PDF about tetanus & its vaccine storage, standardization, temperature, preparation.

1. TETANUS
Rakshitha sagar

2. What is Tetanus?
Tetanus is a serious disease caused by a
bacterial toxin that affects nervous system,
leading to painful muscle contractions,
particularly of jaw and neck muscles. Tetanus
can interfere with ability to breathe and can
threaten life. Tetanus is commonly known as
"lockjaw."

3. Clostridium tetani is a spore-forming anaerobic bacillus.
Spores are present in the environment, particularly in the soil of
warm and moist areas, and may be carried in the intestinal tracts of
humans and animals. Maternal tetanus is a consequence of unclean
delivery and poor postnatal hygiene when the umbilical cord
becomes infected. Tetanus in children and adults following injuries
may also constitute a considerable public health problem.
Under favorable anaerobic conditions, such as in dirty,
necrotic wounds, this ubiquitous bacillus may produce an extremely
potent neurotoxin which causes muscular stiffness and spasm.
Characteristically, early spasms of the facial muscles ("lockjaw") are
followed by spasm of the back muscles and sudden, generalized
tonic seizures and causes disease. Immunity to tetanus is antibody-
mediated and depends upon the ability of antitoxin antibodies to
neutralize tetanus toxin. Recovery from clinical tetanus does not
result in protection against future disease, and immunity can be
obtained only by active or passive immunization such as
vaccination, immunoglobulin therapy, or transfer of maternal
antibodies through the placenta

4. Symptoms
Signs and symptoms of tetanus appear anytime from a few days to
several weeks after tetanus bacteria enter our body through a wound. The
average incubation period is seven to 10 days.
Common signs and symptoms of tetanus include:
• Spasms and stiffness in jaw muscles (trismus)
• Stiffness of neck muscles
• Difficulty swallowing
• Stiffness of abdominal muscles
• Painful body spasms lasting for several minutes, typically triggered by
minor occurrences, such as a draft, loud noise, physical touch or light
• Possible other signs and symptoms include:
• Fever
• Sweating
• Elevated blood pressure
• Rapid heart rate

5. Causes
Tetanus is caused by a toxin made by spores of
bacteria, Clostridium tetani, found in soil, dust and
animal feces. When the spores enter a deep flesh
wound, they grow into bacteria that can produce a
powerful toxin, tetanospasmin. The toxin impairs the
nerves that control muscles (motor neurons). The toxin
can cause muscle stiffness and spasms — the major
signs and symptoms of tetanus.
Nearly all cases of tetanus occur in people who
have never been vaccinated or in adults who haven't
kept up with their 10-year booster shots. No one can't
catch tetanus from a person who has it.

6. Risk Factor
• The following increase likelihood of getting tetanus:
• Failure to get vaccinated or to keep up to date with booster shots against tetanus
• An injury that lets tetanus spores into the wound
• A foreign body, such as a nail or splinter
Tetanus cases have developed from the following:
• Puncture wounds — including from splinters, body piercings, tattoos and injection drugs
• Gunshot wounds
• Compound fractures
• Burns
• Surgical wounds
• Injection drug use
• Animal or insect bites
• Infected foot ulcers
• Dental infections
• Infected umbilical stumps in newborns born of inadequately vaccinated mothers

7. Complications
Once tetanus toxin has bonded to your nerve endings it is
impossible to remove. Complete recovery from a tetanus infection
requires new nerve endings to grow, which can take up to several
months.
Complications of tetanus infection may include:
• Broken bones. The severity of spasms may cause the spine and
other bones to break.
• Blockage of a lung artery (pulmonary embolism). A blood clot that
has traveled from elsewhere in your body can block the main artery
of the lung or one of its branches.
• Death. Severe tetanus-induced (tetanic) muscle spasms can
interfere with or stop your breathing. Respiratory failure is the most
common cause of death. Lack of oxygen may also induce cardiac
arrest and death. Pneumonia is another cause of death.

8. Prevention
One can easily prevent tetanus by being vaccinated.
• The primary vaccine series
• The tetanus vaccine usually is given to children as part of the
diphtheria and tetanus toxoids and a cellular pertussis (DTaP)
vaccine. This vaccination provides protection against three diseases:
a throat and respiratory infection (diphtheria), whooping cough
(pertussis) and tetanus.
• The DTaP vaccine is a series of five shots, typically given in the arm
or thigh to children at ages:
• 2 months
• 4 months
• 6 months
• 15 to 18 months
• 4 to 6 years

9. Tetanus Vaccine
Tetanus vaccine is also known as tetanus toxoid which is an
inactive vaccine used to prevent tetanus. Tetanus vaccines are
based on inactivated tetanus toxin. Toxigenic strains of C. tetani are
grown in liquid media, the toxin is purified, and then inactivated by
treatment with formaldehyde to produce the toxoid antigen. After
purification and sterilization, tetanus toxoid is formulated with
aluminum or calcium salts and administered by intramuscular
injection. On the international market, tetanus toxoid vaccine is
available as a single antigen vaccine (TT), in combination with
diphtheria toxoid in infant and adult doses (DT and Td), and in
combination with diphtheria and whole-cell or a cellular pertussis
(DTP). DTP-containing multi-antigen vaccines (with Hep B, Hib, or
IPV) are increasingly in use in national immunization campaigns.

10. Tetanus Vaccine Preparation
A process for the preparation of
tetanus toxoid, which process comprises
incubating purified tetanus toxin with 0.2 to
1% (v/v) formaldehyde in the presence of
0.005 to 0.25M lysine for from 24 to 32 days
at a pH of from 6.0 to 8.0 and a temperature
of from 30 to 45° C.

11. Standardization of Tetanus
The WHO requirements for the production
and quality control of tetanus toxoid vaccine were
originally formulated in 1964 and revised and
incorporated into recommendations for DTP in
1978. A major revision for the multi-antigen DTP
vaccine was undertaken in 1989. The 2003
amendment updated the recommendations on
potency testing to reduce the number of animals
needed for batch (lot) release purposes and
amended the section on international reference
materials.

12. Temperature of Tetanus
• Store diphtheria, tetanus, and pertussis vaccines
refrigerated between 2°C and 8°C (36°F and 46°F).
• Do not freeze vaccine or expose to freezing temperatures. If
the vaccine has been exposed to inappropriate
conditions/temperatures or handled improperly:
• Store the vaccine at the appropriate temperature
• Isolate from other vaccines
• Mark “Do NOT Use”
• Consult the vaccine manufacturer and/or your state or local
immunization program for guidance

13. Storage of Tetanus
• Store diphtheria, tetanus, and pertussis vaccines in the original
packaging.
• For the diphtheria, tetanus, and pertussis vaccine that require
reconstitution, Pentacle®, the manufacturer packages the diluents
and vaccine together and they should be stored together in the
refrigerator.
• Diphtheria toxoid-, tetanus toxoid-, and a cellular pertussis-
containing vaccines (DTaP and Tdap) are easily confused, increasing
the risk for error. Consider organizing vaccines in the storage unit by
age group or color coding labels to distinguish vaccines from each
other. Labeling the space where the vaccine is stored with name,
age indications, and other information unique to the vaccine can
help prevent vaccine administration errors.

14. Reconstitution & Disposal of Tetanus
• For the diphtheria, tetanus, and pertussis vaccine
that requires reconstitution, Pentacle, do NOT
use if you cannot resuspend the reconstituted
vaccine after thorough agitation. Only
reconstitute Pentacle® with the diluents provided
by the vaccine manufacturer.
• Never use stock vials of normal saline to
reconstitute Pentacle.
• Discard vaccine vials and syringes in compliance
with state and federal regulations.