Non-neonatal Tetanus: Vaccine Preventable Diseases Surveillance Standards

Overview

Globally, approximately 13,500 tetanus cases were reported in 2016 through the WHO/UNICEF Joint Reporting Form, with 85% of cases occurring after the neonatal period (aged > 28 days), hereafter referred to as non-neonatal tetanus or non-NT. This number is likely an underestimate; true tetanus incidence is uncertain. Tetanus is not transmitted from person to person. Tetanus occurs when wounds or injured tissues (such as from unclean deliveries, burns, surgeries, dental or ear infections, or jigger/chigger infestations), are contaminated with Clostridium tetani spores. In some cases, the site of entry is unknown or no longer visible when symptoms start.

The median incubation period is seven days and usually ranges from 3 to 21 days. Characteristic features of tetanus are trismus (lockjaw, or inability to open the mouth), risus sardonicus (forced grin and raised eyebrows), and opisthotonus (backward arching of the spine). Generalized seizure-like spasms occur frequently in response to stimuli. Autonomic nervous system dysfunction (hypertension, abnormal pulse) and spasm of respiratory muscles and larynx can lead to respiratory failure. Among patients in the youngest and oldest age groups, the case-fatality rate approaches 100% without intensive care; with intensive care, the rate can be reduced to 10%–20%.