Causative Agent
Clostridium tetani
Clinical Description
Tetanus is an acute disease induced by the toxin of Clostridium
tetani, a bacterium that grows anaerobically after being introduced
by injury. The neurotoxin causes muscular rigidity and agonising contractions.
These tend to begin as spasms in the masseter and neck muscles (lockjaw),
progressing to the trunk and extremities. Reported case fatality ratios
range from 10-90%, with highest ratios for infants and the elderly.
Transmission
Wound colonisation by tetanus spores, which are present in soil, and
animal faeces. The incubation period is usually three to 21 days, but
may range from one day to several months, depending on the type of wound.
Surveillance in Scotland
- Statutory notification of tetanus by clinical diagnosis
- Laboratory reports of toxigenic Clostridium tetani
Definition for Surveillance Notification (suggested)
Any person with:
- acute onset of hypertonia and/or painful muscular contractions (usually
of the muscles of the jaw and neck) and generalized muscle spasms without
other apparent medical cause
(Centers for Disease Control and Prevention)
Laboratory Report
Laboratory reports of Clostridium tetani (NB laboratory tests are
not normally performed).
Incidence
Tetanus is now extremely rare. During the years 1990-99 there were
only seven notifications and one laboratory report. Nevertheless, vaccination
against tetanus must be maintained, as the continued presence of the
causative organism, toxigenic Clostridium tetani in the environment
makes eradication impossible. This is highlighted by the continuing
small number of cases in Scotland, including a recent outbreak in injecting
drug users.
Prevention
Tetanus vaccination has been offered on a national scale since the
1960s, before which it was offered only to men during their period of
National Service. Tetanus vaccine is included in the UK Childhood Immunisation
schedule, with routine primary vaccination recommended at two, three
and four months, and booster doses at three to five years and 13-18
years. Patients who have had clinical tetanus need to be immunised before
discharge.
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