Notes from the field: Obstetric tetanus in can unvacinated woman after a home birth delivery — Kentucky, 2016

On July 11, 2016, state and local health departments in Kentucky were notified of a case of obstetric tetanus in an unvaccinated woman. Obstetric tetanus, which occurs during pregnancy or within 6 weeks of the end of pregnancy, follows contamination of wounds with Clostridium tetani spores during pregnancy, or the use of contaminated tools or practices during nonsterile deliveries or abortions. CDC did not identify any cases of obstetric tetanus in the United States during 1972–2008 (1,2). State and local health departments in Kentucky investigated this case to identify risk factors and provide recommendations.

The patient, a woman aged 30 years, is a member of an Amish community. In late June, she delivered a child at home, assisted by an unlicensed community childbirth assistant. She had never received a vaccination for tetanus. Delivery was complicated by breech presentation, but no birth trauma, unsterile conditions, or other complications were reported. Nine days postpartum, the patient experienced facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing. She was admitted to the hospital where a clinical diagnosis of tetanus was made, and 6,000 international units of tetanus immunoglobulin were administered intramuscularly. Endotracheal intubation and mechanical ventilation were required. Her hospital course was complicated by seizures and a need for prolonged respiratory support. After approximately a month, the patient was stable and discharged home.