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Tetanus

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Tetanus is an acute, often fatal, disease caused by an exotoxin produced by the bacterium Clostridium tetani. Exotoxins are toxins released by a living bacterial cell into its surroundings. Symptoms of tetanus include generalized rigidity and convulsive spasms of skeletal muscles. The muscle stiffness usually begins in the jaw (lockjaw) and neck and then becomes more generalized throughout the body.

Although records from antiquity (fifth century BCE) contain clinical descriptions of tetanus, it was in 1884 when tetanus was first produced in animals by injecting them with pus from a fatal human tetanus case. During that same year, tetanus was produced in animals by injecting them with samples of soil.

In 1889, Kitasato Shibasaburo isolated the organism from a human, showed that it produced disease when injected into animals, and reported that the toxin could be neutralized by specific antibodies. In 1897, Edmond Nocard demonstrated the protective effect of passively transferred antitoxin, and passive immunization in humans was used for treatment and prevention during World War I. A method for inactivating tetanus toxin with formaldehyde was developed in the early 1920s. This led to the development of tetanus toxoid in 1924, which was first widely used during World War II.

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A vial of tetanus antitoxin and the dried antiserum are held up in someone's hands.

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A package of ca. 1907 dried antitetanic serum at left compared to a vail of tetanus antitoxin ca. 1970–1980

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After the 1940s, reported tetanus incidence rates declined steadily. Since the mid-1970s, about 50 to 100 cases (approximately 0.05 cases per 100,000) have been reported annually in the United States. More recently, from 2009–2018, an average of 29 (range 18–37) cases were reported per year. Of the 297 cases reported during this 10-year timeframe, there were 19 deaths, all in adults aged 55 years or older. In 2018, 23 tetanus cases were reported, with no deaths.

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Tetanus toxoid is combined with diphtheria toxoid as diphtheria and tetanus toxoid (DT) vaccine or tetanus and diphtheria toxoid (Td [Tenivac and Tdvax]) vaccine. Tetanus toxoid is also combined with both diphtheria toxoid and acellular pertussis vaccine as DTaP (Infanrix and Daptacel) or Tdap (Boostrix and Adacel) vaccines. Td contains reduced amounts of diphtheria toxoid compared with DT. DTaP and Tdap contain the same pertussis components, but Tdap contains a reduced quantity of some pertussis antigens and diphtheria toxoid. Boostrix contains a reduced quantity of tetanus toxoid compared to Infanrix. Depending on the age of the patient, certain vaccines are recommended over others (see the Centers for Disease Control and Prevention chart below).

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Graphic depicting cartoon people of various age categories next to information about the appropriate vaccine for the age range

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Poster from the Centers for Disease Control and Prevention about tetanus vaccines

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