Tetanus pada anak

Tentu kita sudah familiar dengan istilah tetanus ini meski tidak semua dari kita benar-benar mengerti apa dan bagaimanakah tetanus itu. Tetanus adalah suatu penyakit infeksi akut yang disebabkan oleh Clostridium Tetanii dengan tanda-tanda meningginya tonus otot serat lintang dan disertai kejang tonik yang bersifat umum. Manifestasi klinik disebabkan oleh eksotoksin yang diproduksi oleh kuman tersebut pada mas a pertumbuhan aktif dalam tubuh manusia.

Klasifikasi
Tetanus pada anak berdasarkankelompok umurnya dapat dibagi atas :
1. Tetanus neonatorum
2. Tetanus anak

Diagnosis
Berdasarkan gejala kliniknya diagnosis tetanus dapat ditegakkan :

Tetanus Neonatorum	Tetanus Anak
Hipertoni & spasme otot · Trismus : bayi tidak dapat minum, menangis dan mulut mencucu (fish mouth). · Mata tertutup. · Spasme otot lain : kaku kuduk, opistotonus, dinding perut tegang, anggota gerak spastik	1. Hipertoni dan spasme otot : · Trismus : sukar makan dan minum, bicara tidak jelas. · Spasme otot leher : leher skit dan kaku, Kernig sign positif · Risus sardonikus · Spasme otot lain : opistotonus, dinding perut tegang, anggota gerak spastik, sukar duduk/jalan.
2. Kejang otot tonik dengan kesadaran tak terganggu.	2. Kejang tonik dengan kesadaran tak teganggu
3. Gangguan refleks positif	4. Gangguan Refleks positif
4. Puntung pusat mungkin ada sekret kotor	5. Mungkin ada luka/riwayat luka, otitis media perforata

Derajat Penyakit
Beratnya penyakit dapat ditentukan berdasarkan :

• Kriteria Trismus dan kejang

Stadium 1 = trismus > 3cm tanpa kejang tonik umum meskipun dirangsang.
Stadium 2 = trismus ≤ 3 cm dengan kejang tonik umum bila dirangsang.
Stadium 3 = trismus ≤ 1 cm dengan kejang umumspontan

• Kriteria Patel & Jong

1. trismus
2. kejang
3. Masa tunas )antara terjadinya luka dan timbul gejala pertama) ≤ 7 hari.
4. Onset periode (antara trismus dan kejang pertama) ≤ 48 jam.
5. Suhu rektal 38°C dalam 24 jam pertama di RS.

Derajat 1 = bila hanya 1 kriteria ditemukan.
Derajat 2 = bila hanya 2 kriteria ditemukan.
Derajat 3 = bila semua kriteria ditemukan.

Diphteria, tetanus, polio and pertussis Vaccines

Diphtheria
Diphtheria is caused by bacteria which are found in the mouth, throat and nose. Diphtheria causes a membrane to grow around the inside of the throat.
This can make it diffi cult to swallow, breathe and can even lead to suffocation.
The bacteria produce a poison which can spread around the body and cause serious complications such as paralysis and heart failure. Around 10 percent of people who contract diphtheria die from it.
Diphtheria can be caught through coughs and sneezes from an infected person.

Tetanus
Tetanus is caused by bacteria which are present in soils, dust and manure. The bacteria can enter the body through a wound which may be as small as a pin prick. Tetanus cannot be passed from person to person.
Tetanus is an often fatal disease which attacks the nervous system. It causes muscle spasms first felt in the neck and jaw muscles. Tetanus can lead to breathing diffi culties, painful convulsions and abnormal heart rhythms.
Because of the effective immunisation, tetanus is now rare in Australia, but it still occurs in adults who have never been immunised against the disease or who have not had their booster vaccines.

Whooping cough
Whooping cough is a highly contagious disease which affects the air passages and breathing. The disease causes severe coughing spasms. Between these spasms, the child gasps for breath. Coughing spasms are often followed by vomiting and the cough can last for months.
Whooping cough is most serious in babies under 12 months of age and often requires admission to hospital. Whooping cough can lead to complications such as haemorrhage, convulsions,
pneumonia, coma, infl ammation of the brain, permanent brain damage and long term lung damage. Around one in every 200 children under six months of age who catches whooping cough will die.
Whooping cough can be caught through coughs and sneezes from an infected person.

Polio
Polio may cause mild symptoms or very severe illness. It is a virus which affects the digestive and nervous systems. It causes fever, vomiting and muscle stiffness and can affect the nerves, causing permanent crippling.
The disease can paralyse breathing and swallowingmuscles, leading to death. Between two and five percent of people with polio die from it and about half of all patients who survive suffer permanent paralysis.
Polio can be caught if the faeces of an infected person contaminates food, water or hands.

Diphtheria, tetanus, whooping cough and polio can be prevented with a safe and effective combination vaccine called Infanrix hexa®. Several injections are needed before good protection is provided. The Infanrix hexa® vaccine contains a small amount of diphtheria and tetanus toxins, which are modifi ed to make them harmless. It also contains purified parts of the pertussis bacterium and three types of inactivated polio viruses with small amounts of antibiotics and preservative.

Pre-immunisation checklist
Before your child is immunised, tell the doctor or nurse if any of the following apply:

• Are unwell on the day of immunisation (temperature over 38.5˚C)
• Have had a severe reaction to any vaccine
• Have a severe allergy to any vaccine component (for example, neomycin).

Possible side effects of diphtheria, tetanus, whooping cough and polio vaccine
Reactions to diphtheria, tetanus, whooping cough
and polio vaccine are much less frequent than the
complications of the diseases.
Common side effects
• Irritable, crying, unsettled and generally unhappy
• Drowsiness or tiredness
• Low grade fever
• Soreness, redness and swelling at the injection
site
• A temporary small lump at the injection site.
Sometimes a booster dose of diphtheria, tetanus
and whooping cough vaccine can cause a very
large local reaction of redness and swelling in the
limb. This reaction should be reported to your
immunisation provider and may require a visit to
the doctor.
Extremely rare side effects
• Hypotonic-hyporesponsive episode (HHE).
Infant may show signs of paleness, limpness
and be unresponsive. This may occur one to 48
hours following vaccination. The whole episode
may last from a few minutes to 36 hours.
Follow-up of children with HHE shows no longterm
neurological or other side effects.
• Severe allergic reaction.
If mild reactions do occur, they may last one to
two days. The side effects can be reduced by:
• Drinking extra fl uids
• Not overdressing
• Placing a cold, wet cloth on the sore injection
site
• Giving your child paracetamol to reduce any
discomfort (note the recommended dose for the
age of your child)
If reactions are severe or persistent, or if you are
worried, contact your doctor or hospital.