TETANUS
By :group 4
TETANUS
An acute disease caused by exo-toxin of
Clostridium tetani.
Characterized by:
Muscular rigidity present throughout the illness
Paroxysmal spasm of voluntary musle.
1. Masseter (lock jaw or trismus )
2. Facial muscle (risus sardonicus)
3. Muscle of back and neck(opisthotonus)
4. Muscle of lower limb and abdomen
Mortality is very high(40-80%)
EPIDEMIOLOGICAL DETERMINANT
1. Agent factor
a. Agent
Cl tetani is gram positive,anaerobic,spore-
bearing organism which is drum stick in
appearance
The spores are resistant to number of
agents(boiling,phenol,cresol,autoclaving for
15 min at 120°
The spore germinate under anaerobic
condition and produce
exotoxin”tetanospasmin”
b. Reservoir of infection
The natural habitat of organism is soil and dust.
The bacilli is found in intestine of many herbivorous animals
and are excreated in their feaces. The bacilli may also be
found in human intestine without causing ill effects.
c. Exotoxin
It is highly lethal.
Lethal dose for 70kg man -0.1mg
The toxin acts on nervous system ie,motor end plate in
skeketal system, brain, spinal cord, sympathetic system.
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Not transmitted from perso to person
2. Host factor
a. Age
It is disease of active age(5-40 yrs)
Tetanus in new-born is k/a neonatal tetanus
Birth under aseptic condition or if umbilical stump is
dressed improperly.
b. Sex
Males there is higher incidence
Females are more exposed to risk of tetenus during
delivery or abortion leading to ‘puerperal tetanus’
c. Occupation
Agricultural worker
d. Rural-urban difference
More in rural area
e. Immunity
No age is immune unless previously
immunized
2 injection of tetanus toxoid can provide
immunity which can last for several years
An immunity less than 6 month can be
transferred to baby if mother is immunized
during pregnancy .
ENVIRONMENTAL AND SOCIAL FACTOR
ENVIRONMENT
Soil, agriculture, cattles.
SOCIAL
Application of dust or animal dung in wound.
Unhygienic delivery practice.
MODE OF TRANSMISSION
First there is contamination of wound by spores. Then
germination and elaboration of exotoxin takes place.
Finally there is binding of exotoxin to the receptors.
The range of injuries and accident that lead to tetanus
can be
Pin prick
Skin abrasion
Puncture wound
Burns
Human bite
Animal bite
Sting etc
Incubation period- Usually 6-10 days , but can
range from 1 day to several months.
TYPES OF TETANUS
Traumatic
Puerperal
Otogenic
Idiopathic -microtrauma, absorption of
tetanus toxin from intestine, inhalation of
tetanus spores.
Tetanus neonaturum
PREVENTION
ACTIVE IMMUNIZATION
With tetanus toxoid
Toxoid stimulates the production of anti-toxin
The aim of vaccination is to maintain the level of
anti-toxin ie, 0.01 IU/ml serum throughout the life.
PREPARATION FOR IMMUNIZATION
1. Combined vaccine-DPT
2. Monovalent vaccine
Plain or fluid(formal) toxoid
Tetanus vaccine, absorbed(PTAP,APT)
1. Combined vaccine-DPT
Tetanus vaccine is given along
with diphtheria and pertusis vaccine.
The WHO EPI schedule is 6week,10week and
14week.
National schedule for India is
6week,10week,14 week followed by booster
of DPT at 18 mth, booster of DT at 5-6yrs
and booster of TT at 10 years.
MONOVALENT VACCINE
Purified tetanus toxoid have largely replaced
plain toxoid coz it stimulate a higher and
long-lasting immunity response than plain
toxoid.
1st dose-------1-2month-------2nd dose-----1year----
1st booster-------5year------2nd booster.
PASSIVE IMMUNIZATION
Temporary protection against tetanus can be
provided by
1. Human tetanus hyperimmunoglobulin(TIG)
2. ATS(Equine)
ACTIVE AND PASSIVE IMMUNIZATION
In non-immune person 0.5ml in one arm and
1500 IU ATS(equine) or 250-500 IU(HTIG)
in another arm .Followed by 6 week later
0.5 ml of tetanus toxoid and third 1 year
later.
ANTIBIOTICS
Single injection (IM) Benzathine Penicillin 1.2
mega unit.
For person sensitive to penicillin
Erythromycin estolate-500mg×6hrly×7days
Antibiotics treatment should not be relied if
patient is seen 6 hour after injury.
It is not sure whether antibiotics reach the
bacilli if dead tissues are present around.
PREVENTION OF NEONATAL TETANUS
Clean delivery practice reduce neonatal
tetanus.
Three cleans prevents neonatal tetanus
1. Clean hands
2. Clean surface
3. Clean cord care
Thank you
