Tetanus Information

Throughout the world there are thought to be at least 1 million cases each year. In many developing countries the death rate can be almost 50% and this is the most common vaccine preventable cause of death among newly born infants. If the mother is given adequate vaccine during pregnancy the child will be well protected against this disease. Cover against this disease should be considered for all travellers particularly those who will be undertaking an adventure style holiday.

Geographical distribution

The disease is found throughout the world and Ireland may report one case each year. In the developing regions of the world the rate is significantly higher with the highest proportion showing in Africa and Asia.

Mode of Infection

The bacteria (Clostridium tetani) is held in the soil and animal faeces and gains entry to the human through a laceration on the skin. Deep puncture wounds are usually high risk and need to be treated seriously though in a number of cases the initial wound may be inapparent. In a neonate when a contaminated dressing is placed against the umbilicus following birth. The incubation period is usually one week to 10 days though this can be significantly longer under circumstances.

Symptoms

The initial clinical sings and symptoms include muscular spasms (particular of the jaw muscles – trismus) associated with neck pains and a sore throat. Full neck spasm may follow with difficulty eating or swallowing and spasms throughout the body. Rapid heart rate with a fluctulating blood pressure and excessive secretions combine to make this a most serious illness. Respiratory obstruction and paralysis of the diaphragm may lead to complete collapse and treatment may involve artificial respiration. A localised form of the disease is also recognised which is not usually too severe though treatment is urgent to prevent dissemination occuring. Up to 50% of patients can die from this condition even with excellent medical care.

Diagnosis

Clinical suspecion is essential to make an early disgnosis in this condition. It is rare to find the bacteria in wounds and as it is the exotoxin which causes the profound symptoms cluture techniques are unhelpful.

Treatment

High dose penicillin, anti toxin serum and artificial ventilation may all be required to control and care for these patients. It should be remembered that these patients also require active vaccination against tetanus as the disease does not protect against further attacks.