Cause: Toxin produced by the bacterium Clostridium tetani.
Illness and treatment: Most cases are generalized tetanus, with descending rigidity and painful spasms of skeletal muscles starting with the jaw and neck (referred to as “lockjaw”). Treatment is with human tetanus immune globulin (TIG), wound care, antibiotics, and supportive care. Active immunization should begin or continue as soon as the person is stable.
Sources: Spores are widely distributed in soil and in the intestinal tracts (and feces) of animals and humans. The spores can also be found on skin as well as in contaminated heroin. C. tetani usually enters the body through a wound (apparent or inapparent) and grows in damaged tissue.
Additional risks: Almost all reported cases of tetanus are persons with no vaccination or without a booster in the preceding decade. During 1980 – 2000, most cases were persons 40 years and older. Cases under 40 years are now increasing, in part due to injection-drug use.
Prevention: Universal childhood immunization with regular booster doses for adolescents and adults prevents toxin production in contaminated wounds.
Recent Washington trends: The most recent case was reported in 2005 in a person approximately 60 years of age who had been gardening and got a splinter in a finger. The person's most recent tetanus booster dose had been given 20 years prior to onset of illness.
Purpose of Reporting and Surveillance
- To assist in the diagnosis of potential cases and facilitate prompt administration of tetanus immune globulin (TIG)
- To identify groups at risk for tetanus (due to under-immunization, occupation, drug use, etc.) and focus prevention efforts
Legal Reporting Requirements
- Health care providers: notifiable to local health jurisdiction within 3 business days
- Health care facilities: notifiable to local health jurisdiction within 3 business days
- Laboratories: no requirements for reporting
- Local health jurisdictions: notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary information required within 21 days.