Clostridium tetani, a spore-forming, anaerobic, gram-positive bacterium. Bacteria are ubiquitous in the environment.
Direct contamination of open wounds and non-intact skin. “Tetanus-prone” wounds include those contaminated with dirt, human or animal excreta, or saliva; punctures; burns; crush injuries; or injuries with necrotic tissue.
Distributed worldwide. More common in rural and agricultural regions, areas where contact with soil or animal excreta is likely, and areas where immunization is inadequate. Tetanus can affect any age group.
Incubation period is 10 days (range, 3–21 days). Acute symptoms typically include muscle rigidity and spasms, often in the jaw (lockjaw) and neck. Tetanus is usually classified as local, cephalic, generalized, and neonatal. Symptoms of localized tetanus include muscle spasms confined to the injury site. Cephalic tetanus is characterized by head or face wound and flaccid cranial nerve palsies. Progression from these forms to generalized tetanus may occur. Generalized tetanus is characterized by lockjaw, generalized spasms, risus sardonicus, and opisthotonus. Neonatal tetanus occurs in newborns who have contaminated umbilical stumps and whose mothers are unimmunized or inadequately immunized. Severe tetanus can lead to respiratory failure and death. Case-fatality ratios are high even where modern intensive care is available.
Diagnosis is clinical; no confirmatory laboratory tests are available. Tetanus is a nationally notifiable disease.
Tetanus requires hospitalization, treatment with human tetanus immune globulin (TIG), a tetanus toxoid booster, agents to control muscle spasm, aggressive wound care, and antibiotics. Metronidazole is the most appropriate antibiotic. The wound should be debrided widely and excised if possible.
All travelers should be up-to-date with tetanus toxoid vaccine before departure. Ensure adequate immunity to tetanus by completing the childhood primary vaccine series with tetanus toxoid, a booster dose during adolescence, and at 10-year intervals thereafter during adulthood. An age-appropriate tetanus toxoid–containing vaccine may be needed as early as 5 years since the last dose for high-risk wounds. In addition, for unvaccinated or inadequately vaccinated people or people with HIV infection or other severe immunodeficiency, a prophylactic dose of TIG may also be required. For detailed information regarding the tetanus vaccine, visit www.cdc.gov/vaccines/vpd-vac/tetanus.
CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine in adults aged 65 years and older—Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep. 2012 June 29;61(25): 468–70.
Tiwari TSP. Tetanus. In: Kris Heggenhougen and Stella Quah, editors. International Encyclopedia of Public Health, Volume 2. San Diego: Academic Press; 2016.
World Health Organization. Tetanus vaccine: WHO position paper—February 2017. Wkly Epidemiol Rec. 2017;92(6):53–76.