Abstract

PIP: In Sri Lanka, tetanus is a notifiable disease and all cases are personally investigated by the Ministry of Health. Between 1967-1978, government hospitals' staff treated on average 2000 cases of all types of tetanus/year of which a mean of 765 (37.7%) cases/year were neonatal. Within this time period, the incidence of neonatal tetanus ranged from 123.9-248/100,000. 2 years after the initiation of the Expanded Program on Immunization (EPI) in Sri Lanka, the incidence rate fell below 100/100,000. Data for the 1st 6 months of 1981 showed a further decline to 44.4/100,000. The case fatality rate (CFR) for hospital admissions for neonatal tetanus was about 42%. Between 1975-1980, hospital physicians treated 10,809 cases of tetanus. 423 (52.2%) of the cases were neonatal. 254 cases (60.1%) were males and 144 (34%) were females with 25 (5.9%) not specified. The CFR for those cases where the outcome was known decreased from 84.4% in 1975 to 53% in 1979, only to increase to 60% in 1980. The mean incubation period was 6.2 days, while the incubation period was 2 weeks for 90.3% of the cases. In terms of immunization status, the CFR stood at 78.6% for the unimmunized group, 64.9% for those who received 1 dose of the tetanus toxoid (TT), and 57.1% for those who received 2 doses. An increase in coverage of pregnant women who received TT occurred after the EPI program was initiated. For example, in 1974, 7.6% of pregnant women received 1 TT dose and 4.3% received 2 TT doses, by 1980, these percentages rose to 70.5% and 48.5% respectively. Both these percentages exceeded the EPI 1980 target of immunizing 35% of all pregnant women. Based on an assessment survey of 3 provinces EPI has further increased its target to 80%.