These usually begin near the site of injury and often become generalised. Tetanus may occur after a trivial or inapparent injury. Case fatality rate is 30 to 90 per cent, varying inversely with the incubation period. It is a clinically compatible illness without other apparent cause, with or without a history of injury, and with or without laboratory evidence of the organism or its toxin. Public Health Significance and Occurrence Tetanus is now rare in this community and usually reflects waning immunity in the elderly.
Occurrence is worldwide.
Nosocomial cases have been described and may be a particular risk in setting peripheral vascular disease in the elderly. Neonatal tetanus is common in developing countries, but is extremely rare in Australia. Method of Diagnosis Attempts at laboratory confirmation are of little help. The organism is often not recovered from the site of infection and usually there is no detectable antibody response. Reservoir C. tetani is widely distributed in cultivated soil and in the gut of humans and animals.