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JanneMikkola

Tetanus

Essentials

  • Tetanus is prevented by vaccination and careful treatment of contaminated wounds.
  • The disease must be identified early in unvaccinated patients

Definition

  • Tetanus is a severe systemic infection in the unvaccinated individual caused by Clostridium tetani, which can be found in high concentrations in the soil and in normal intestinal flora.

Symptoms

  • First, a local wound infection in which the bacteria multiply and produce toxin.
  • Within days or weeks, a generalized systemic infection with spasms of skeletal muscles, most often beginning at the mandibular joint (trismus, also called lockjaw)
  • Localized tetanus consists of muscle rigidity and painful spasms close to the site of injury.
  • In spite of intensive care, mortality is high.

Diagnosis

  • Depends mostly on history and clinical features. The usefulness of aspirate Gram-stain and culture is limited.

Treatment Diazepam for Treating Tetanus, Vitamin C for Treating Tetanus

  • Making the airway secure, supportive care with antimicrobials, anticonvulsive medications and sedation require intensive care in most cases.
  • Human antitetanus immunoglobulin and debridement of the wound are the cornerstones of treatment.
  • Metronidazole orally or i.v. is the drug of choice. The dose for adults is 500 mg × 3 and for children 30 mg/kg daily in three doses. G penicillin is an alternative.
  • Active immunization should be initiated during convalescense.

Prevention

  • In most developed countries, a universal immunization is effective and the boosters are given every 10 or 20 years, depending on local programmes and the person's age.
    • Td vaccine gives protection also against diphtheria.
    • Find out about local recommendations.
  • The wounds are to be thoroughly cleaned.

Booster vaccination after trauma

  • Depends on the wound and the person's immunization level; see table T1
  • Frequent vaccinations increase the probability of local reactions.

Booster vaccionation after trauma

Immunization levelHigh risk of tetanusLow risk of tetanus
  • Dirty puncture wounds
  • Open fractures
  • Animal bites
  • Injuries contaminated by soil/dirt or faeces
  • Frostbites, burns, and other wounds that require surgical debridement and contain lots of dead tissue
  • Clean wounds
Good protection
  • Earlier HASH(0x2f82cc8) 3 doses of tetanus vaccine
Td or dtap if previous dose over 10 years ago*

Antitetanus immunoglobulin in very high risk wounds based on individual assessment		Td or dtap if previous dose over 20 years ago*
Inadequate protection
  • Earlier < 3 doses of tetanus vaccine or unclear number of doses
Complete the basic vaccination series by using an age-specific vaccine adapting the timeline to accelerated schedule 0, 2 and 6 months.*
  • <5 years of age: DTap-IPV-Hib
  • <13 years of age: DTaP-IPV
  • >13 years of age: Td or dtap

Antitetanus immunoglobulin 250 IU i.m. using separate syringes on the other side of the body		Complete the basic vaccination series by using an age-specific vaccine adapting the timeline to accelerated schedule 0, 2 and 6 months.*
  • <5 years of age: DTap-IPV-Hib
  • <13 years of age: DTaP-IPV
  • >13 years of age: Td or dtap
* Notice that local differences with regard to the recommended vaccine type or timelines may apply. The information shown here are based on the policy in Finland.

Td = Tetanus (T) and diphtheria (d) vaccine
dtap = Diphtheria (d), tetanus (t), and acellular pertussis (ap) vaccine
DTap-IPV-Hib = Diphtheria (D), tetanus (T), acellular pertussis (aP), polio (IPV), and Haemophilus influenzae type b (Hib) vaccine
DTaP-IPV = Diphtheria (D), tetanus (T), acellular pertussis (aP), and polio (IPV) vaccine

Evidence Summaries ⬆