TETANUS
TETANUS
INTRODUCTION
Tetanus – a Greek word – stretch. First described by Hippocrates and Susruta. Tetanus an neurological disease characterized by an acute onset of hypertonia, painful muscular contractions (usually of the muscles of the jaw and neck), and generalized muscle spasms without other apparent medical causes. Only vaccine preventable disease that is infectious but not contagios.
CAUSATIVE AGENT
Caused by CLOSTRIDIUM TETANI, Anaerobic, Motile, Gram Positive Bacilli Oval, colorless, terminal spores- tennis racket or drumstick shape It is found worldwide in soil, in inanimate environment, in animal faces and occasionally human faces.
AGENT FACTOR
1. Agent: Cl. Tetani
Oval, colorless, terminal spores- tennis racket or drumstick shape. Spores are highly resistant to a number of injurious agents, including
2. Reservoir of infection: Natural habitat, Soil and Dust
Also found in intestine of Cattle, horses, goats, sheep, and excreted in faces.
Can survive for yours in nature without causing ill effects
Are blown about in dust and occur in wide variety of situations.
3. Toxins
When the oxygen levels in the surrounding tissue is sufficiently low, the implanted C. Tetani spore then germinates into a new, active vegetative cell that grows and multiplies and most importantly produces tetanus toxin- Tetanospasmin and Tetanolysis.
Tetanolysin is not believed to be of any significance in the clinical course of Tetanus.
Tetanospasmin is a neurotoxin and causes the clinical manifestations of tetanus.
Astounding lethal toxicity, exceeded only by botulinum toxin
Lethal dose: 0.1mg for a 70 kg-man
The toxin acts on 4 areas of neurons system:
Motor end plates in Skeletal system
Spinal Cord
Brain
Sympathetic System
Principal Action is to block inhibition of spinal reflexes
4. Period of Communicability: None
HOST FACTOR
Age: It is the disease of active age (5-40 years old) new born baby, female during delivery or abortion.
Sex: Higher incidence in males than females
Occupation: Agricultural workers are at higher risk
Rural-Urban difference: Incidence of tetanus in urban areas is much lower than in rural areas
Immunity: Herd immunity does not protect the individual.
ENVIRONMENTAL and SOCIAL FACTORS
Tetanus is a positive environmental hazard. Depends upon man’s physical and ecological surroundings.
Factors Contributing:
- Unhygienic custom habits
- Unhygienic delivery practices
- Ignorance of infection and
- Lack of primary health care services.
ROUTES OF INFECTIONS/MODE OF TRANSMISSION
Trivial pin trick, skin abrasion
Puncture wound, burns, human bites
Animal bites and stings
Unsterile surgery, IUD
Bowel surgery and Dental Extraction
Injections, unsterile division of Umbilical cord
Compound Fractures, Otitis Media
Chronic skin ulcers, Eye infection
Gangrenous Limb
Thus tetanus is an wound infection “No Wound No Tetanus”
INCUBATION PERIOD
Usually incubation period ranges from 3-21 days but can ranges from the day to injury to several months. Average incubation period is 10 days. Depends on character, location, and extent of wound.
TYPES OF TETANUS
- Traumatic
- Puerperal
- Otogenic
- Idiopathic
- Tetanus neonatorum
- Cephalic
PREVENTION
Tetanus is completely preventable by active tetanus immunization. Immunization is thought to provide protection for 10years. Active Immunization: Combined and Monovalent
Active, Combined
Offered routinely in combination with diphtheria vaccine and killed B. Pertussis organisms as DPT Vaccine.
1st dose - 6th week (DPT)
2nd dose - 10th week (DPT)
3rd dose - 14th week (DPT)
1st booster - 18th week (DPT)
2nd booster - 5th Completed year (DPT)
3rd booster - 10th year (TT)
4th booster - 16th year (TT)
Monovalent vaccines
Purified tetanus Toxoid (adsorbed) supplanted the plain Toxoid-higher and long lasting immunity response. Primary course of immunization – 3doses. Each 0.5ml, injected into given at intervals of 0,2,12 months. The longer the interval b/w two doses, better is the immune response. Booster dose: after 5year f/b every 10year. Stored between +2oC to +8 oC and must not be allowed to freeze any time
Passive immunization
Temporary protection – human tetanus immunoglobin/ATS. Human Tetanus Hyper-immunoglobin: 250-500IU. Produces protective antibody level for at-least 4-6 weeks. Does not cause serum sickness. Longer passive protection compared to horse ATS(30days / 7-10days). Produced at serum institute pune.
ATS (EQUINE)
If human ATS not available
1500IU s/c after sensitivity testing
Protection: 7-10days
High risk of serum sickness
It stimulates formation of antibodies to it, hence a person who has one received ATS tends to rapidly eliminate subsequent doses.
ACTICE & PASSIVE IMMUNIZATION
In non-immunized persons. 1500 IU of ATS / 2500-500 units of Human lg in one arm & 0.5ml of adsorbed Tetanus Toxoid (PTAP or APT) into other arm / gluteal region. Followed 8 weeks later by 0.5ml of Tetanus Toxoid. 1 year later, 0.5ml of Tetanus Toxoid 3rd dose. Again at 5 years and 10 years
Purpose: Immediate Temporary Protection + Long Lasting Protection
Antibiotics
Theoretically, antibiotics may prevent multiplication of C. Tetani, thus halting production of toxin. Benzathine Penicillin is the drug of choice.
Penicillin: 1.2 MU IV in 2-4 divided doses-For 3-4 weeks.
Erythromycin is alternative for penicillin allergic patients 500mg 6h for 7days. Started as soon as possible after Jnjury. (around 6h). Alone it is ineffective in prevention of tetanus as it is not a substitute to immunization.
Prevention of neonatal tetanus
Clean delivery practices alone is effective. (about 90%). 3 cleans: clean hand, clean delivery surface, clean cord care. Tetanus toxoid protects both mother and child. Unimmunized pregnant women: 2doses tetanus toxoid (16th -36th weeks). 1st dose as early as possible during pregnancy. 2nd dose – at least a month later / 3 weeks before delivery. Immunized pregnant women: a booster is sufficient. No need of booster in every consecutive pregnancy. To newborn of unimmunized mother, 750IU (HTG) within 6 hours of birth.
IMMUNITY CATEGORY
A- Has had a complete course of toxoid or booster dose with in the past 5 year
B- Has had a complete course of toxoid or booster dose more then 5 year ago and less then 10 years ago
C- Has had a complete course of toxoid or booster dose more then 10 years ago
D- Has had a complete course or toxoid or immunity status unknown.
CAUSATIVE AGENT
Caused by CLOSTRIDIUM TETANI, Anaerobic, Motile, Gram Positive Bacilli Oval, colorless, terminal spores- tennis racket or drumstick shape It is found worldwide in soil, in inanimate environment, in animal faces and occasionally human faces.
AGENT FACTOR
1. Agent: Cl. Tetani
Oval, colorless, terminal spores- tennis racket or drumstick shape. Spores are highly resistant to a number of injurious agents, including
2. Reservoir of infection: Natural habitat, Soil and Dust
Also found in intestine of Cattle, horses, goats, sheep, and excreted in faces.
Can survive for yours in nature without causing ill effects
Are blown about in dust and occur in wide variety of situations.
3. Toxins
When the oxygen levels in the surrounding tissue is sufficiently low, the implanted C. Tetani spore then germinates into a new, active vegetative cell that grows and multiplies and most importantly produces tetanus toxin- Tetanospasmin and Tetanolysis.
Tetanolysin is not believed to be of any significance in the clinical course of Tetanus.
Tetanospasmin is a neurotoxin and causes the clinical manifestations of tetanus.
Astounding lethal toxicity, exceeded only by botulinum toxin
Lethal dose: 0.1mg for a 70 kg-man
The toxin acts on 4 areas of neurons system:
Motor end plates in Skeletal system
Spinal Cord
Brain
Sympathetic System
Principal Action is to block inhibition of spinal reflexes
4. Period of Communicability: None
HOST FACTOR
Age: It is the disease of active age (5-40 years old) new born baby, female during delivery or abortion.
Sex: Higher incidence in males than females
Occupation: Agricultural workers are at higher risk
Rural-Urban difference: Incidence of tetanus in urban areas is much lower than in rural areas
Immunity: Herd immunity does not protect the individual.
ENVIRONMENTAL and SOCIAL FACTORS
Tetanus is a positive environmental hazard. Depends upon man’s physical and ecological surroundings.
Factors Contributing:
- Unhygienic custom habits
- Unhygienic delivery practices
- Ignorance of infection and
- Lack of primary health care services.
ROUTES OF INFECTIONS/MODE OF TRANSMISSION
Trivial pin trick, skin abrasion
Puncture wound, burns, human bites
Animal bites and stings
Unsterile surgery, IUD
Bowel surgery and Dental Extraction
Injections, unsterile division of Umbilical cord
Compound Fractures, Otitis Media
Chronic skin ulcers, Eye infection
Gangrenous Limb
Thus tetanus is an wound infection “No Wound No Tetanus”
INCUBATION PERIOD
Usually incubation period ranges from 3-21 days but can ranges from the day to injury to several months. Average incubation period is 10 days. Depends on character, location, and extent of wound.
TYPES OF TETANUS
- Traumatic
- Puerperal
- Otogenic
- Idiopathic
- Tetanus neonatorum
- Cephalic
PREVENTION
Tetanus is completely preventable by active tetanus immunization. Immunization is thought to provide protection for 10years. Active Immunization: Combined and Monovalent
Active, Combined
Offered routinely in combination with diphtheria vaccine and killed B. Pertussis organisms as DPT Vaccine.
1st dose - 6th week (DPT)
2nd dose - 10th week (DPT)
3rd dose - 14th week (DPT)
1st booster - 18th week (DPT)
2nd booster - 5th Completed year (DPT)
3rd booster - 10th year (TT)
4th booster - 16th year (TT)
Monovalent vaccines
Purified tetanus Toxoid (adsorbed) supplanted the plain Toxoid-higher and long lasting immunity response. Primary course of immunization – 3doses. Each 0.5ml, injected into given at intervals of 0,2,12 months. The longer the interval b/w two doses, better is the immune response. Booster dose: after 5year f/b every 10year. Stored between +2oC to +8 oC and must not be allowed to freeze any time
Passive immunization
Temporary protection – human tetanus immunoglobin/ATS. Human Tetanus Hyper-immunoglobin: 250-500IU. Produces protective antibody level for at-least 4-6 weeks. Does not cause serum sickness. Longer passive protection compared to horse ATS(30days / 7-10days). Produced at serum institute pune.
ATS (EQUINE)
If human ATS not available
1500IU s/c after sensitivity testing
Protection: 7-10days
High risk of serum sickness
It stimulates formation of antibodies to it, hence a person who has one received ATS tends to rapidly eliminate subsequent doses.
ACTICE & PASSIVE IMMUNIZATION
In non-immunized persons. 1500 IU of ATS / 2500-500 units of Human lg in one arm & 0.5ml of adsorbed Tetanus Toxoid (PTAP or APT) into other arm / gluteal region. Followed 8 weeks later by 0.5ml of Tetanus Toxoid. 1 year later, 0.5ml of Tetanus Toxoid 3rd dose. Again at 5 years and 10 years
Purpose: Immediate Temporary Protection + Long Lasting Protection
Antibiotics
Theoretically, antibiotics may prevent multiplication of C. Tetani, thus halting production of toxin. Benzathine Penicillin is the drug of choice.
Penicillin: 1.2 MU IV in 2-4 divided doses-For 3-4 weeks.
Erythromycin is alternative for penicillin allergic patients 500mg 6h for 7days. Started as soon as possible after Jnjury. (around 6h). Alone it is ineffective in prevention of tetanus as it is not a substitute to immunization.
Prevention of neonatal tetanus
Clean delivery practices alone is effective. (about 90%). 3 cleans: clean hand, clean delivery surface, clean cord care. Tetanus toxoid protects both mother and child. Unimmunized pregnant women: 2doses tetanus toxoid (16th -36th weeks). 1st dose as early as possible during pregnancy. 2nd dose – at least a month later / 3 weeks before delivery. Immunized pregnant women: a booster is sufficient. No need of booster in every consecutive pregnancy. To newborn of unimmunized mother, 750IU (HTG) within 6 hours of birth.
IMMUNITY CATEGORY
A- Has had a complete course of toxoid or booster dose with in the past 5 year
B- Has had a complete course of toxoid or booster dose more then 5 year ago and less then 10 years ago
C- Has had a complete course of toxoid or booster dose more then 10 years ago
D- Has had a complete course or toxoid or immunity status unknown.
TETANUS
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