Tetanus and
Tetanus Toxoid
Epidemiology and Prevention of Vaccine-
Preventable Diseases
National Immunization Program
Centers for Disease Control and Prevention
Revised March 2002
Tetanus
First described by Hippocrates
Etiology discovered in 1884 by Carle
and Rattone
Passive immunity used for treatment
and prophylaxis during World War I
Tetanus toxoid first widely used during
World War II
Clostridium tetani
Anaerobic gram-positive, spore-
forming bacteria
Spores found in soil, dust, animal
feces; may persist for months to years
Multiple toxins produced with growth
of bacteria
Tetanospasmin estimated human lethal
dose = 150 ng
Tetanus Pathogenesis
Anaerobic conditions allow germination
of spores and production of toxins.
Toxin binds in central nervous system
Interferes with neurotransmitter release
to block inhibitor impulses.
Leads to unopposed muscle contraction
and spasm.
Tetanus Clinical Features
Incubation period 8 days (range, 3-21 days)
Three clinical forms: Local (uncommon),
cephalic (rare), generalized (most common)
Generalized tetanus: descending
symptoms of trismus (lockjaw), difficulty
swallowing, muscle rigidity, spasms
Spasms continue for 3-4 weeks; complete
recovery may take months
Neonatal Tetanus
Generalized tetanus in newborn infant
Infant born without protective passive
immunity
High fatality rate without therapy
Estimated 270,000 deaths worldwide in
1998
Tetanus Complications
Laryngospasm
Fractures
Hypertension
Nosocomial infections
Pulmonary embolism
Aspiration
Death
Tetanus Wound Management
Clean, minor All other
wounds wounds
Vaccination History Td TIG Td TIG
Unknown or <3 doses Yes No Yes Yes
3+ doses No* No No** No
* Yes, if >10 years since last dose
** Yes, if >5 years since last dose
Tetanus Epidemiology
Reservoir Soil and intestine of
animals and humans
Transmission Contaminated wounds
Tissue injury
Temporal pattern Peak in summer or
wet season
Communicability Not contagious
Tetanus - United States, 1947-2001*
700
600
500
Cases
400
300
200
100
0
1950 1960 1970 1980 1990 2000
*2001 provisional data
Tetanus - United States, 1980-2001*
100
90
80
70
60
Cases
50
40
30
20
10
0
1980 1985 1990 1995 2000
*2001 provisional data
Tetanus United States, 1980-2000
Age Distribution
1000
900
800
700
600
Cases
500
400
300
200
100
0
<5 5-14 15-24 25-39 40+
Age group (yrs)
Age Distribution of Reported Tetanus
Cases, 1991-1995 and 1996-2000
1991-1995 1996-2000
80 72
Percent of Cases
70
58
60
50 42
40
28
30
20
10
0
<40 40+
Age group (yrs)
Tetanus - 1995-1997
Injuries and Conditions
Puncture
37%
Unknown
6%
Diabetes
3%
Laceration Surgery
17% 3%
Chr wound
7%
Abrasion IDU
9% 18%
Data available for 120 of 124 reported cases
DTaP, DT, and Td
Diphtheria Tetanus
DTaP, DT 7-8 Lf units 5-12.5 Lf units
Td (adult) 2 Lf units 5 Lf units
Pertussis vaccine and pediatric DT
used through age 6 years. Adult Td
used for persons 7 years and older.
Tetanus Toxoid
Formalin-inactivated tetanus toxin
Schedule Three or four doses + booster
Booster every 10 years
Efficacy Approximately 100%
Duration Approximately 10 years
Should be administered with diphtheria
toxoid as DTaP, DT, or Td
Routine DTaP Primary
Vaccination Schedule
Dose Age Interval
Primary 1 2 months ---
Primary 2 4 months 4 wks
Primary 3 6 months 4 wks
Primary 4 15-18 months 6 mos
Children Who Receive DT
The number of doses of DT needed
to complete the series depends on
the childs age at the first dose:
if first dose given at <12 months of
age, 4 doses are recommended
if first dose given at >12 months, 3
doses complete the primary series
Routine DTaP Schedule
Children <7 years of age
Booster Doses
4-6 years, before entering
school
11-12 years of age if 5 years
since last dose (Td)
Every 10 years thereafter (Td)
Routine Td Schedule
Persons >7 years of age
Dose Interval
Primary 1 ---
Primary 2 4 wks
Primary 3 6-12 mos
Booster dose every 10 years
Diphtheria and Tetanus Toxoids
Adverse Reactions
Local reactions (erythema, induration)
Exaggerated local reactions reactions
(Arthus-type)
Fever and systemic symptoms
uncommon
Severe systemic reactions rare
Diphtheria and Tetanus Toxoids
Contraindications and Precautions
Severe allergic reaction to
vaccine component or following
prior dose
Moderate to severe acute illness
National Immunization Program
Hotline 800.232.2522
Email nipinfo@[Link]
Website [Link]/nip
