# Presentation: 909163

## Tetanus and Tetanus Toxoid

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Center for Immunization and Respiratory Diseases**
**Centers for Disease Control and Prevention**

**Revised March 2008**

## Note to presenters:

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

## Tetanus

**First described by Hippocrates**
**Etiology discovered in 1884 by Carle and Rattone**
**Passive immunization used for treatment and prophylaxis during World War I**
**Tetanus toxoid first widely used during World War II**

## Clostridium tetani

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

## 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**

## Tetanus Clinical Features

**Incubation 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, spasms**
**Spasms continue for 3-4 weeks**
**Complete recovery may take months**

## Neonatal Tetanus

**Generalized tetanus in newborn infant**
**Infant born without protective passive immunity**
**Estimated more than 250,000 deaths worldwide in 2000-2003***

***www.who.int/immunization_monitoring/diseases/neonatal_tetanus/en/index.html**

## Tetanus Complications

**Laryngospasm****	**
**Fractures****	****	****	****	**
**Hypertension**
**Nosocomial infections**
**Pulmonary embolism**
**Aspiration pneumonia**
**Death**

##  Tetanus Wound Management

*** Tdap may be substituted for Td if the person has not**
**   ****previously received Tdap and is 10 years or older**
**+ Yes, if more than 10 years since last dose**
**** Yes, if more than 5 years since last dose**

## 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**

## Tetanus—United States, 1947-2006

**Tetanus—United States, 1947-2006**

**Year**

## Tetanus—United States, 1980-2006

**Tetanus—United States, 1980-2006**

**Year**

## Tetanus—United States, 1980-2003Age Distribution

**Tetanus—United States, 1980-2003****Age Distribution**

**N=1,277**

## Age Distribution of Reported Tetanus Cases, 1991-1995 and 1996-2000

**Age Distribution of ****Reported Tetanus Cases, ****1991-1995 and 1996-2000**

**Notes:**
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.

## Tetanus—1998-2000Injuries and Conditions

**Tetanus—1998-2000****Injuries and Conditions**

**Data available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12**

**Notes:**
1995-1997 is the most recent summary of tetanus cases reported in the U.S.

## DTaP, DT, and Td

**DTaP, DT**
**Td, Tdap (adult)**

_**Diphtheria**_
**7-8 Lf units**
**2-2.5 Lf units**

_**Tetanus**_
**5-12.5 Lf units**
**5 Lf units**

**DTaP and pediatric DT used through age 6 years.  Adult Td for persons 7 years and older. Tdap for persons 10-18 years (Boostrix) or 11-64 years (Adacel)**

## 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, Td, or Tdap**

## Routine DTaP Primary Vaccination Schedule

## Children Who Receive DT

**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**

**Notes:**
Recommendation from the 1991 DTP ACIP statement

## Routine DTaP Schedule for Children  Younger Than 7 years of Age

**4-6 years of age, before entering school**
**11-12 years of age if 5 years since last dose (Tdap)**
**Every 10 years thereafter (Td)**

**Booster Doses**

## Routine Td Schedule for Unvaccinated Persons 7 Years of Age and Older

**Booster dose every 10 years**

***ACIP recommends that **_**one**_** of these doses (preferably the first) be administered as Tdap**

## Diphtheria and Tetanus ToxoidsAdverse Reactions

**Local reactions (erythema, induration)**
**Exaggerated local reactions (Arthus-type)**
**Fever and systemic symptoms not common**
**Severe systemic reactions rare**

## Diphtheria and Tetanus ToxoidsContraindications and Precautions

**Severe allergic reaction to vaccine component or following a prior dose**
**Moderate or severe acute illness**

## CDC Vaccines and ImmunizationContact Information  

**Telephone     800.CDC.INFO**** **
**Email****	****	****  nipinfo@cdc.gov**** **
**Website****	****  www.cdc.gov/vaccines**