Tetanus is caused by Clostridium tetani bacteria entering the body through wounds. It causes painful muscle spasms. The disease is most common in agricultural workers and affects those aged 5-40. Immunization provides effective prevention, either through active immunization with tetanus toxoid vaccines or passive immunization with antitoxin immunoglobulins. Both methods provide temporary protection, while active immunization also confers long-lasting immunity and is the preferred prevention method.

1. Tetanus (Lock Jaw)
It is an acute disease that result from the contamination of the
wound by the spores
Punctures, lacerated and contused wound provide the better
germination ground for the anaerobic organism to produce
the toxin, than compared to clean – cut open wound

2. Causative Agent
The causative agent of the disease is “Exotoxin of the
clostridium tetani”
The clostridium tetani is
Gram +ve, anaerobes spore bearing bacilli (Rod or drum stick
appearance)

3. Host
Man is the host of the disease
Age: 5 – 40 years (More predispose to the trauma and
accident)
Gender: The males are at most risk than female
Occupation: Agricultural worker
Immunity:
No age is immune unless protected by the previous
immunization

4. Reservoir Of The Infection
Domestic animal especially the horse and the man himself
Faces of the man and animal contaminated the soil, which is
the immediate source

5. Mode Of The Transmission
Direct Transmission:
Direct close free contact with the infectious persons via
a) Hand Shaking
b) Embracing
c) Sleeping Together
Indirect Transmission:
It is via using the non – living things such as
Clothes
Towels (Fomite borne)

6. Period Of The Incubation &
Communicability
Incubation Period:
Incubation period vary from the 4 days to 21 – days or more
Average is one to three weeks
Short incubation period is more serious and fatal
It is not communicable from man to man

7. Susceptibility & Resistance
Old & Young
Male & Female are all susceptible to the infection
Active immunization with the tetanus toxoid provide the
immunity and the risk of the tetanus following the minor
injuries is reduced
Passive immunization with the antitoxin is very useful

8. Environmental Factors That
favor The disease transmission
a) Unhygienic customs and habits such as application of the
dust or the animal dung to the wound
b) Unhygienic delivery practice, using the unstrelized,
instrument for cutting the umbilical cord
c) Ignorance Of The Infection
d) Lack Of The Primary Health care services

9. Types Of Tetanus
1) Traumatic Tetanus
2) Puerperal Tetanus
3) Otogenic Tetanus
4) Tetanus Neonatorum
5) Idiopathic tetanus

10. Tetanus Neonatorum
The tetanus neonatorum is occurs in the new borne babies
Infant typically contact the disease at birth, when delivered in
non – aseptic condition, especially when the umbilical cord is
cut with the unclean instrument
Also when the umbilical stump is dressed with ashes, soil or
cow dung
The first symptom is seen about the 7th day
There is progressive difficulty in suckling & excessive crying
Body gets fits which are generalized, opisthotonous,
There is also development of the cyanosis and apeanic spell
may also occurs

11. Clinical Feature
1) Onset is usually insidious, heralded by stiffness of the
muscles of the jaw, or neck
2) Difficulty in opening the mouth, (Trismus or lock jaw)
3) Difficulty in swallowing
4) Spasm of the cheek muscles (Risus Sardonicus)
5) Opisthotonus develop
6) Sensorium remain unaltered
7) Apprehension present
8) Respiratory Obstruction & laryngiospasm
9) Cyanosis
10) Asphyxia
11) Stimuli may cause the generalized spasm of the several
min.

12. Differential Diagnosis
Local infection of the jaw or throat
Meningitis
Encephalitis
Rabies
Stry chnine poisoning
Low serum calcium level

13. Complication
1) Pulmonary complication may follow aspiration
2) Severe seizure may gives muscular haematoma and rib
fracture
3) Fluid & Electrolytes complication may occurs due to
deficient intake of the fluid
4) Disturbance of the autonomic control that may lead to
variation in pulses, fluctuation in BP & variation in
temperature

14. Pulmonary Complication
Aspiration Pneumonia
Atelectasis
Pneumothorax
Mediastinal Emphysema
Apnea
Caryngiospasm

15. Prognosis
The prognosis is depend upon the
Severity Of The Disease
Age Of The Patient
Facilities for the intensive care
The high mortality is in neonatal tetanus
Over 60% mortality is lowest between 10 – 20 years age
group (I.e. less than 20%)

16. Prevention
Active Immunization
Passive Immunization
Passive – Active Immunization

17. Active Immunization
It stimulate the production of the antitoxins
Preparation Available
1) Combined Vaccine DPT:
2) Monovalent Vaccine (plan or fluid for mal toxoid or
tetanus vaccine adsorbed)
Two doses of the tetanus vaccine adsorbed each of 0.5 ml
injected in to the arm given at 1 – 2 month interval is given
The first booster dose is given a years after the initial dose
Second booster dose at 5 – years after the 1st booster dose
These providing the much better response

18. Passive Immunization
This can be achieved by the injection
TIG: (Humane tetanus hyperimmunoglobulin)
Anti – tetanus serum (ATS)

19. TIG
1) It is best prophylactic to use
2) Dose is 250 – 500 IU for all age
3) It does not cause the serum reaction
4) Gives a long passive protection of up to 30 – days or more

20. ATS
a) It is prepared from the horse serum
b) Dose is 1500 IU is given S/C after the test dose
c) Gives passive protection for about 7 – 10 days
d) Rapidly excreted from the body
e) Cause the sensitivity reaction

21. Active & Passive Immunization
Simultaneous active and passive immunization is given in non
– immune person
The purpose of the anti – toxin is for immediate temporary
protection
The purpose of the toxoid is for long – lasting protection

22. Prophylaxis
Creating awareness by education among the people of the
danger of the injury and value of the immunization (active or
passive or both) is the first step in the prevention
Local treatment of the wound is insignificant but an
important in preventing the disease
All necrotic tissues debris, foreign bodies must be removed
All pregnant women should be immunized with tetanus
toxoid

23. Prevention
Thus immunization against the tetanus is most effective
method of the prevention
Tetanus virtually never occurs in fully immunized person
Immunization should be started shortly after the birth
Booster should be given at school age and every 10 – years
thereafter throughout life