{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:00Z","timestamp":1772740860281,"version":"3.50.1"},"reference-count":46,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Postneonatal tetanus remains a significant cause of mortality and morbidity in low- and middle-income countries (LMICs). Intrathecal human tetanus immunoglobulin (ITIG) has emerged as a potential therapeutic option; however, its efficacy and safety remain unclear. This retrospective study was conducted in a Level-3 pediatric intensive care unit (PICU) in North India over 19 years (2006\u20132024) that included 63 children (ages 1 month\u201312 years) with postneonatal tetanus. Beginning in 2012, we began using ITIG (1,000 U within 24 hours of admission) in addition to standard treatment. Children who received ITIG (\n                    <jats:italic>n<\/jats:italic>\n                    = 39) were compared with those who did not receive ITIG (\n                    <jats:italic>n<\/jats:italic>\n                    = 24) (ITIG and no-ITIG group, respectively). The primary outcome was in-hospital mortality, and secondary outcomes were length of mechanical ventilation, PICU stay, and complication rates. The median (interquartile range) age was 7 (3\u20139) years, 77.8% were boys, and none were fully immunized. The main portals of entry were injury (47.6%) and otogenic (36.5%). The majority had generalized tetanus (96.8%) with a severity grade of 3b (79.4%). Common complications included respiratory failure (98.4%), autonomic dysfunction (79.4%), and rhabdomyolysis (66.6%). The ITIG group was associated with significantly lower mortality (10.3% vs. 50%,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.001), similar durations of ventilation and PICU stay, and reduced rates of rhabdomyolysis, shock, and acute kidney injury. Administration of ITIG in postneonatal tetanus in an LMIC setting was associated with significantly lower mortality and complications. There is a need to conduct trials to evaluate the efficacy of ITIG in postneonatal tetanus, especially in LMICs, where disease burden and the cost of intensive care are significant considerations.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0549","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T16:11:55Z","timestamp":1767715915000},"page":"436-440","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Intrathecal Tetanus Immunoglobulin in Postneonatal Tetanus: A Retrospective Comparative Study (TIG-TET Study)"],"prefix":"10.4269","volume":"114","author":[{"given":"Jyothi","family":"Jayaram","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siva","family":"Vyasam","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suresh Kumar","family":"Angurana","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthi","family":"Nallasamy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun","family":"Bansal","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muralidharan","family":"Jayashree","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Infect Dis","first-page":"118","article-title":"Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"132","author":"Li","year":"2023"},{"key":"b2","series-title":"BMJ Paediatr Open","article-title":"Global analysis of tetanus incidence and mortality in children under 5 years: Findings from the Global Burden of Disease Study 2021","volume":"9","author":"He","year":"2025"},{"key":"b3","series-title":"Indian Pediatr","first-page":"765","article-title":"Experience of pediatric tetanus cases from Mumbai","volume":"37","author":"Tullu","year":"2000"},{"key":"b4","series-title":"Indian J Pediatr","first-page":"267","article-title":"Post-neonatal tetanus: Issues in intensive care management","volume":"68","author":"Singhi","year":"2001"},{"key":"b5","series-title":"Indian J Pediatr","first-page":"43","article-title":"Intrathecal tetanus immunoglobulins in the management of tetanus","volume":"74","author":"Geeta","year":"2007"},{"key":"b6","series-title":"Indian Pediatr","first-page":"987","article-title":"Tetanus in pediatric patients \u2013 Predictors affecting mortality and role of immunoglobulin","volume":"48","author":"Aggarwal","year":"2011"},{"key":"b7","series-title":"Trop Doct","first-page":"157","article-title":"Tetanus \u2013 Still a scourge in the 21st century: A paediatric hospital-based study in India","volume":"42","author":"Mishra","year":"2012"},{"key":"b8","series-title":"J Infect Public Health","first-page":"121","article-title":"Epidemiological trends of tetanus from East Delhi, India: A hospital-based study","volume":"7","author":"Narang","year":"2014"},{"key":"b9","series-title":"J Trop Pediatr","first-page":"15","article-title":"Post-neonatal tetanus in a PICU of a developing economy: Intensive care needs, outcome and predictors of mortality","volume":"64","author":"Angurana","year":"2018"},{"key":"b10","series-title":"J Pediatr Intensive Care","first-page":"256","article-title":"Clinical profile and outcome of pediatric tetanus at a tertiary care center","volume":"10","author":"Mondkar","year":"2021"},{"key":"b11","series-title":"Lancet","first-page":"1657","article-title":"Tetanus","volume":"393","author":"Yen","year":"2019"},{"key":"b12","series-title":"J Neurochem","first-page":"1244","article-title":"Tetanus and tetanus neurotoxin: From peripheral uptake to central nervous tissue targets","volume":"158","author":"Megighian","year":"2021"},{"key":"b13","series-title":"Natl Med J India","first-page":"209","article-title":"A randomized double-blind sham-controlled study of intrathecal human anti-tetanus immunoglobulin in the management of tetanus","volume":"11","author":"Agarwal","year":"1998"},{"key":"b14","series-title":"BMJ","first-page":"615","article-title":"Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrathecal or intramuscular route","volume":"328","author":"Miranda-Filho Dde","year":"2004"},{"key":"b15","series-title":"Trop Med Int Health","first-page":"1075","article-title":"Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: A meta-analysis","volume":"11","author":"Kabura","year":"2006"},{"key":"b16","series-title":"Sante","first-page":"125","article-title":"[Intrathecal therapy with 1500 UI of antitetanic serum and 1.5 g of intravenous metronidazole: Prognosis of tetanus in hospitalized patients in Togo]","volume":"18","author":"Wateba","year":"2008"},{"key":"b17","series-title":"Trop Med Int Health","first-page":"555","article-title":"Incremental costs of treating tetanus with intrathecal antitetanus immunoglobulin","volume":"18","author":"Miranda-Filho","year":"2013"},{"key":"b18","series-title":"Lancet Glob Health","first-page":"e862","article-title":"Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: A 2 x 2 factorial randomised controlled trial","volume":"10","author":"Van Hao","year":"2022"},{"key":"b19","series-title":"Indian J Crit Care Med","first-page":"S155","article-title":"Intensive care management of severe tetanus","volume":"25","author":"Karnad","year":"2021"},{"key":"b20","series-title":"Crit Care","first-page":"R204","article-title":"Acute renal failure \u2013 Definition, outcome measures, animal models, fluid therapy and information technology needs","volume":"8","author":"Bellomo","year":"2004"},{"key":"b21","series-title":"Kidney Int","first-page":"1028","article-title":"Modified RIFLE criteria in critically ill children with acute kidney injury","volume":"71","author":"Akcan-Arikan","year":"2007"},{"key":"b22","series-title":"Nephron Clin Pract","first-page":"c179","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012"},{"key":"b23","series-title":"Am J Infect Control","first-page":"309","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008"},{"key":"b1","series-title":"Int J Infect Dis","first-page":"118","article-title":"Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"132","author":"Li","year":"2023"},{"key":"b2","series-title":"BMJ Paediatr Open","article-title":"Global analysis of tetanus incidence and mortality in children under 5 years: Findings from the Global Burden of Disease Study 2021","volume":"9","author":"He","year":"2025"},{"key":"b3","series-title":"Indian Pediatr","first-page":"765","article-title":"Experience of pediatric tetanus cases from Mumbai","volume":"37","author":"Tullu","year":"2000"},{"key":"b4","series-title":"Indian J Pediatr","first-page":"267","article-title":"Post-neonatal tetanus: Issues in intensive care management","volume":"68","author":"Singhi","year":"2001"},{"key":"b5","series-title":"Indian J Pediatr","first-page":"43","article-title":"Intrathecal tetanus immunoglobulins in the management of tetanus","volume":"74","author":"Geeta","year":"2007"},{"key":"b6","series-title":"Indian Pediatr","first-page":"987","article-title":"Tetanus in pediatric patients \u2013 Predictors affecting mortality and role of immunoglobulin","volume":"48","author":"Aggarwal","year":"2011"},{"key":"b7","series-title":"Trop Doct","first-page":"157","article-title":"Tetanus \u2013 Still a scourge in the 21st century: A paediatric hospital-based study in India","volume":"42","author":"Mishra","year":"2012"},{"key":"b8","series-title":"J Infect Public Health","first-page":"121","article-title":"Epidemiological trends of tetanus from East Delhi, India: A hospital-based study","volume":"7","author":"Narang","year":"2014"},{"key":"b9","series-title":"J Trop Pediatr","first-page":"15","article-title":"Post-neonatal tetanus in a PICU of a developing economy: Intensive care needs, outcome and predictors of mortality","volume":"64","author":"Angurana","year":"2018"},{"key":"b10","series-title":"J Pediatr Intensive Care","first-page":"256","article-title":"Clinical profile and outcome of pediatric tetanus at a tertiary care center","volume":"10","author":"Mondkar","year":"2021"},{"key":"b11","series-title":"Lancet","first-page":"1657","article-title":"Tetanus","volume":"393","author":"Yen","year":"2019"},{"key":"b12","series-title":"J Neurochem","first-page":"1244","article-title":"Tetanus and tetanus neurotoxin: From peripheral uptake to central nervous tissue targets","volume":"158","author":"Megighian","year":"2021"},{"key":"b13","series-title":"Natl Med J India","first-page":"209","article-title":"A randomized double-blind sham-controlled study of intrathecal human anti-tetanus immunoglobulin in the management of tetanus","volume":"11","author":"Agarwal","year":"1998"},{"key":"b14","series-title":"BMJ","first-page":"615","article-title":"Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrathecal or intramuscular route","volume":"328","author":"Miranda-Filho Dde","year":"2004"},{"key":"b15","series-title":"Trop Med Int Health","first-page":"1075","article-title":"Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: A meta-analysis","volume":"11","author":"Kabura","year":"2006"},{"key":"b16","series-title":"Sante","first-page":"125","article-title":"[Intrathecal therapy with 1500 UI of antitetanic serum and 1.5 g of intravenous metronidazole: Prognosis of tetanus in hospitalized patients in Togo]","volume":"18","author":"Wateba","year":"2008"},{"key":"b17","series-title":"Trop Med Int Health","first-page":"555","article-title":"Incremental costs of treating tetanus with intrathecal antitetanus immunoglobulin","volume":"18","author":"Miranda-Filho","year":"2013"},{"key":"b18","series-title":"Lancet Glob Health","first-page":"e862","article-title":"Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: A 2 x 2 factorial randomised controlled trial","volume":"10","author":"Van Hao","year":"2022"},{"key":"b19","series-title":"Indian J Crit Care Med","first-page":"S155","article-title":"Intensive care management of severe tetanus","volume":"25","author":"Karnad","year":"2021"},{"key":"b20","series-title":"Crit Care","first-page":"R204","article-title":"Acute renal failure \u2013 Definition, outcome measures, animal models, fluid therapy and information technology needs","volume":"8","author":"Bellomo","year":"2004"},{"key":"b21","series-title":"Kidney Int","first-page":"1028","article-title":"Modified RIFLE criteria in critically ill children with acute kidney injury","volume":"71","author":"Akcan-Arikan","year":"2007"},{"key":"b22","series-title":"Nephron Clin Pract","first-page":"c179","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012"},{"key":"b23","series-title":"Am J Infect Control","first-page":"309","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008"}],"container-title":["The American Journal of Tropical Medicine and 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