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Tetanus and Tetanus Toxoid

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

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Tetanus and Tetanus Toxoid

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  1. Tetanus and Tetanus Toxoid Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised March 2002

  2. Tetanus • First described by Hippocrates • Etiology discovered in 1884 by Carleand Rattone • Passive immunity used for treatment and prophylaxis during World War I • Tetanus toxoid first widely used during World War II

  3. 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

  4. 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.

  5. 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

  6. 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

  7. Tetanus Complications • Laryngospasm • Fractures • Hypertension • Nosocomial infections • Pulmonary embolism • Aspiration • Death

  8. Clean, minor wounds All other wounds Vaccination History Unknown or <3 doses 3+ doses Td TIG Yes No No* No Td TIG Yes Yes No** No Tetanus Wound Management * Yes, if >10 years since last dose ** Yes, if >5 years since last dose

  9. 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

  10. Tetanus - United States, 1947-2001* *2001 provisional data

  11. Tetanus - United States, 1980-2001* *2001 provisional data

  12. Tetanus – United States, 1980-2000 Age Distribution

  13. Age Distribution of Reported Tetanus Cases, 1991-1995 and 1996-2000

  14. Tetanus - 1995-1997 Injuries and Conditions Data available for 120 of 124 reported cases

  15. Diphtheria 7-8 Lf units 2 Lf units Tetanus 5-12.5 Lf units 5 Lf units DTaP, DT Td (adult) DTaP, DT, and Td Pertussis vaccine and pediatric DT used through age 6 years. Adult Td used for persons 7 years and older.

  16. 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

  17. Dose Primary 1 Primary 2 Primary 3 Primary 4 Age 2 months 4 months 6 months 15-18 months Interval --- 4 wks 4 wks 6 mos Routine DTaP Primary Vaccination Schedule

  18. Children Who Receive DT • The number of doses of DT needed to complete the series depends on the child’s 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

  19. Routine DTaP ScheduleChildren <7 years of age • 4-6 years, before entering school • 11-12 years of age if 5 years since last dose (Td) • Every 10 years thereafter (Td) Booster Doses

  20. Dose Primary 1 Primary 2 Primary 3 Interval --- 4 wks 6-12 mos Routine Td Schedule Persons >7 years of age Booster dose every 10 years

  21. Diphtheria and Tetanus ToxoidsAdverse Reactions • Local reactions (erythema, induration) • Exaggerated local reactions reactions (Arthus-type) • Fever and systemic symptoms uncommon • Severe systemic reactions rare

  22. Diphtheria and Tetanus ToxoidsContraindications and Precautions • Severe allergic reaction to vaccine component or following prior dose • Moderate to severe acute illness

  23. National Immunization Program • Hotline 800.232.2522 • Email nipinfo@cdc.gov • Website www.cdc.gov/nip

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