Activism Against Gender-Based Violence campaign falls every year between the International Day for the Elimination of Violence against Women on November 25th, and Human Rights Day on December 10th. It is a time to raise awareness and galvanize global support and action to end violence against women and girls around the Read More >

Posted on by Dr. Daniela Ligiero, Executive Director and CEO, Together for GirlsLeave a commentTags ,

Rubella and CRS Elimination: A Race Worth Winning

AEFI management kit

AEFI Management Kit. Photo credit: Rania Tohme/CDC More than 100,000 children worldwide are born with congenital rubella syndrome (CRS) every year to mothers infected with the rubella virus. Sadly, these children will suffer a lifetime because of birth defects such as blindness, deafness, and heart disease, even though a cost-effective vaccine is widely available to Read More >

Posted on by Susan Reef, MD, MPH, Medical Epidemiologist and Rubella Team Lead, Global Immunization Division & Gavin Grant, MD, MPH, Medical Epidemiologist, Global Immunization DivisionLeave a commentTags , , ,