Obstetric tetanus in an unvaccinated Amish woman after a home birth has emphasized the need for preventative healthcare.
The Centers for Disease Control and Prevention (CDC) reports that on July 11, 2016, the state and local health departments in Kentucky learned of the 30-year-old woman's illness. She was never vaccinated against tetanus and experienced "stiff neck and jaw and difficulty swallowing and breathing" nine days postpartum.
Tetanus is triggered by Clostridium tetani bacteria, which is transmitted via spores that enter the body through broken skin like wounds, burns, insect bites, or even surgical procedures. These spores are everywhere in the environment, from soil to manure, and are reactivated once they enter the body after an incubation period of between 3 and 21 days.
The majority of people who have contracted tetanus in the US were either never vaccinated or failed to have a follow-up booster every 10 years.
The first common sign of tetanus is muscle cramping or "lock jaw," which can be followed by muscle spasms (often in the stomach), painful muscle stiffness, trouble swallowing, seizures, headache, fever, or changes in blood pressure and increased heart rate. Complications arising from tetanus could even include uncontrolled tightening of the vocal cords (laryngospasm), broken bones, a pulmonary embolism, or even pneumonia.
Meanwhile, obstetric tetanus occurs during pregnancy or 6 weeks after birth. It involves the contamination of wounds with the C. tetani spores during pregnancy, or using contaminated tools/practices during non-sterile deliveries or abortion (e.g., if someone gives birth at home or in the back of a cab).
The woman in question was rushed to hospital, where she was dosed with tetanus immunoglobulin. This is medication made up of antibodies used to battle the infection in those with a severe wound, or who have not been vaccinated, so don't have anti-tetanus antibodies of their own. The family declined a tetanus vaccine for the infant after the mother was stabilized and discharged, however. Thankfully, both mother and baby were fine.
The Advisory Committee on Immunization Practices (ACIP) advises parents to get their children a five-dose vaccine at the ages of 2, 4, 6, 15–18 months, and 4–6 years. At 11–12 years, they should receive a vaccine booster. The committee also recommends that adults should get tetanus boosters every ten years, whilst unvaccinated people should receive a 3-dose primary series.
Pregnant women should be administered with 3 doses of tetanus and reduced diphtheria toxoids. The Tdap vaccine (which protects from diphtheria and pertussis, as well as tetanus) is also recommended for all previously vaccinated pregnant women at 27 to 36 weeks gestation, to protect infants from pertussis.
The CDC notes that although the Amish community don't reject vaccinations on religious grounds, this particular group did not historically access preventative measures when it came to health. Another case in point would be the measles outbreak in an unvaccinated Amish community in Ohio. The incident prompted the health departments to educate the community of 400 people on the benefits of immunization via a door-to-door campaign about the ACIP recommendations.
Not everyone took this advice on board, however. None of the people in the Amish community there had been previously vaccinated against any disease, and even the 47% who took the initial dose of tetanus vaccine declined to finish the series.
However, the CDC report that there are additional outreach methods planned. They're making an effort to build trust between health providers and the Amish community in order to emphasize the benefits of immunization for non-immunized or under-immunized people.
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