Tetanus

Causative agent

It is caused by the bacterium Clostridium tetani which produces toxins that attack the nervous system.

Clinical features

The disease is characterised by painful muscular contractions at the jaws and the neck; sometimes the trunk is also affected and generalised spasms of muscles may occur. In severe cases, infected persons may not be able to swallow or open his/her mouth. When tetanus affects muscles that help to breathe, the patient may die very quickly.

Mode of transmission

The bacteria are found in soil and animal faeces. They get into the body through a break in the skin (such as a cut, puncture or tiny wound). Infection can also occur after burn or animal bite. Tetanus does not spread from one person to another.

Incubation period

The incubation period is 3 to 21 days, with most cases developing symptoms within 14 days of infection.

Management

Affected persons should be hospitalised for treatment including tetanus immunoglobulin, antibiotics and thorough wound treatment. In severe cases, muscle relaxants, tracheostomy and mechanical ventilation to assist breathing may be required. Active immunisation should be started concurrently with therapy if there is incomplete, uncertain or no history of immunisation.

Prevention

Proper wound management

• Clean wound immediately and cover properly with waterproof adhesive dressings until healed.
• Perform hand hygiene before and after touching wounds.
• Wounds should be assessed regularly. Consult doctor promptly if symptoms of infection develop.

Vaccination

• Depending on the type of wound and immunisation history of the person, s/he may need to receive tetanus toxoid or immunoglobulin to prevent tetanus.
• Immunisation with tetanus toxoid containing vaccines protects against tetanus. The tetanus toxoid can be administered alone or as a combined vaccine, e.g. diphtheria & tetanus vaccine (DT), diphtheria, tetanus, acellular pertussis and inactivated poliovirus vaccine (DTaP-IPV) (Please refer to the Hong Kong Childhood Immunisation Programme). A complete series of tetanus toxoid according to the immunisation schedule gives effective protection for at least 10 years.