Epidemiology of Tetanus

1. Prepared By
Mrs. Namita Batra Guin
Associate Professor

2. Acute disease
Caused by Clostridium tetani
Characterized by muscular rigidity, painful
paroxysmal spasms of voluntary muscles,
especially masseters trismus- lock jaw,
facial muscles- risus sardonicus and
muscles of back and neck(opisthotonus)
Mortality is very high.

3. Comparatively rare disease in developed
countries.
Neonatal tetanus is a killer disease
Tends to occur in areas with poor access
to health care.
Total no. of deaths caused by tetanus
world wide in year 2002 was 2,13,000 in
which neonatal tetanus was estimated to
be 1,80,000.

4.  Important endemic infection in India.
 Factors leading to disease are: hand washing,
delivery practices, traditional birth customs and
interest in immunization.
 70,000 cases continue to occur in U.P, M.P,
Rajasthan, Orissa, Bihar and Assam.
 Districts are divided into 3 categories depending
upon the NT incidence rates, immunization
coverage levels in pregnant women and proportion
of clean deliveries by trained personnels

5.  AGENT FACTORS:
• Agent: C. tetani, gram positive, spore bearing,
anerobic. They produce potent exotoxin-
“tetanospasmin”
• Reservoir of infection: natural habitat is soil and dust.
Intestine of many herbivore animals.
• Exotoxin: produce soluble toxin. Lethal in nature. Toxin
acts in 4 areas of nervous system- motor end plates,
spinal cord, brain and sympathetic system.
• Period of communicability: none. Not transmitted from
person to person.

7. HOST FACTORS:
• Age: disease of active age, neonates.
• Sex: higher in males but females are more
exposed to risk of tetanus. Males are more
sensitive to toxin.
• Occupation: agriculture
• Rural- urban difference: incidence is lower in
urban.
• Immunity: no age protected unless protected by
immunization. Herd immunity doesn’t protect the
individual.

8. ENVIRONMENTAL AND SOCIAL
FACTORS:
• Soil, agriculture, animal husbandry and
surroundings.
• Unhygienic customs and habits, unhygienic
delivery practices
• Ignorance of infection and lack of primary health
care.

9. By contamination of wounds with spores.
Injuries like: pin prick, skin abrasion,
puncture wounds, burns, stings, unsterile
surgery etc.
Sequence of events: introduction of
spores, germination and elaboration of the
exotoxin and binding to the receptor.
INCUBATION PERIOD: 6 to 10 days

10.  TRAUMATIC: major important cause of tetanus.
 PUERPERAL: tetanus follows abortion.
 OTOGENIC: ear may be a portal entry. It is a
pediatric problem.
 IDIOPATHIC: no definite history
 TETANUS NEONATORUM:common infection of
the umbilical stump after birth. First symptom may
be seen at 7th day. Also known as 8th day disease
in Punjab.

12. Active immunization: aim is to prevent
community and ensure a protective level of
antitoxin.
Two preparations:
• Combined vaccine: DPT
• Monovalent : plain toxoid, tetanus vaccine

13.  Combined vaccine: primary course consists 3
doses starting at 6weeks, followed by the
booster dose at 18weeks and second booster
at 5-6 years, 3rd booster dose after 10 years.
 Monovalent vaccine:adsorbed tetanus toxoid
stimulate higher and long lasting immunity.
Primary course consists of two doses TT
adsorbed at interval of 1-2months. TT must
not be allowed to freeze at any time.

14. Passive immunization:
• Human tetanus hyperimmunoglobulin: best
prophylactic. Dosage- 250-500 IU. It gives a
longer passive protection upto 30days.
• ATS (equine): anti-tetanus serum. . Standard
dose-1500 Injected S/C after sensitivity testing.

15. Antibiotics: single dose of 1.2 megaunits of
long acting penicillin, I.M. Penicillin has no
effects on tetanus spores. For Penicillin
sensitive patients erythromycin 500mg 6
hourly orally.
Antibiotic alone is ineffcetive in prevention
of tetanus, it is not substitute to
immunization.

16.  Through clean delivery practices- 3 clean-
clean hands, clean delivery surface and clean
cord care i.e. clean blade, clean tie and no
application on the cord.
 Two doses of TT to pregnant women.
 No women should be denied even one dose
of tetanus toxoid if she is late in pregnancy.
 Infant born to unimmunized mother- antitoxin-
heterologous serum 750IU within 6 hrs of
birth.

17. All wounds must be thoroughly cleaned-
this will abolish the anaerobic conditions in
the wound.
If ATS is given- adrenaline 1 in 1000 for IM
injection in dose of 0.5 to 1ml and
hydrocortisone 100mg for I.V. for
anaphylactoid reaction.

18. TETANUS MAY
OCCUR INSPITE OF
ACTIVE OR PASSIVE
IMMUNIZATION OR
BOTH.