TETANUS
DR. TAHIR HUSSAIN KANHAR
Tetanus and Tetanus Toxoid
Epidemiology and Prevention of VaccinePreventable Diseases
National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention
Revised May 2009
Note to presenters:
Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at [Link]
Tetanus
First described by Hippocrates Etiology discovered in 1884 by Carle and
Rattone Passive immunization used for treatment and prophylaxis during World War I Tetanus toxoid first widely used during World War II
Clostridium tetani
Anaerobic gram-positive, spore-forming
bacteria Spores found in soil, animal feces; may persist for months to years Multiple toxins produced with growth of bacteria Tetanospasmin estimated human lethal dose = 2.5 ng/kg
Tetanus Pathogenesis
Anaerobic conditions allow germination
of spores and production of toxins
Toxin binds in central nervous system Interferes with neurotransmitter release
to block inhibitor impulses and spasm
Leads to unopposed muscle contraction
Tetanus Clinical Features
Incubation period; 8 days
(range, 3-21 days) Three clinical forms: local (not common), cephalic (rare), generalized (most common) Generalized tetanus: descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms Spasms continue for 3-4 weeks Complete recovery may take months
Neonatal Tetanus
Generalized tetanus in newborn infant Infant born without protective passive
immunity Estimated more than 250,000 deaths worldwide in 2000-2003*
*[Link]/immunization_monitoring/diseases/neonatal_tetanus/en/[Link]
Tetanus Complications
Laryngospasm Fractures Hypertension Nosocomial infections Pulmonary embolism Aspiration pneumonia Death
Tetanus Wound Management
Clean, minor wounds All other wounds
Vaccination History Unknown or less than 3 doses 3 or more doses
Td* Yes No+
TIG No No
Td* Yes
TIG Yes
No** No
* Tdap may be substituted for Td if the person has not previously received Tdap and is 10 years or older + Yes, if more than 10 years since last dose ** Yes, if more than 5 years since last dose
Tetanus Epidemiology
Reservoir Transmission Temporal pattern Communicability
Soil and intestine of animals and humans Contaminated wounds Tissue injury Peak in summer or wet season Not contagious
TetanusUnited States, 1947-2007
700 600 500
Cases
400 300 200 100 0
1950 1960 1970
Year
1980
1990
2000
*2005 provisional total
TetanusUnited States, 1980-2007
100 90 80 70 60 50 40 30 20 10 0
1980 1985 1990 1995
Year
Cases
2000
*2005 provisional total
TetanusUnited States, 1980-2003 Age Distribution
1000 900 800 700 600 500 400 300 200 100 0 <5 5-14 15-24 25-39 40+
Cases
Age group (yrs)
N=1,277
Age Distribution of Reported Tetanus Cases, 1991-1995 and 1996-2000
1991-1995
80 70 60 50 40 30 20 10 0
1996-2000
72 58
Percent of Cases
42 28
<40
40+
Age group (yrs)
Tetanus1998-2000 Injuries and Conditions Other
17% Puncture 37% Chr wound 11%
IDU 5% Abrasion 6%
Laceration 24%
Data available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12
DTaP, DT, and Td
DTaP, DT Td, Tdap (adult) Diphtheria 7-8 Lf units 2-2.5 Lf units Tetanus 5-12.5 Lf units 5 Lf units
DTaP and pediatric DT used through age 6 years. Adult Td for persons 7 years and older. Tdap for persons 10 through 64 years (Boostrix) or 11 through 64 years (Adacel)
Tetanus Toxoid
Formalin-inactivated tetanus toxin Schedule Three or four doses + booster
Booster every 10 years
Efficacy Approximately 100%
Duration Approximately 10 years Should be administered with diphtheria toxoid as
DTaP, DT, Td, or Tdap
Routine DTaP Primary Vaccination Schedule
Dose
Primary 1 Primary 2 Primary 3 Primary 4
Age
2 months 4 months 6 months 15-18 months
Interval
--4 wks 4 wks 6 mos
Children Who Receive DT
The number of doses of DT needed to
complete the series depends on the childs age at the first dose:
if first dose given at younger than 12 months of age, 4 doses are recommended if first dose given at 12 months or older, 3 doses complete the primary series
Routine DTaP Schedule for Children Younger Than 7 Years of Age
Booster Doses
4 through 6 years of age, before entering
school 11 or 12 years of age if 5 years since last dose (Tdap) Every 10 years thereafter (Td)
Routine Td Schedule for Unvaccinated Persons 7 Years of Age and Older
Dose* Primary 1 Primary 2 Primary 3
Interval --4 wks 6 to 12 mos
Booster dose every 10 years
*For children 10 years of age and older ACIP recommends that one of these doses (preferably the first) be administered as Tdap
Diphtheria and Tetanus Toxoids Adverse Reactions
Local reactions (erythema, induration) Exaggerated local reactions (Arthustype) Fever and systemic symptoms not common Severe systemic reactions rare
Diphtheria and Tetanus Toxoids Contraindications and Precautions
Severe allergic reaction to vaccine
component or following a prior dose Moderate or severe acute illness
CDC Vaccines and Immunization
Contact Information
Telephone
[Link] nipinfo@[Link]
Email
Website [Link]/vaccines