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Tetanus and Tetanus Toxoid

Tetanus and Tetanus Toxoid. Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention. Dr Esteghamati EPI Manager. Tetanus. First described by Hippocrates Etiology discovered in 1884 by Carle and Rattone

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Tetanus and Tetanus Toxoid

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  1. Tetanus and Tetanus Toxoid Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Dr Esteghamati EPI Manager

  2. Tetanus • First described by Hippocrates • Etiology discovered in 1884 by Carleand Rattone • Passive immunity used for treatment and prophylaxis during World War I • Tetanus toxoid first widely used during World War II

  3. Clostridium tetani • Anaerobic gram-positive, spore-forming bacteria • Spores found in soil, dust, animal feces; may persist for months to years • Multiple toxins produced with growth of bacteria • Tetanospasmin estimated human lethal dose = 2.5 ng/kg

  4. 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. • Leads to unopposed muscle contraction and spasm.

  5. Tetanus Clinical Features • Incubation period 8 days (range, 3-21 days) • Three clinical forms: Local (uncommon), 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

  6. Neonatal Tetanus • Generalized tetanus in newborn infant • Infant born without protective passive immunity • High fatality rate without therapy • Estimated 215,000 deaths worldwide in 1998

  7. Tetanus Complications • Laryngospasm • Fractures • Hypertension • Nosocomial infections • Pulmonary embolism • Aspiration • Death

  8. Clean, minor wounds All other wounds Vaccination History Unknown or <3 doses 3+ doses Td TIG Yes No No* No Td TIG Yes Yes No** No Tetanus Wound Management * Yes, if >10 years since last dose ** Yes, if >5 years since last dose

  9. Tetanus Epidemiology • Reservoir Soil and intestine of animals and humans • Transmission Contaminated wounds Tissue injury • Temporal pattern Peak in summer or wet season • Communicability Not contagious

  10. Tetanus – United States, 1980-2002 Age Distribution

  11. Tetanus - 1998-2000 Injuries and Conditions Data available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12

  12. 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, or Td

  13. Neonatal tetanus • Suspected case: Any neonatal death between 3 and 28 days of age in which the cause of death is unknown or Any neonate reported as having suffered from neonatal tetanus between 3 and 28 day of age and not to be investigated

  14. Confirmed • Any neonate with normal ability to suck and cry during the first 2 days of life and -who, between 3 and 28 days can not suck normally and become stiff or has spasm

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