The 30-year-old woman, a member of the Amish community in Kentucky, gave birth at home in June 2016, according to the report. She was aided by an unlicensed childbirth assistant in her community. The baby was in a breech position (buttocks first) before delivery, but the woman did not experience physical trauma from the birth, and there were no other complications, the report said.
However, nine days after giving birth, the woman experienced neck pain and numbness in her face. Her symptoms got worse over the next 24 hours — her neck and jaw became stiff, and she had difficulty swallowing and breathing, the report said.
She was taken to a hospital, where she was diagnosed with tetanus — an infection caused by the bacteria Clostridium tetani. The bacteria release a toxin that can cause painful muscle contractions, particularly in the jaw, as well as whole-body spasms.
Tetanus infections are rare in the United States; there are only about 30 reported cases per year, according to the Centers for Disease Control and Prevention. And cases of obstetric tetanus, which occur in pregnancy or within six weeks of childbirth, are even rarer; according to the report, there were no reported cases of obstetric tetanus from 1972 to 2008, the most recent years for which data are available.
The infection was once much more common. Reported tetanus cases in the U.S. have declined by 95 percent since 1947, when the United States started keeping track of cases. This decline has been due, in part, to the introduction of tetanus vaccines, according to the CDC. Nearly everyone who contracts tetanus today in the United States has never received a tetanus shot or is not up-to-date with their vaccinations, the CDC said.
The woman in the report had never received a tetanus shot. She was treated with a medicine called tetanus immunoglobulin, which can neutralize the toxin released by the bacteria if the toxin has not already bonded to nerve tissue, according to the Mayo Clinic.
The woman experienced seizures and needed medical support to aid in breathing. But after spending one month in the hospital, she had recovered enough to go home, the report said.
Doctors working on her case recommended that the woman's baby receive tetanus immunoglobulin in case the infection had passed from mother to child during childbirth, but the family declined this preventive treatment, according to the report. The infant was monitored for signs of infection, but no problems were seen.
"This case highlights the importance of tetanus vaccination for all persons," the researchers wrote in their report.
People in the Amish community generally do not have religious objections to getting vaccinations, but typically, they just do not get preventive health care, including vaccinations, the report said.
To help boost vaccination rates in the Kentucky Amish community, members of the local health department made door-to-door visits to explain the benefits of vaccination. They were able to vaccinate 47 people, or 12 percent of the community's members, with either the "Tdap" vaccine, which prevents tetanus, diphtheria and pertussis (also known as whopping cough); or the "Td" vaccine, which protects against tetanus and diphtheria.
However, since then, none of the vaccinated members have agreed to have follow-up shots, because they perceived little need for ongoing vaccination, the report said. Local health officials plan to have additional outreach initiatives in the area.
The CDC recommends that children receive a five-dose series of the diphtheria, tetanus and pertussis vaccine, followed by a booster shot in adolescence. It's recommended that adults receive a booster shot every 10 years, and that pregnant women receive the shot during their third trimester, sometime between 27 and 36 weeks of pregnancy.
The report was published Thursday (March 23) in the CDC journal Morbidity and Mortality Weekly Report.
SOURCE: http://www.livescience.com/58408-tetanus-infection-home-birth.html
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