Conference abstract

Neonatal tetanus cases in Central African Republic: a neglected tragedy

Pan African Medical Journal - Conference Proceedings. 2018:9(46).22 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.46.775

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Keywords: Neonatal tetanus, immunization coverage, tetanus vaccine, mortality, HRUB
Oral presentation

Neonatal tetanus cases in Central African Republic: a neglected tragedy

Daniel Martinez Garcia1,&, Valentina Papadimitriou1, Iza Ciglenecki1, Alan Gonzalez1, Marie Claude Bottineau1, Dago Inagbe1, Emilie Macher1

1Médecins Sans Frontières (MSF), Operational Centre Geneva, Geneva

&Corresponding author
Daniel Martinez Garcia, Médecins Sans Frontières, Operational Centre Geneva, Geneva

Abstract

Introduction: tetanus is a vaccine preventable disease, which has a very low incidence in population with immunization coverage, neonatal tetanus has a high fatality rate and poor long-term outcomes. Médecins sans frontiers, operational centre Geneva, has been supporting the pediatric department of “Hôpital Universitaire de Berberati” (HRUB) since 2014. Here we describe clinical characteristics and outcomes of patients with neonatal tetanus admitted to HRUB.

Methods: retrospective data analysis. We reviewed individual patient files of all cases admitted between March 2014 and August 2017. Inclusion criteria were neonates with clinically suspected tetanus. Severity was graded according to Dakar score, which includes incubation period, period of onset, entry site, spasms, fever and tachycardia.

Results: out of 124 cases, detailed data was available for 106 patients. 7 cases were excluded because of their age (>28 days) and 11 cases due to insufficient clinical arguments. 42 patients (40%) came from Berberati town. There were slightly more males, n = 62 (58%). Number of reported cases increased over time: 10 in 2014, 20 in 2015, 36 in 2016 and 40 in 2017 until September. 73 cases (69%) were graded as severe according to Dakar score. 52 patients had non-assisted home birth and no maternal vaccination coverage. Case fatality was high with 63 deaths (59%). 9 neonates (8%) had a weight below 2000gr, all of them died.

Conclusion: we described one of the largest cohorts of neonatal tetanus cases from a single hospital in Central African Republic, with high mortality. Persistence of neonatal tetanus is likely linked to very low rates of maternal tetanus immunization and low access to safe deliveries. MSF recently conducted mass tetanus vaccination targeting women in reproductive age in the area, but more attention to improved access to reproductive health is urgently needed.