OET Listening Bölüm C: Tetanus: Risks and Prevention

Good morning.

My name is Sally Perkins, and I'm one of the registered nurses working here in the hospital.

Very soon I'm going to highlight the importance of immunisation and medical treatment for tetanus infection by talking about some case reports.

But first I'd like to give you a little background into the disease.

Tetanus is caused by a toxin produced in bacteria found worldwide in soil, dust and manure,

and it can contaminate many surfaces and substances.

Because of this, the disease cannot be eradicated completely,

but infection can be prevented through immunisation with tetanus-toxoid-containing vaccines.

People who contract tetanus and recover do not have natural immunaity,

so they can be reinfected and therefore also need to be immunised.

To be protected throughout life, the World Health Organisation recommends that an individual receives 6 doses

of a tetanus-toxoid-containing vaccine,

which can be done through a routine immunisation program.

Tetanus is characterised by painful muscular contractions and spasms.

Involvement of the muscles of the jaw and neck has led to tetanus also being known as 'lock jaw'.

It is not directly transmitted from person to person.

Instead, the bacteria enters the body through a cut or wound.

The majority of patients develop the disease as a result of a deep wound or puncture,

but even a tiny pinprick or scratch can be enough for the bacteria to enter the body.

Although tetanus cases are much rarer than they used to be,

tetanus is still a life-threatening disease because of inadequate vaccination levels and inappropriate wound care.

Another major issue is that only one third of people who have a tetanus prone wound actually seek medical treatment.

One of the main reasons given by people for not getting the tetanus vaccine is that we already have high levels of naturally occurring anti-toxin through unintentionally ingesting the tetanus bacteria in day-to-day living,

granting natural immunity without ever needing a single dose of medication or vaccination.

Others state that if you've potentially been exposed to tetanus,

fully cleaning the wound will reduce the potential for bacteria to enter the bloodstream.

The problem with these approaches is that if you have been infected and aren't aware of it,

medical treatment may come too late.

Now I'd like to present some case studies to illustrate the danger of taking tetanus protection for granted.

First, the case of a 45-year-old woman who lives on a farm and sought medical care after experiencing leg, back and jaw pain

although she had no specific injury.

Because the woman was also having difficulty breathing,

doctors had to do a tracheostomy and put her on ventilator.

After two weeks in intensive care, the patient faced weeks of physical rehabilitation.

In all, the woman was hospitalised for six weeks of medical care.

Because the symptoms were recognised early on and because the woman hadn't completely stopped breathing,

she was able to make a complete recovery.

She had not received a regular tetanus booster shot and the status of her primary vaccination was unknown.

The second incident I'd like to share with you occurred when a 4-year-old boy was taken by his parents to his GP with a one-week history of general malaise, mild fever, lethargy and weight loss.

He subsequently developed dysphagia, difficulties opening his mouth and dehydration.

Due to the concerns about the boy's refusal of fluids, a paediatrician was consulted.

The boy then began to show signs of 'lockjaw' and muscle rigidity.

Together with the lack of immunisation and a toenail infection, this finally led to the diagnosis of tetanus.

The boy was then transferred to a paediatric intensive care unit for initial treatment.

Initially, the frequency and severity of his muscle spasms increased during the day in ICU,

but he did make a full recovery after four further weeks of treatment.

The final case involves an otherwise healthy 53-year-old man who arrived at the emergency department of his local hospital complaining of severe stiffness in his jaw and difficulty swallowing,

but without any apparent wound or cuts.

Following an exhaustive examination and attempts to alleviate his symptoms, a diagnosis of tetanus was made by the medical team.

He was treated with tetanus immune globulin and tetanus toxoid, and kept unconscious for two weeks.

The man was discharged after spending nearly a month in hospital, including his nearly three week stay in the ICU,

and he was not able to recall the date of his last tetanus injection.

I'm sure you'll agree, this case highlights how everyone is at risk of this disease.