Tetanus results from contamination of wounds with the spore-forming bacterium Clostridium tetani. The bacterium produces tetanospasmin (tetanus toxoid, TT), a neurotoxin that causes muscle spasm and contraction, with the characteristic fixed smile, locked jaw and arching back, and sudden, generalized seizures.
Muscle spasm and contraction, with the characteristic fixed smile, locked jaw and arching back, and sudden, generalized seizures
The infectious agent is the bacterium C. tetani.
Mode of transmission
Infection occurs when C. tetani spores – found worldwide in soil and in the gastro- intestinal tracts of animals (including humans) – are introduced into the body through any type of wound (open wounds, puncture wounds or surgical sites) via soil or objects contaminated with animal or human faeces. Cases have followed wounds considered too trivial for medical attention.
Neonatal tetanus usually occurs through the introduction of spores via the umbili- cal cord (e.g. through use of a contaminated instrument to cut the umbilical cord during delivery, or through the application of contaminated materials to the umbilical stump after delivery).
Immunization is the best means of prevention; strategies include:
- Education of public on the necessity of immunization
- universal active immunization with TT (or vaccines containing TT)
- a full primary course of TT plus tetanus immunoglobulin (if available) for tetanus-prone wounds such as puncture, missile, burn and sepsis wounds; those contaminated with soil or manure; and any wound more than 6 hours old
Prevention of maternal and neonatal tetanus requires maternal immunization with TT and use of hygienic delivery practices (e.g. assistance by a trained attend- ant, delivery in a clean health facility and modification of harmful traditional practices).
- WHO vaccine-preventable diseases monitoring system. Geneva, World Health Organization, 2010 (http://www.who.int/vaccines/globalsummary/immunization/countryprofileselect.cfm, accessed 9 August 2010).
- Guidelines on immunization against tetanus. Sri Lanka, Ministry of Healthcare and Nutrition, no date (http://www.epid.gov.lk/pdf/Circulars/2010-06-07/TETANUS%20CIRCULAR.pdf, accessed 9 August 2010).
Prevention and management of wound infection. Geneva, WHO, 2010 (http://www.who.int/ hac/techguidance/tools/manuals/en/index.html, accessed 11 August 2010).