Mode: environmental exposure to bacillus

incubation: 3-21d; commonly 10d

Vaccine: Toxoid containing

• DTaP-IPV-HepB/Hib

• DTap-IPV

• Tdap

• Td

• 6wk, 3mo, 5mo, 4yrs, 11yrs, 45,65, pregnancy

effectiveness

too rare to test effectiveness

• tetanus toxin

  • Clostridium tetani

    • Gram + bacillus (anaerobe)

Wound control

• following injury

  • clean and devitalised tissue removed

• if tetanus prone and doubt re immunisation

  • TIG

  • \3 dose primary immunisation course

• tetanus prone =

  • compound #

  • bite wounds

  • deep, penetrating wounds

  • wounds containing foreign bodies

  • complicated by pyogenic infections

  • extensive tissue damage

  • superficial wound obviously contaminated soil, dust, horse manure

    • especially if delayed 4hrs

  • reimplantation of avulsed tooth

• Guide

  • ≥ 3 doses

    • \<5 years

      • No Td/Tdap or TIG

    • 5-10 yrs

      • clean minor

        • No Td/Tdap or TIG

      • tetanus prone

        • booster dose

    • >10yrs (all tetanus prone)

      • booster

  • \< 3 doses

    • clean minor

      • complete course immunisations

    • tetanus prone wounds

      • complete course

      • TIG

        • 250IU IM

          • ASAP

          • if >24hours

            • 500IU

Clinical

• muscular rigidity

  • painful contraction spasms

    • characteristic facial grimace

    • arching back

      • (opisthotonus)

• remains alert until severely hypoxic

• initial symptoms

  • weakness, stiffnes, cramps

  • difficult chewing

• 10 overall mortality

  • higher in older people