EVERYTHING DETAILED ABOUT TETANUS FROM INTRODUCTION TO ITS MANAGEMENT AND PREVENTION

2. WHAT IS TETANUS?
AN ACUTE DISEASE INDUCED BY THE EXOTOXIN OF
CLOSTRIDIUM TETANI AND CLINICALLY
CHARACTERISED BY MUSCULAR DISEASE WHICH
PERSIST THROUGHOUT ILLNESS PUNCTUATED BY
PAINFULL PAROXYSMAL SPASMS OF THE VOLUNTARY
MUSCLES
THE VOLUNTARY MUSCLES MOSTLY AFFECTED ARE:-
MASSETER(TRISMUS OR LOCK JAW)
FACIAL MUSCLE(RISUS SARDONICUS)
THE MUSCLE OF BACK AND NECK(OPHISTHOTONUS)
MUSCLES OF LOWER LIMB AND ABDOMEN.
MORTALITY RATE: 40-80 %

3. 10392
4650
WORLDWIDE
TOTAL
TETANUS
CASES
NEONATAL
TETANUS
2814
528
INDIA
0
2000
4000
6000
8000
10000
12000
6235
1688
4157
1126
dead
cured
366
121
ODISHA
250
300
350
400
ODISHA
308
57

4. CLASSIFICATION OF DISTRICTS
(NEONATAL TETANUS ELIMINATION)
 NT HIGH RISK:-RATE >1/1000 LIVE BIRTHS
OR – TT COVERAGE <70 %
OR-ATTENDED DELIVERIES <50%
 NT CONTROL:-RATE <1/1OOO LIVE BIRTHS
AND -TT COVERAGE >70 %
AND-ATTENDED DELIVERIES>50%
 NT ELIMINATION:-RATE <0.1/1000 LIVE BIRTHS
AND-TT2 COVERAGE >90%
AND-ATTENDED DELIVERIES >75%
# INDIA HAS VALIDATED NT ELIMINATION IN 15 STATES

5. EPIDEMIOLOGICAL
DETERMINANTS
AGENT FACTORS HOST FACTORS
ENVIRONMENTAL
& SOCIAL
FACTORS
AGENT:
Clostridium tetani
RESRVOIR OF
INFECTION:
Soil and Dust
TOXIC AGENT:
Exotoxin of
Cl.tetani (0.1 mg for
70 kg man)
AGE: 5-40 yrs
SEX: Males
OCCUPATION:
Agricultural workers
MORE COMMON IN
RURAL AREAS THAN
URBAN AREAS
IMMUNISATION
PREVENTS
OCCURRENCE OF
THE DISEASE
Tetanus is a positive
environmental
hazard
Unhygenic customs
and habits(e.g:
application of dust or
animal dung to
wounds)
Unhygenic delivery
practices(e.g:using
unnsterilized
instruments for cutting
the umbilical cord

6. TYPES OF
TETANUS
TRAUMATIC
PUERPERAL
OTOGENIC
IDIOPATHIC
TETANUS
NEONATORUM

7. ACTIVE IMMUNIZATION
 COMBINED VACCINE:DPT IMMUNIZATION
CONSISTS OF 3 DOSES GIVEN AT INTERVALS
OF 4-8 WEEKS STARTING AT 6 WEEKS OF AGE
FOLLOWED BY BOOSTER DOSE AT 18
MONTHS AND A SECOND BOOSTER
DOSE(ONLY DT) AT 5-6 YEARS OF AGE AND A
3RD BOOSTER(ONLY TT) AFTER 10 YEARS OF
AGE.
 MONOVALENT VACCINE IMMUNIZATION
CONSISTS OF TWO DOSES OF TT
ADSORBED(0.5 ml) AT INTERVALS OF 1-2
MONTHS.

8. PASSIVE IMMUNIZATION
 HUMAN TETANUS
HYPERIMMUNOGLOBULIN
Given in a dose of 250 IU
which gives protection for 30 days
 ATS given in a dose of 1500 IU after
sensitivity test which gives protection for 7-
10 days

9. ACTIVE AND PASSIVE
IMMUNIZATION
 The patient is given 1500 units of ATS
or 250 units of HUMAN Ig in one arm
and 0.5 ml of adsorbed TT into the
other arm or gluteal region. This
should be followed 6 weeks later by
another dose of 0.5 ml of tetanus
toxoid, and a third dose one year later.

10. ANTIBIOTICS
 BENZATHINE PENICILLIN: 1.2 MU IM
INJ.
 FOR PTS SENSITIVE TO PENICILLIN
ERYTHROMYCIN-500 mg × 6 hrly × 7
days.*ANTIBIOTICS SHOULD BE GIVEN AS SOON AS POSSIBLE.
(BEFORE 6 hrs)

11. FACTORS RESPONSIBLE FOR
TETANUS AFTER INJURY
 CONTAMINATION OF WOUND FROM SOIL
AND DUST(RESERVOIR OF INFECTION)
 PRESENCE OF FOREIGN BODY
 NECROTIC TISSUE DUE TO INJURY OR
TRAUMA.
*ALL THESE ABOVE FACTORS PROVIDE ANAEROBIC
CONDITIONS WHICH FAVOUR GERMINATION OF
TETANUS SPORES.

12. HOW TO PREVENT ANAEROBIC
CONDITIONS?
The anaerobic conditions can be prevented by
SURGICAL TOILETING:
1. REMOVAL OF FOREIGN BODY IF PRESENT.
2. WASH THE WOUND WITH NORMAL SALINE.
3. DEBRIDEMENT OF NECROTIC TISSUE.
4. USAGE OF ANTISEPICS LIKE POLYVIDONE IODINE
5. LEAVE THE WOUND OPEN.

13. SCHEME FOR THE PREVENTION OF TETANUS
IN WOUNDED
ALL WOUNDS RECEIVE SURGICAL TOILET
WOUNDS LESS THAN 6 HOURS
OLD,CLEAN,NON PENETRATING AND WITH
NEGLIGIBLE TISSUE DAMAGE
OTHER WOUNDS
IMMUNITY
CATEGORY
TREATMENT
A NOTHING MORE REQUIRED
B TOXOID 1 DOSE
C TOXOID 1 DOSE
D TOXOID COMPLETE
COURSE
IMMUNITY
CATEGORY
TREATMENT
A NOTHING MORE REQUIRED
B TOXOID 1 DOSE
C TOXOID 1 DOSE+HUMAN
TET Ig
D TOXOID COMPLETE
COURSE+HUMAN TET Ig
•A-Has had a complete course of toxoid or a booster dose within past 5 years.
•B-Has had a complete course of toxoid or a booster dose > 5 years & <10 years.
•C-Has had a complete course of toxoid or a booster dose > 10 years.
•D-Has not had a complete course of toxoid or immunity status is unknown.

14. METHOD OF ADMINISTRATION
AND PRECAUTION
•HUMAN TETANUS HYPERIMMUNOGLOBULIN 250 IU IS GIVEN
INTRAMUSCULAR(PROTECTION FOR 330 DAYS)
•ATS GIVEN IN 1500 IU AFTER SENSITIVITY TESTING
•SENSITIVITY TESTING IS DONE BY GIVING 0.1 ML IN
TUBERCULIN SYRINGE SUBCUTANEOUSLY AND OBSERVED
THE PATIENT IS OBSERVED FOR 30 MINS ATLEAST FOR ANY
GENERALISED ANAPHYLACTIC REACTIONS.
•AS A PRECAUTION ADRENALINE SOLUTION 1 IN 1000 FOR IM
INJECTIONIN THE DOSAGE OF 0.5 ml TO 1 ml AND
HYDROCORTISONE 100 mg FOR IV INJECTION
•IF THERE IS ANY SENSITIVITY ATS SHOULD NOT BE
ADMINISTERED.

15. THANK YOU