Tetanus is a neurological disease caused by Clostridium tetani bacteria, characterized by painful muscle spasms. There are four main types: local, cephalic, generalized, and neonatal. Generalized tetanus is the most common form, with an incubation period of 2 days to weeks. Globally, tetanus causes 18 cases per 100,000 people annually, with higher rates in developing nations. In Nepal, tetanus was a major cause of death but vaccination programs have significantly reduced cases. Risk factors include agricultural work, unhygienic delivery practices, lack of healthcare, and puncture wounds introducing soil-containing bacteria into the body.

1. TETANUS-
Introduction and Epidemiology

2. INTRODUCTION
 Tetanos (Gr.) =to stretch
Tetanus is a neurological disease,
characterized by an acute onset of
hypertonia, painful muscular contractions
and generalised muscle spasms without
other apparent medical causes.
Symptoms include trismus, resus
sardoricus, opisthotonus, respiratory
failure, dysphagia, ANS effects like
hypertension, tachycardia, excessive
sweeting, hyperpyrexia, peripheral
vasoconstriction).
Only VPD that is infectious but not
contagious.

3. Causative agent: Clostridium
tetani
Spore- Drumstick/ Tennis racket
appearance

4. TYPES OF TETANUS
1. LOCAL TETANUS:
 Contraction and spasm are only limited to site
of injury.
 Usually lasts for a week and then subsides to
milder and less threatening form.
 Proper treatment is required to avoid it’s
development into generalised tetanus.
2. CEPHALIC TETANUS:
 Rarest form
 Associated with lesions of the head or
face(otitis media)
 Incubation period:1 to 2 days
 Results in flaccid cranial nerve palsies rather
than spasm. Spasm of the jaw muscles may
also be present.
 Can progress to the generalized form.

5. 3. GENERALIZED TETANUS:
Most common form of tetanus (80%)
Descending pattern
Spasms continues for 3-4 weeks and
recovery can last for months.
Incubation period: 2days- few weeks(8
days in average)
4. NEONATAL TETANUS
Occurs in newly born children due to
infection of unhealed umbilical stump,
when it is cut with an unsterile
instrument.
Incubation period: 4-14 days

6. EPIDEMIOLOGY
An important cause of death worldwide
with high case fatality, in the developing
world (comparatively less in developed
countries- 43 cases per year in USA).
Global incidence:18 cases per 1 lakh popn
per year
 Case fatality: 20-50%
Easily preventable by vaccination
Ubiquitous distribution, but more in tropics,
hot damp climates with soil highly rich in
organic matters.
Tetanus neonatarum: Due to lack of MCH
care.

7. EPIDEMIOLOGY IN NEPAL
 Tetanus is the major cause of morbidity and
mortality in Nepal.
 To control tetanus government of Nepal has
introduced EPI in 1979 which significantly
reduced the burden of VPDs including
tetanus.
 Different programs like maternal and neonatal
tetanus elimination program, safe
motherhood program, tetanus toxoid (TT)
campaign, training to birth attendants, health
education etc are being conducted by GON.
 NT has been eliminated in Nepal since 2005.
Now Nepal is aiming at controlling tetanus
and sustaining NT elimination status.

8.  In 1996, 6700 estimated deaths due to
NT
Mortality rate= 8.8 per 1000 live
births.
 In 1997, 5800 estimated deaths
Mortality rate=7 per 1000 live births.
 During the fiscal year 2003/2004, 63
cases of NT and 169 cases of non
neonatal tetanus were reported.
 During the fiscal year 2006/2007, 42
cases of NT and 155 cases of non
neonatal tetanus were reported.

9. Study conducted at BPKIHS
 Over 22 months period from 2004 to
2006, there were 19 cases of pediatric
tetanus and 5 cases of NT.
 During the fiscal year 2006/2007,
Morbidity at age 20-49= 43.2% of
cases
Pediatric tetanus= 26.3% cases

10. DETERMINANTS
Agent factors:
1. Reservoir: Soil and intestine of
mammals.
2. Toxins: Tetanospasmin and Tetanolysin
(LD= 0.1 mg)
3. Period of communicability: None
Host factors:
1. Age: Active age(5-40 years), new born
baby, female during delivery and
abortions.
2. Sex: Male> Female
3. Occupation: Agricultural workers
4. Distribution: Rural>urban

11. Environmental & social factors:
1. Unhygienic delivery practices
2. Traditional birth customs
3. Interest in immunization
4. Lack of PHC services
Route of infections:
1. Pin prick & skin abrasion
2. Puncture wounds, burns
3. Unsterile surgery, IUDs and injections
4. Unsterile division of umbilical cord
5. Compound fractures, Otitis media
6. Chronic skin ulcers, Eye infections
7. Gangrenous limbs
-NO WOUND, NO INFECTIONS

12. Tetanus prone wound:
1. >6 hours before surgery
2. Puncture type wound showing devitalised
tissue, contaminated with soil.

13. Content Sources:
 Textbook of Preventive and Social
Medicine-K. Park
 Anantanarayan and Paniker’s
Textbook of Microbiology
 Kathmandu University Medical Journal
(2009), Vol. 7, No. 3, Issue 27, 315-
322
 WHO report (2018)
 Pictures Source:Internet