Tetanus and Tetanus ToxoidEpidemiology and Prevention of Vaccine-Preventable Diseases

National Immunization ProgramCenters for Disease Control and PreventionRevised January 2006

Note to presenters:

Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

TetanusFirst described by HippocratesEtiology discovered in 1884 by Carle and RattonePassive immunization used for treatment and prophylaxis during World War ITetanus toxoid first widely used during World War II

Clostridium tetaniAnaerobic gram-positive, spore-forming bacteriaSpores found in soil, animal feces; may persist for months to yearsMultiple toxins produced with growth of bacteriaTetanospasmin estimated human lethal dose = 2.5 ng/kg

Tetanus PathogenesisAnaerobic conditions allow germination of spores and production of toxinsToxin binds in central nervous systemInterferes with neurotransmitter release to block inhibitor impulsesLeads to unopposed muscle contraction and spasm

Tetanus Clinical FeaturesIncubation 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, spasmsSpasms continue for 3-4 weeks; complete recovery may take months

Neonatal TetanusGeneralized tetanus in newborn infantInfant born without protective passive immunityEstimated >215,000 deaths worldwide in 1998

Tetanus ComplicationsLaryngospasmFracturesHypertensionNosocomial infectionsPulmonary embolismAspiration pneumoniaDeath

Tetanus Wound Management* Yes, if >10 years since last dose** Yes, if >5 years since last dose

Tetanus EpidemiologyReservoirSoil and intestine of animals and humans Transmission Contaminated wounds Tissue injury

Temporal pattern Peak in summer or wet season

CommunicabilityNot contagious

Tetanus1998-2000Injuries and ConditionsData available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12

Tetanus ToxoidFormalin-inactivated tetanus toxinScheduleThree or four doses + booster Booster every 10 yearsEfficacyApproximately 100%DurationApproximately 10 yearsShould be administered with diphtheria toxoid as DTaP, DT, Td, or Tdap

Routine DTaP Primary Vaccination Schedule

Children Who Receive DTThe number of doses of DT needed to complete the series depends on the childs age at the first dose:if first dose given at

Routine DTaP ScheduleChildren

Diphtheria and Tetanus ToxoidsAdverse ReactionsLocal reactions (erythema, induration)Exaggerated local reactions (Arthus-type)Fever and systemic symptoms not commonSevere systemic reactions rare

Diphtheria and Tetanus ToxoidsContraindications and PrecautionsSevere allergic reaction to vaccine component or following a prior doseModerate or severe acute illness

1995-1997 is the most recent summary of tetanus cases reported in the U.S.Recommendation from the 1991 DTP ACIP statement