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05 tetanus7p
Tetanus is caused by Clostridium tetani bacteria which produces a toxin. The bacteria spores can be found in soil and animal feces and enter the body through wounds. The toxin causes painful muscle spasms by blocking neurotransmitter release in the central nervous system. Tetanus is prevented through routine vaccination with tetanus toxoid which is administered as part of the DTaP, Td, or Tdap vaccines in a primary series and booster shots. The vaccine is highly effective at preventing tetanus if protection is maintained through regular booster doses.
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05 tetanus7p
- 1. Tetanus and TetanusToxoid Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised March 2002
- 2. Tetanus • Firstdescribed by Hippocrates • Etiology discovered in 1884 by Carle and 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 = 150 ng
- 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 270,000 deaths worldwide in 1998
- 7. Tetanus Complications •Laryngospasm • Fractures • Hypertension • Nosocomial infections • Pulmonary embolism • Aspiration • Death
- 8. Tetanus Wound Management Vaccination History Unknown or <3 doses 3+ doses Td TIG Yes No No* No Td TIG Yes Yes No** No Clean, minor wounds All other wounds * 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 - UnitedStates, 1947-2001* 700 600 500 400 300 200 100 0 1950 1960 1970 1980 1990 2000 Cases *2001 provisional data
- 11. Tetanus - UnitedStates, 1980-2001* 100 90 80 70 60 50 40 30 20 10 0 1980 1985 1990 1995 2000 Cases *2001 provisional data
- 12. 1000 900 800 700 600 500 400 300 200 100 0 <5 5-14 15-24 25-39 40+ Age group (yrs) Cases Tetanus – United States, 1980-2000 Age Distribution
- 13. Age Distribution ofReported Tetanus Cases, 1991-1995 and 1996-2000 1991-1995 1996-2000 Cases of Percent 28 Age group (yrs) 72 42 58 80 70 60 50 40 30 20 10 0 <40 40+
- 14. Tetanus - 1995-1997 Injuries and Conditions Puncture 37% Laceration 17% IDU 18% Abrasion 9% Unknown Diabetes 3% 6% Surgery 3% Chr wound 7% Data available for 120 of 124 reported cases
- 15. DTaP, DT, andTd DTaP, DT Td (adult) Diphtheria 7-8 Lf units 2 Lf units Tetanus 5-12.5 Lf units 5 Lf units Pertussis vaccine and pediatric DT used through age 6 years. Adult Td used for persons 7 years and older.
- 16. 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
- 17. 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
- 18. Children Who ReceiveDT • The number of doses of DT needed to complete the series depends on the child’s age at the first dose: –if first dose given at <12 months of age, 4 doses are recommended –if first dose given at >12 months, 3 doses complete the primary series
- 19. Routine DTaP Schedule Children <7 years of age Booster Doses • 4-6 years, before entering school • 11-12 years of age if 5 years since last dose (Td) • Every 10 years thereafter (Td)
- 20. Routine Td Schedule Persons >7 years of age Dose Primary 1 Primary 2 Primary 3 Interval --- 4 wks 6-12 mos Booster dose every 10 years
- 21. Diphtheria and TetanusToxoids Adverse Reactions • Local reactions (erythema, induration) • Exaggerated local reactions reactions (Arthus-type) • Fever and systemic symptoms uncommon • Severe systemic reactions rare
- 22. Diphtheria and TetanusToxoids Contraindications and Precautions • Severe allergic reaction to vaccine component or following prior dose • Moderate to severe acute illness
- 23. National Immunization Program •Hotline 800.232.2522 •Email [email protected] •Website www.cdc.gov/nip
Editor's Notes
- #14Â The age distribution of reported tetanus cases shifted to a younger age group in 1995-1997, due primarily to the contribution cases in California. Many of these cases were young Hispanic men who developed tetanus as a result of injection drug use, particularly heroin.
- #15Â 1995-1997 is the most recent summary of tetanus cases reported in the U.S.
- #19Â Recommendation from the 1991 DTP ACIP statement