Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease.

Aim: To review management of children admitted with tetanus to Starship Children's Hospital from 2000 to 2013. Methods: Retrospective chart review of children aged 0-15 years admitted to Starship Children's Hospital with tetanus from 2000 to 2013. Follow-up of immunisation status was via the National Immunisation Register and/or phone contact with patient's primary health care provider. Results: Four cases of tetanus occurred, all in unimmunised children. All four required paediatric intensive care unit admission (length of stay (LOS) 2.5-7 weeks) for ventilatory support; three required tracheostomy. Specific tetanus treatment included metronidazole, tetanus immunoglobulin and antispasmodic medications such as magnesium sulphate and benzodiazepines. Three remain partially or unimmunised following discharge. Conclusion: Tetanus in children is a rare but preventable life-threatening disease, requiring costly intensive care management. Immunisation is cheap and effective in preventing tetanus and should be offered to all children, including tetanus cases for their future protection.