VPMD: Tetanus

What is tetanus?

Tetanus is a an infectious disease caused by the toxin producing bacteria, Clostridium tetani. The bacteria is ubiquitous in nature, most commonly present in soil and farm animal stool. Due to the hardy nature of the bacteria’s spores it can survive extreme conditions and still be infectious. Tetanus bacteria primarily enters the body through accidental or procedural wounds. It causes severe illness in the unimmunized including newborns and pregnant women. Neonatal tetanus is rare in developed countries where optimal sterilization techniques are used for procedural tools. It is a disease that impacts multiple systems by primarily interfering with the nerve-muscle communication. Tetanus is not a contagious disease, but its contracted through exposure to spores in the environment.

What are the signs of tetanus?

The most severe form of tetanus is the generalized form. In this form of tetanus, there is widespread involuntary muscle spasms and rigidity, seizures, autonomic dysfunction ( heralded by abnormal heart rate, abnormal heart rhythm, and blood pressure). They may also have fever and chills. Complications from the abnormal neuromuscular function include, pneumonia, fractures, and death. Tetanus is primarily diagnosed through clinical findings, a positive wound culture is demonstrated in a minor number of cases.

How is tetanus treated?

The cornerstone of tetanus is supportive therapy in the hospital. This includes close observation and intervention for abnormal temperature, hemodynamics, control muscle spasms, respiratory function. Neutralization of the toxin is achieved through administration of Tetanus specific antibodies (TIG) and antibiotic therapy.

How is tetanus prevented?

Tetanus containing vaccines are the primary mode of prevention. In the US, the primary tetanus series if given at 2,4,6 months of age with the DTaP vaccine. Boosters are then given between 12-15 months, 4 and 11 years old and every 10 years thereafter.

My Experience with Tetanus

While in residency, I participated in the care of a teen in the PICU with tetanus. I recall witnessing the extreme changes in their hemodynamic state and needing to keep them sedated. Despite the several interventions given, the variable that could not be controlled was time to resolution of symptoms. While I do not recall how they contracted the disease, I do remember it occurred in a person that belonged to a group of people who do not regularly vaccinate for religious reasons. This vaccination is now part of the few vaccinations that this group will receive largely due to proven disease impact.

Sources: CDC, WHO, NHS, NLM