TETANUS

PATHOGEN:

Tetanus is an acute, often fatal, disease caused by a toxin produced by Clostridium tetani
bacteria. C. tetani is a gram-positive, obligately anaerobic, spore-forming bacterium.

RESERVOIR(S):

C. tetani spores are widely distributed and are found in soil, water and on vegetation
(inanimate reservoirs).
Note: The spores are also carried transiently in the GI tract of many animals, including
horses, cattle, dogs, cats, and even humans, and are excreted in feces, but animals and
humans are NOT considered to be reservoir hosts.

TRANSMISSION& SYMPTOMS:

C. tetani spores enter the body through a break in the skin, usually from contaminated soil.
If the spores enter a site beyond the reach of oxygen, they will germinate and the bacteria
will begin to produce toxins. . Tetanus is not transmitted from person-to-person.

DISEASE

Symptoms of tetanus can appear anywhere from three days to three weeks after exposure to
the bacterial spores.

Symptoms are due to the tetanus toxin, tetanospasmin, which is a neurotoxin that interferes
with the release of inhibitory neurotransmitters, resulting in unopposed muscle contraction
and spasm.

Generalized tetanus is the most common form of the disease. Symptoms usually start at the
top of the body and work down. Lockjaw is often the first symptom, followed by stiffness in
the neck and difficulty swallowing; muscle spasms may occur frequently, last for several
minutes, and persist for up to a month. Other symptoms may include fever, sweating,
elevated blood pressure, and rapid heartbeat. Seizures, coma and death may occur and
death is usually due to respiratory or cardiac arrest.

Overall, the mortality rate for tetanus is about 45%, but is only about 15% in unvaccinated
individuals in the United States and 6% in those who at some point received 1-2 doses of
tetanus toxoid. Cases most likely to be fatal occur in individuals who have not been
vaccinated and in persons over sixty years of age.

TREATMENT:

Tetanus is treated with antibiotics to kill tetanus bacteria and tetanus antitoxin to neutralize
the toxin. Most tetanus anti-toxin is derived from pooled human plasma obtained from
immune individuals. Tetanus toxoid will likely also be administered.

Medications are also administered to control muscle spasms and reduce disturbances in
heartbeat, blood pressure, and body temperature.

VACCINE:

Vaccination is the best way to protect against tetanus. Due to widespread immunization,
tetanus is now a rare disease in the U.S. Tetanus is prevented using a tetanus toxoid that is
administered in combination vaccines, such as the DPT and DTaP vaccines which protect
against diphtheria, pertussis, and tetanus, and the Td vaccine, which protects against both
tetanus and diphtheria. A Td booster shot is recommended every 10 years. Vaccinated
mothers confer temporary immunity to their newborn babies because the maternal IgG
antibody made against the toxoid crosses the placenta.