05-Tetanus7p.ppt

8/8/2019 05-Tetanus7p.ppt

1/23

Tetanus andTetanus Toxoid

Epidemiology and Prevention of Vaccine-

Preventable Diseases

National Immunization Program

Centers for Disease Control and Prevention

evised !arc" #$$#


2/23

Tetanus

•%irst described by &ippocrates

• Etiology discovered in '(() by Carle

and attone

• Passive immunity used for treatmentand prop"ylaxis during *orld *ar I

• Tetanus toxoid first +idely used during*orld *ar II


3/23

Clostridium tetani

• ,naerobic gram-positive spore-forming bacteria

•.pores found in soil dust animalfeces/ may persist for mont"s to years

• !ultiple toxins produced +it" gro+t" of

bacteria

• Tetanospasmin estimated "uman let"al

dose 0 '1$ ng


4/23

Tetanus Pat"ogenesis

•,naerobic conditions allo+ germination ofspores and production of toxins2

• Toxin binds in central nervous system

• Interferes +it" neurotransmitter release tobloc3 in"ibitor impulses2

• 4eads to unopposed muscle contractionand spasm2


5/23

Tetanus Clinical %eatures

•Incubation period ( days 5range 6-#' days7

• T"ree clinical forms8 4ocal 5uncommon7cep"alic 5rare7 generalized 5most common7

• 9eneralized tetanus8 descending symptoms oftrismus 5loc3:a+7 difficulty s+allo+ing musclerigidity spasms

• .pasms continue for 6-) +ee3s/ completerecovery may ta3e mont"s


6/23

Neonatal Tetanus

• 9eneralized tetanus in ne+born infant

• Infant born +it"out protective passive

immunity

• &ig" fatality rate +it"out t"erapy

• Estimated #;$$$$ deat"s +orld+ide in'


7/23

Tetanus Complications

• 4aryngospasm

• %ractures

•&ypertension

• Nosocomial infections

• Pulmonary embolism

• ,spiration

• Deat"


8/23

Tetanus *ound !anagement

Vaccination &istory

=n3no+n or >6 doses

6? doses

Td TI9

@es No

NoA No

Td TI9

@es @es

NoAA No

Clean minor

+ounds

,ll ot"er

+ounds

A @es if B'$ years since last dose

AA @es if B1 years since last dose


9/23

Tetanus Epidemiology

• eservoir .oil and intestine of animalsand "umans

• Transmission Contaminated +ounds Tissue in:ury

• Temporal pattern Pea3 in summer or

+et season

• Communicability Not contagious


10/23

$

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11/23

$

'$

#$

6$

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1$C$

;$

($


12/23

$

'$$#$$

6$$

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13/23

#(

;#

)#

1(

$

'$

#$

6$

)$

1$C$

;$

($

>)$ )$?

,ge group 5yrs7

P e r c e n t o f C a s

e s

'


14/23

Puncture6;E

4aceration

';E

ID=

'(E

,brasion


15/23

DTaP DT and Td

DTaP DT

Td 5adult7

Dip"t"eria

;-( 4f units

# 4f units

Tetanus

1-'#21 4f units

1 4f units

Pertussis vaccine and pediatric DT

used t"roug" age years2 ,dult Tdused for persons ; years and older2


16/23

Tetanus Toxoid

•%ormalin-inactivated tetanus toxin

• .c"edule T"ree or four doses ? booster Fooster every '$ years

• Efficacy ,pproximately '$$

• Duration ,pproximately '$ years

• ."ould be administered +it" dip"t"eria toxoid asDTaP DT or Td


17/23

outine DTaP Primary

Vaccination .c"edule

DosePrimary '

Primary #Primary 6

Primary )

,ge# mont"s

) mont"s mont"s

'1-'( mont"s

Interval

---) +3s

) +3s

mos


18/23

C"ildren *"o eceive DT

• T"e number of doses of DT needed

to complete t"e series depends on

t"e c"ildGs age at t"e first dose8

–if first dose given at >'# mont"s of

age ) doses are recommended

–

if first dose given at B'# mont"s 6doses complete t"e primary series


19/23

outine DTaP .c"edule

C"ildren >; years of age

• )- years before entering

sc"ool

• ''-'# years of age if 1 years

since last dose 5Td7

• Every '$ years t"ereafter 5Td7

Fooster Doses


20/23

outine Td .c"edule

Persons B; years of age

Dose

Primary '

Primary #Primary 6

Interval

---

) +3s-'# mos

Fooster dose every '$ years


21/23

Dip"t"eria and Tetanus Toxoids

,dverse eactions

• 4ocal reactions 5eryt"ema induration7

• Exaggerated local reactions reactions

5,rt"us-type7

• %ever and systemic symptoms

uncommon

• .evere systemic reactions rare


22/23

Dip"t"eria and Tetanus Toxoids

Contraindications and Precautions

• .evere allergic reaction to

vaccine component or follo+ing

prior dose

• !oderate to severe acute illness


23/23

National Immunization Program

•&otline ($$2#6#2#1##

•Email nipinfoHcdc2gov

•*ebsite +++2cdc2govnip

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