Tetanus infection in an 11-year-old male with full infant vaccination history: a rare case report

Tetanus is a potentially life-threatening neurologic disorder caused by the toxin-producing bacterium Clostridium tetani. Primary prevention is achieved through vaccination, typically administered during infancy, however, breakthrough cases of tetanus in fully immunized individuals, especially in pediatric populations have been noted posing unique challenges for diagnosis and management. Uganda currently does not provide tetanus booster doses beyond infancy. The World Health Organisation (WHO) recommends 3 dose Tetanus Toxoid (TT) booster doses at ages 12–23 months, 4–7 years and 9–15 years whereas the US-Centers for Disease control (CDC) recommends 3 additional doses at 15–18 months, 4–6 months and at 11–12 years. This case report represents an unusual occurrence of tetanus an 11-year-old male who had completed the standard infant vaccines recommended in Uganda but still manifested with symptoms consistent with the disease. An 11-year-old male Muganda was referred to Mulago National Referral Hospital's Acute Care Unit from a peripheral health facility with worsening backache, trismus, difficulty swallowing, and heightened sensitivity to touch and noise. On admission, he presented with severe pain, an arched back, and frequent muscle spasms indicative of tetanus, despite receiving the standard recommended infant vaccines in Uganda. The patient received intravenous metronidazole, alternate diazepam, and chlorpromazine, leading to a steady improvement in symptoms after which he was discharged on day 29. This case underscores the critical necessity of remaining vigilant for tetanus, even in individuals with a documented history of complete immunization at infancy. Additionally, this scenario highlights the pressing need for reviews of vaccination policies in regions where the recommended booster doses are not currently integrated into routine immunization schedules. Emphasizing adherence to these booster doses is key to enhancing tetanus immunity throughout childhood and adolescence.