Vaccine Preventable Diseases – Tetanus

Vaccinations seem to cause some controversies in the United States whenever it is the moral / ethical / political issues surrounding Gardasil or the alleged link between childhood vaccines and autism. Although one thing is clear, vaccinations have made some of the most common and devastating diseases non-existent in this country. In my opinion, vaccinations are the most successful use of immunological principles to human health worldwide.

Vaccinations in simple terms are to introduce various antigenic materials, depending on the vaccine, to produce an immune response or antibodies in human or animals.

One of the great successes in disease prevention is the tetanus toxoid. Because of widespread corruption in the US, there are less than 100 cases of tetanus reported annually.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, Clostridium tetani. This spores of this organism is very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail, however the rust has nothing to do with tetanus. At this point the spores germinate into the bacteria which multiply and produce toxin.

A form of tetanus found in newborns called neonatal tetanus occurs in infants born without protective passive immunity, because the mother is not immune. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. Although rare in this country, it causes about a quarter of a million deaths worldwide.

Depending on the amount of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3-4 weeks. The typical features of a tetanus spasm are the position of opisthotonos and the facial expressions known as "risus sardonicus". The death rate for this disease ranges from 10-80% depending on age and quality of care.

There are really no laboratory finds that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriological confirmation.

This disease in not transmitted from person to person.

The prevention of tetanus is through immunization. The Advisory Committee on Immunization Practices (ACIP) recommends 5 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for infants and children. One dose of DTaP vaccine is recommended at each of the following ages: 2 months, 4 months, 6 months, 15-18 months, and 4-6 years old. DTaP vaccine may be given at the same time as other vaccines. A booster shot of Tdap (an adult formulation) is recommended at ages 11-18 years. And then again boost at least every 10 years.

Even if you had tetanus and recovered, this potent toxin produces no immunity and the primary immunizations are indicated after recovery to prevent a second infection.