804 Outcomes of Pediatric Tetanus in Western India

Abstract

Background Despite being easily preventable with a highly effective vaccine, tetanus remains a significant source of morbidity and mortality. We determined the clinical profile and outcome of management of paediatric tetanus admitted to our tertiary care hospital over 7 years. Methods Retrospective chart evaluation of all patients admitted from 2005 to 2012 between age groups of 1 month and 18 years. Demographic and Clinical Profile, Management in the hospital and variables affecting outcomes were studied. Results 65 patients (43 males, 22 girls) were admitted. Average age was 8.4 years. 12 children died, 32 discharged while 21 were transferred to another facility. 24/65 were unvaccinated, 21/65 partially vaccinated and 10 received proper immunization. Average incubation period (IP) was 7 days with patients with otogenic tetanus having IP of 15 days. 19 patients were ventilated for average duration of 5.74 days while 18 required tracheotomy. 25 patients had laryngeal spasms and 7 had autonomic instability. 14 patients did not receive Tetanus Immunoglobulin (TIG) while 51 received TIG in various forms (intrathecal, intramuscular or both). 5 patients who received only intrathecal survived while 13 of 19 that received both survived. 3/27 who received intramuscular tetanus died and 3/14 who received no TIG died. Odd Ratio for Death in No TIG use vs TIG use was 1.16 (CI 0.26.6, 5.3). Conclusions Tetanus is prevalent in India and causes significant morbidity and mortality. 27.3% mortality shows that treating tetanus is still difficult. Use of intrathecal TIG was not associated with a beneficial effect.