The prevalence of Tetanus in Canada and India

A critical comparison of the vaccination and hygienic influences on the prevalence of Tetanus in Canada and India.

Tetanus is caused by a toxin, tetanaspasmin, produced by the bacterium Clostridium tetani (Guifoile 2008, p. 10). This toxin affects the inhibiting motor neurons within the body, causing muscle contractions to become erratic and violent. These contractions are extremely painful for the individual suffering them, the contractions being violent enough to cause the strongest of bones in the body to fracture. In the last century, around 1940, the likelihood of death if you contracted tetanus was approximately 90% (Guifoile 2008, p. 10). Over time, however, vaccines and effective treatment options were developed, decreasing the mortality rate of tetanus. The vaccination programs of two countries, Canada and India, are both considerably thorough for the protection against tetanus. Furthermore, Canada has a high standard of hygiene and sanitation, further lowering the risk of tetanus in the country. India, however, does not have as high sanitation or hygiene standards, which may have an effect on the protection of tetanus.

Both India and Canada follow vaccination procedures in order to prevent tetanus infection. Because of this, tetanus in Canada is quite rare; the PHAC (2014) states that through the years of 1990 and 2010 there were approximately 4 cases per year of tetanus in Canada. In India, though the prevalence of tetanus has declined, it is still a ‘…major health problem […] with significant morbidity and mortality due to […] incomplete vaccination’ (Kole et al. 2013). Skowronksi et al. (2004) reports that in New Delhi, India, 53% of adults were reported to have no protection against tetanus. This is comparable to Canada, in which a study reported that roughly 55% of adults do not have protection against tetanus. Whilst less have gotten vaccinated in Canada compared to the number of adults vaccinated in India, Tetanus is still a threatening disease in India. Considering this, both Indian and Canadian infants are given the tDap/DTap vaccinations. In Canada, routine vaccinations for newborns are given at 2 months of age, then again at 4, 6, 8, and 12-23 months. The Canadian vaccination schedule suggests that children under the age of 6 should be vaccinated more than 20 times (Public Health Agency of Canada (PHAC) 2014). Furthermore, Skowkronski et al. (2004) states that Canadian immunization programs are ‘…publicly-funded in all provinces’. This is similar to in India, as the National Immunization Schedule ensures all children in the country under the Expanded Program of Immunization (EPI) are immunized free of charge. Moreover, the newborn vaccinations are not done as frequently in India. Newborn children are not vaccinated until 8 weeks of age, then they are again vaccinated at 16 weeks. Another vaccination is given at 15-18 months (Viswanathan 2005). Whilst both Canada and India provide vaccinations against tetanus to newborn children and infants, this may not have any relation to the prevalence of tetanus in India, however, due to the tetanus bacterium being spread only by wounds or fecal-oral transmission (Ji, cited by Mercola 2012).

The majority of fields and roads are contaminated with animal feces in India. Because of this, Kole et al. (2013) suggests that the farming population in India should be ‘…targeted for complete tetanus immunization’ as they may be exposed more often to animal feces and contaminated soil. Contrastingly in Canada, there is a largely higher level of hygiene and sanitation; unlike India, human or animal fecal matter does not sit in the streets. As such, the risk of the soil or environment having been contaminated by the tetanus bacteria is low. This may link back to Canada’s low prevalence of tetanus despite the lack of vaccinated individuals. As tetanus spreads through fecal matter and the bacterium can reside in the soil, Ji (cited by Mercola 2012) suggests that hygiene, sanitation and proper nutrition should be focused on in order to prevent the transmission of tetanus and other ‘fecal-oral route’ viruses. This may also reduce the morbidity of tetanus if a person is infected. Ji states:

‘You simply can’t vaccinate people out of [unhealthy] conditions, and as India’s new epidemic of vaccine-induced polio cases clearly demonstrates, the ‘cure’ may be far worse than the disease itself’ (cited by Mercola 2012).

Whilst Ji is discussing the affects of the 2011 polio epidemic in India caused by vaccinations, this statement can still be applied to tetanus as the process of infection is the same: fecal-oral route. However, tetanus can also be transmitted through punctures or wounds (Guilfoile 2008) which strengthens the link between India’s poor sanitation and hygiene and the prevalence of tetanus: many Indian people walk with bare feet, increasing the likelihood of stepping on a stick/nail/other such thing that is contaminated with the tetanus bacterium. Furthermore, according to Guilfoile (2008), ‘…has been found […] in the fecal matter of humans and other animals…’ thus leading to the tetanus bacterium being ‘…common in the soil in rural areas…’ in the country.

Both India and Canada both provide free and routine vaccinations again tetanus (TDap/dTap vaccine), and both countries ensure newborns are vaccinated and are given booster shots. It has been established that both countries have fairly thorough vaccination schedules, though Canada’s schedule includes more frequent vaccinations for infants. However, it can be thought that the number of immunizations against tetanus do little to protect against the bacterium that cause tetanus, as these bacteria are transferred via the mouth through fecal matter (Ji, cited by Mercola 2012). It can be concluded that India, due to fecal matter amongst the streets and the generally low standard of hygiene within the country, is an area of which tetanus infection is much more likely, with or without vaccination. Due to Canada’s higher sanitation and hygiene levels, despite the lower vaccination rate, tetanus is much less prevalent there and has a lower mortality rate.

Word count – 968

References

Mercola, J 2012, Confirmed: India’s Polio Eradication Campaign in 2011 Caused 47,500 Cases of Vaccine-Induced Polio Paralysis, Mercola, viewed 12 April 2015, <http://articles.mercola.com/sites/articles/archive/2012/08/28/polio-eradication-campaign.aspx>

Kole, A, Roy, R & Kole, D 2013, ‘Tetanus: still a public health problem in India — observations in an infectious diseases hospital in Kolkata’, South-East Asia Journal of Public Health, pp. 184-186

Public Health Agency of Canada 2014, Canadian Immunization Guide, Public Health Agency of Canada, viewed 9 April 2015, <http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-tet-eng.php>

Vijayalakshmi, M 2014, Resources, All For Kids India, viewed 9 April 2015, <http://www.allforkidsindia.com/Resources/VaccineOptions.aspx>

Vashishtha, V 2011, FAQs on Vaccines and Immunization Practices, Jaypee Brothers Medical Publishers, New Delhi, India, p. 37.

Viswanathan, R 2005, Get Your Tetanus Shot Today!, Rediff, viewed 9 April 2015, <http://www.rediff.com/getahead/2005/jun/13tetanus.htm>

Skowronski, D, Pielak, K, Remple, V, Halperin, B, Patrick, D, Naus, M & McIntyre, C 2004, ‘Adult tetanus, diphtheria and pertussis immunization: knowledge, beliefs, behaviour and anticipated uptake’, Vaccine, vol. 23, no. 3, pp. 353-361.

Guifoile, P 2008, Deadly Diseases and Epidemics: Tetanus, Infobase Publishing, New York, New York, pp. 10-16.

Foundations of Health (HLTH 1029) Assignment 1: Academic Paper (20%) Word limit: 1,000 including in-text references and tables, but excluding reference list. Papers not meeting the submission format required by the School will be asked to resubmit their paper. No other changes are able to be made!
The Graduate Qualities being assessed by this assignment are to demonstrate and apply a body of knowledge communicates effectively information literacy can work independently
Name:	Essay Question:
Component	Grade	HD	D	C	P1P2	F
Construct a good essay in terms of an introduction, body and conclusion 20%		The essay has an excellent construction with a clear, well worded introduction which defines key words and outlines the argument, a body which discusses the argument/aim of the paper and a conclusion which are clearly linked throughout the essay. There will be minimal or no typographical, spelling or grammatical errors.	The essay has a very good construction with a clear introduction, body and conclusion which are linked throughout the essay. There will be minor , infrequent typographical, spelling or grammatical errors	The essay is missing either a clear introduction or conclusion, but the body of the text is well constructed. The flow of the argument through all sections of the paper is not clear or clearly linked. There will be some typographical and/or grammatical and/or spelling errors more generic throughout the paper	The essay has significant problems with construction. The components of the essay are not well defined, and the argument is not made very clear. There is still some link between the aim of the paper and the conclusion. There will be frequent typographical and/or grammatical and/or spelling	The essay has major problems with construction. There is no logical flow of an argument and no section of the paper is well defined. There will be some major typographical and/or grammatical and/or spelling errors frequently occurring throughout the paper.
Presents a good argument 20%		The argument/aim is excellently presented in the introduction, argued in the body and summarised in the conclusion. More than one perspective of the argument has been clearly considered and well presented in the body and the conclusion logically follows the case presented in the body of the text. No new information presented in the conclusion	The argument/aim is clearly presented in the introduction, argued in the body and summarised in the conclusion. More than one perspective of the argument has been considered in the body but lacks a little in depth and the conclusion follows the case presented in the body of the text. No new information presented in the conclusion	The argument/aim is apparent as the paper progresses, but may not be clearly presented in the introduction. Only one perspective of the argument has been presented in the body. There is lack of clarity in the conclusion or new information has been included in the conclusion	It is difficult to follow the argument through the paper. A clear argument/aim was not stated. Only one perspective of the argument is presented in the body of the text and is not well argued. The conclusion does not summarise the argument and/or introduces new information	The argument/aim of the paper is very difficult to follow and is poorly argued. There is no flow of the argument through the paper.

Component	Grade	HD	D	C	P1P2	F
Make use of their own voice 20%		Excellent use of their own voice. It is very clear what their own ideas are and how they are using the literature to support them. No use of quotes unless quoting absolutely key words that could not be paraphrased adequately.	Very good use of their own voice. It is clear what their own ideas are and how they are using the literature to support them. Some ‘translation’ or sources that could have been better presented in their own voice. Minimal/no use of quotes.	Some use of their own voice. A more heavy reliance on ‘translating’ the sources use rather than using them to support their own ideas. Some reliance on quotes to present information that could be easily paraphrased.	Little use of their own voice. Difficult to see how they are using the literature to support their own ideas as opposed to reflecting the ideas of the original author. Nearly all paper is ‘translation’ of sources and/or heavy reliance on quotes.	No use of their own voice. Very difficult to see how they are using the literature to support their own ideas. The whole paper is ‘translation’ of sources and/or heavy reliance on quotes.
Identify and use good quality resources 10%		Excellent depth and breadth of sources accessed indicating an excellent search. All sources are of a good to excellent standard.	Very good depth and breadth of sources accessed. Majority of sources are of a good standard indicating a good search.	Good depth and breadth of sources accessed. There may be some use of unreliable sources indicating a more superficial search.	Acceptable depth and breadth of sources accessed. While most sources are from unreliable sources at least one source will be of an acceptable standard indicating that some level of searching has occurred.	The depth and breadth of sources accessed is unacceptable. All sources are of a low standard indicating a poor search strategy.
Use adequate and correct referencing skills 30%		The referencing style was consistent and correct in both the text and the reference list. Excellent attribution is made throughout.	There may be some minor mistakes in the in-text and/or reference list and very good attribution is made throughout	There may be some inconsistency and/or mistakes in the referencing style both in-text and/or in the reference list. Reasonable attribution is made throughout	There will be major mistakes in the referencing style both in-text and/or in the reference list. Just acceptable attribution is made throughout.	The referencing style and the level of attribution made throughout are not acceptable. NOTE: This section must be passed to pass this paper. A failure in this section is indicative of plagiarism and the students will be asked to see the AIO.
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