<ul><li>Tetanus and Tetanus Toxoid </li></ul>Epidemiology and Prevention of Vaccine-Preventable Diseases National Immuniza...
Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at...
Tetanus <ul><li>First described by Hippocrates </li></ul><ul><li>Etiology discovered in 1884 by Carle and Rattone </li></u...
Clostridium tetani <ul><li>Anaerobic gram-positive, spore-forming bacteria </li></ul><ul><li>Spores found in soil, dust, a...
Tetanus Pathogenesis <ul><li>Anaerobic conditions allow germination of spores and production of toxins </li></ul><ul><li>T...
Tetanus Clinical Features <ul><li>Incubation period; 8 days  (range, 3-21 days) </li></ul><ul><li>Three clinical forms: Lo...
Neonatal Tetanus <ul><li>Generalized tetanus in newborn infant </li></ul><ul><li>Infant born without protective passive im...
Tetanus Complications <ul><li>Laryngospasm </li></ul><ul><li>Fractures </li></ul><ul><li>Hypertension </li></ul><ul><li>No...
Tetanus Wound Management * Yes, if >10 years since last dose ** Yes, if >5 years since last dose Vaccination History Unkno...
Tetanus Epidemiology <ul><li>Reservoir Soil and intestine of      animals and humans </li></ul><ul><li>Transmission   Cont...
Tetanus—United States, 1947-2002
Tetanus—United States, 1980-2002
Tetanus—United States, 1980-2002 Age Distribution
Age Distribution of  Reported Tetanus Cases,  1991-1995 and 1996-2000
Tetanus—1998-2000 Injuries and Conditions Data available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12
DTaP, DT, and Td DTaP, DT Td (adult) Diphtheria 7-8 Lf units 2 Lf units Tetanus 5-12.5 Lf units 5 Lf units Pertussis vacci...
Tetanus Toxoid <ul><li>Formalin-inactivated tetanus toxin </li></ul><ul><li>Schedule Three or four doses + booster Booster...
Routine DTaP Primary Vaccination Schedule Dose Primary 1 Primary 2 Primary 3 Primary 4 Age 2 months 4 months 6 months 15-1...
Children Who Receive DT <ul><li>The number of doses of DT needed  to complete the series depends on the child’s age at the...
Routine DTaP Schedule Children <7 years of age <ul><li>4-6 years, before entering school </li></ul><ul><li>11-12 years of ...
Routine Td Schedule Unvaccinated Persons  > 7 Years of Age Booster dose every 10 years Dose Primary 1 Primary 2 Primary 3 ...
Diphtheria and Tetanus Toxoids Adverse Reactions <ul><li>Local reactions (erythema, induration) </li></ul><ul><li>Exaggera...
Diphtheria and Tetanus Toxoids Contraindications and Precautions <ul><li>Severe allergic reaction to vaccine component or ...
National Immunization Program <ul><li>Hotline 800.232.2522 </li></ul><ul><li>Email [email_address] </li></ul><ul><li>Websi...
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Tetanus8p

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  • 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.
  • 1995-1997 is the most recent summary of tetanus cases reported in the U.S.
  • Recommendation from the 1991 DTP ACIP statement
  • Tetanus8p

    1. 1. <ul><li>Tetanus and Tetanus Toxoid </li></ul>Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised December 2004
    2. 2. Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp
    3. 3. Tetanus <ul><li>First described by Hippocrates </li></ul><ul><li>Etiology discovered in 1884 by Carle and Rattone </li></ul><ul><li>Passive immunity used for treatment and prophylaxis during World War I </li></ul><ul><li>Tetanus toxoid first widely used during World War II </li></ul>
    4. 4. Clostridium tetani <ul><li>Anaerobic gram-positive, spore-forming bacteria </li></ul><ul><li>Spores found in soil, dust, animal feces; may persist for months to years </li></ul><ul><li>Multiple toxins produced with growth of bacteria </li></ul><ul><li>Tetanospasmin estimated human lethal dose = 2.5 ng/kg </li></ul>
    5. 5. Tetanus Pathogenesis <ul><li>Anaerobic conditions allow germination of spores and production of toxins </li></ul><ul><li>Toxin binds in central nervous system </li></ul><ul><li>Interferes with neurotransmitter release to block inhibitor impulses </li></ul><ul><li>Leads to unopposed muscle contraction and spasm </li></ul>
    6. 6. Tetanus Clinical Features <ul><li>Incubation period; 8 days (range, 3-21 days) </li></ul><ul><li>Three clinical forms: Local (not common), cephalic (rare), generalized (most common) </li></ul><ul><li>Generalized tetanus: descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms </li></ul><ul><li>Spasms continue for 3-4 weeks; complete recovery may take months </li></ul>
    7. 7. Neonatal Tetanus <ul><li>Generalized tetanus in newborn infant </li></ul><ul><li>Infant born without protective passive immunity </li></ul><ul><li>High fatality rate without therapy </li></ul><ul><li>Estimated >215,000 deaths worldwide in 1998 </li></ul>
    8. 8. Tetanus Complications <ul><li>Laryngospasm </li></ul><ul><li>Fractures </li></ul><ul><li>Hypertension </li></ul><ul><li>Nosocomial infections </li></ul><ul><li>Pulmonary embolism </li></ul><ul><li>Aspiration </li></ul><ul><li>Death </li></ul>
    9. 9. Tetanus Wound Management * Yes, if >10 years since last dose ** Yes, if >5 years since last dose Vaccination History Unknown or <3 doses 3+ doses Td TIG Yes No No* No Td TIG Yes Yes No** No Clean, minor wounds All other wounds
    10. 10. Tetanus Epidemiology <ul><li>Reservoir Soil and intestine of animals and humans </li></ul><ul><li>Transmission Contaminated wounds Tissue injury </li></ul><ul><li>Temporal pattern Peak in summer or wet season </li></ul><ul><li>Communicability Not contagious </li></ul>
    11. 11. Tetanus—United States, 1947-2002
    12. 12. Tetanus—United States, 1980-2002
    13. 13. Tetanus—United States, 1980-2002 Age Distribution
    14. 14. Age Distribution of Reported Tetanus Cases, 1991-1995 and 1996-2000
    15. 15. Tetanus—1998-2000 Injuries and Conditions Data available for 129 of 130 reported cases. Source: MMWR 2003;52(SS-3):1-12
    16. 16. DTaP, DT, and Td DTaP, DT Td (adult) Diphtheria 7-8 Lf units 2 Lf units Tetanus 5-12.5 Lf units 5 Lf units Pertussis vaccine and pediatric DT used through age 6 years. Adult Td for children 7 years of age and older.
    17. 17. Tetanus Toxoid <ul><li>Formalin-inactivated tetanus toxin </li></ul><ul><li>Schedule Three or four doses + booster Booster every 10 years </li></ul><ul><li>Efficacy Approximately 100% </li></ul><ul><li>Duration Approximately 10 years </li></ul><ul><li>Should be administered with diphtheria toxoid as DTaP, DT, or Td </li></ul>
    18. 18. Routine DTaP Primary Vaccination Schedule Dose Primary 1 Primary 2 Primary 3 Primary 4 Age 2 months 4 months 6 months 15-18 months Interval --- 4 wks 4 wks 6 mos
    19. 19. Children Who Receive DT <ul><li>The number of doses of DT needed to complete the series depends on the child’s age at the first dose: </li></ul><ul><ul><li>if first dose given at <12 months of age, 4 doses are recommended </li></ul></ul><ul><ul><li>if first dose given at >12 months, 3 doses complete the primary series </li></ul></ul>
    20. 20. Routine DTaP Schedule Children <7 years of age <ul><li>4-6 years, before entering school </li></ul><ul><li>11-12 years of age if 5 years since last dose (Td) </li></ul><ul><li>Every 10 years thereafter (Td) </li></ul>Booster Doses
    21. 21. Routine Td Schedule Unvaccinated Persons > 7 Years of Age Booster dose every 10 years Dose Primary 1 Primary 2 Primary 3 Interval --- 4 wks 6-12 mos
    22. 22. Diphtheria and Tetanus Toxoids Adverse Reactions <ul><li>Local reactions (erythema, induration) </li></ul><ul><li>Exaggerated local reactions (Arthus-type) </li></ul><ul><li>Fever and systemic symptoms not common </li></ul><ul><li>Severe systemic reactions rare </li></ul>
    23. 23. Diphtheria and Tetanus Toxoids Contraindications and Precautions <ul><li>Severe allergic reaction to vaccine component or following prior dose </li></ul><ul><li>Moderate or severe acute illness </li></ul>
    24. 24. National Immunization Program <ul><li>Hotline 800.232.2522 </li></ul><ul><li>Email [email_address] </li></ul><ul><li>Website www.cdc.gov/nip </li></ul>

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