Tetanus

Tetanus is an acute infectious disease caused by exposure to the spores of the bacterium, Clostridium tetani, that exists worldwide in the soil and in animal intestinal tracts and excrements.

Tetanus is a non-communicable disease, i.e. it does not spread from person to person. The spores of the bacterium enter the body through contaminated skin wounds or deep tissue injuries. Neurotoxins produced under anaerobic conditions (e.g. devitalized or necrotic tissue) in deep wounds contaminated with the bacterial spores lead to tetanus. The most important toxin of Clostridium tetani is tetanospasmin [2]. This toxin blocks inhibitory neurotransmitters in the central nervous system and causes the muscular rigidity and spasms typical of generalized tetanus. Symptoms can include [3]:

• jaw cramping or the inability to open the mouth (trismus, lockjaw)
• muscle spasms often in the back, abdomen and extremities (ophistotonus)
• sudden painful muscle spasms often triggered by sudden noises
• trouble swallowing
• seizures
• headache
• fever and sweating
• changes in blood pressure or fast heart rate (tachycardia).

The incubation period of tetanus varies between 3 to 21 days after infection [1,2].

Tetanus can affect persons of all ages [4].

Treatment of tetanus include timely administration of human tetanus immune globulin, antibiotics and supportive care.

The disease may occur at any age and case-fatality rates are high even where intensive care is available. In the absence of medical intervention, the case-fatality rate approaches 100% [5]. Tetanus cannot be fully eradicated because the Clostridium tetani exists throughout the environment in soil and the feces of many different animals [1,2].

There is no naturally-acquired immunity to tetanus. Immunity to tetanus can be acquired only by active (vaccination) or passive immunization (immunoglobulin administration). The disease remains an important public health problem in many parts of the world where immunization programmes are suboptimal, particularly in the least developed districts of low income countries.

The majority of reported tetanus cases are birth-associated (neonatal tetanus), occurring in low income countries among insufficiently vaccinated mothers and their newborn infants, following unhygienic deliveries and abortions, and poor postnatal hygiene and umbilical cord care practices. Neonatal tetanus occurs when non-sterile instruments are used to cut the umbilical cord or when contaminated material (mud) is used to cover the umbilical stump. Deliveries carried out by persons with uncleansed hands or on a contaminated surface are also risk factors [4] In countries that have reduced the burden of maternal and neonatal tetanus through vaccination, a considerable proportion of tetanus cases continue to occur following injuries in children and adults [2].

For more details, please see WHO disease description for Tetanus.