KATHMANDU, Oct 28: Last month, Ram Mandal (name changed), 27, of Rautahat was admitted to Teku Hospital in critical condition after stepping on a rusty nail.
He received neither timely treatment nor the tetanus vaccine, leading to severe symptoms of the disease. After a prolonged treatment, he eventually recovered with assistance from a social security fund, which covered approximately Rs 400,000 in medical expenses due to his family’s financial situation.
Mandal’s case is not an isolated incident; statistics indicate that many patients with tetanus seek treatment at the hospital each year. In October of the current fiscal year, two tetanus patients were treated at Sukraraj Tropical and Infectious Disease Hospital in Teku. Data from the previous fiscal year 2023/24 show that one individual died among ten reported cases of the disease, while the year 2022/23 saw 16 infections, with four resulting in fatalities.
Over the last four years, 42 tetanus patients have been treated at the Teku Hospital. However, the hospital lacks comprehensive follow-up data on patient recoveries. Dr Milan Bajracharya at the hospital said that many patients require referrals to other hospitals for specialized care and that some arrive in critical condition.
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There is a significant gap in accurate data regarding tetanus infections in Nepal, especially concerning age groups outside of newborns. Records indicate that only eight newborns were diagnosed with tetanus over the past four years, reflecting a broader issue in tracking cases among older populations.
Tetanus, caused by the bacterium Clostridium tetani, typically enters the body through wounds, particularly those inflicted by rusty metal objects. Symptoms can manifest within one to two weeks after infection, including muscle stiffness, fever, and intense pain. Prompt treatment is essential; delays can lead to severe complications and potentially fatal outcomes.
Dr Bajracharya said that many patients do not seek treatment until it is too late, complicating recovery, particularly for older individuals with existing health issues. “Most of the patients come late for treatment,” he said, highlighting the need for greater awareness and timely vaccination to prevent future cases of this dangerous disease.
Likewise, he noted that the severity of tetanus infections varies based on the location of the wounds. Symptoms may manifest more quickly depending on the part of the body where the injury occurs. “If the injury occurs near the neck, chest, or abdomen, the infection can become more complicated,” he said.
While tetanus is less common in developed countries, there has been a notable rise in cases in Nepal and similarly less developed nations. “It is well-known that tetanus can arise from a wound, yet awareness about the consequences of such injuries remains insufficient,” Dr Bajracharya said. Despite increased awareness over the past decade, many workers and farmers—who often have less education—still lack understanding about the importance of vaccination.
Nepal initiated its tetanus vaccination program in 1977, including it in routine immunization schedules since 1984. Pregnant women and infants receive three doses of the vaccine to help prevent tetanus in newborns. However, even vaccinated individuals can still become infected if the bacteria enter the body through a wound. Dr Abhiyaan Gautam, head of the vaccine branch of the hospital highlighted that while regular vaccination has reduced cases, some infections continue to occur.
Thanks to its vaccination efforts, Nepal was recognized as a country successfully which eradicated tetanus in 2005. Nonetheless, ongoing cases suggest the need for further investigation and review of vaccination strategies in the coming year.
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