Tetanus

First described by Hippocrates, tetanus is a disease caused by Clostridium tetani, an organism that only flourishes in dead tissue and produces an exotoxin which passes to the central nervous system (1).

• the toxin targets anterior horn cells and once fixed, it cannot be neutralized by antitoxin

The infection does not transmit from person to person and there is no herd immunity (3)

Tetanus is a notifiable disease in UK (2).

Tetanus is caused by a neurotoxin produced by Clostridium tetani, an anaerobic spore-forming Gram positive bacterium (4)

• C. tetani can be present in the gastrointestinal tract and faeces of horses and other animals
  • spores are widespread in the environment, including soil
  • spores can survive hostile conditions for long periods of time and human infection is acquired when C. tetani spores are introduced into the wounds contaminated with soil
• note that tetanus may also follow injecting drug use or abdominal surgery
• in some cases no exposure is reported and it is assumed that unnoticed minor wounds were the route of entry
• incubation period of the disease is usually between 3 and 21 days, although it may range from one day to several months depending on the character, extent and localisation of the wound

Reference:

• (1) Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book 2011. Chapter 20: Tetanus
• (2) Health Protection Agency (HPA) 2011. List of notifiable diseases
• (3) Department of Health (DH). Immunisation against infectious disease. 'The Green Book'  2019 updated edition
• (4) UK Health Security Agency (September 2023). Guidance on the management of suspected tetanus cases and the assessment and management of tetanus-prone wounds