Page 140 - JSOM Winter 2018

FIGURE 2 This hospitalized neonate was displaying a bodily rigidity and mechanical ventilation may be required. Tetanus immune
produced by Clostridium tetani exotoxin. This condition is known as globulin should be administered intramuscularly in a dose of
neonatal tetanus.
500 international units (IU), within infiltration of some of the
dose around the wound site. Metronidazole (30mg/kg/day di-
vided every 6 hours; maximum 4g/day) or parental penicillin G
(100,000U/kg/per day divided every 4 to 6 hours; maximum 12
millionU/day) for 7 to 10 days, have been shown to decrease the
number of vegetative C. tetani organisms that produce spores.
Tetanus disease does not result in immunity against the disease,
and vaccinations should be administered when possible.

Vaccination
Infants and children should be given a tetanus containing vac-
Source: CDC; https://phil.cdc.gov/Details.aspx?pid=6374 cination at 2, 4, 6, and 12 to 15 months, as well as the time
of “school age shots” between 4 and 6 years of age. An addi-
tional vaccination is recommended at 11 to 12 years of age
FIGURE 3 This photomicrograph depicts a group of Clostridium
tetani bacteria, responsible for causing tetanus in humans. Note against tetanus, diphtheria, and pertussis (Tdap) with tetanus
that some of these organisms had entered their endospore phase, boosters (Td) every 10 years thereafter. The Tdap vaccination
displaying the classic tennis racket morphology. is now recommended in the third trimester of every pregnancy.
Deaths worldwide due to neonatal tetanus have decreased
from almost 500,000 a year in the mid 1990s to 49,000 in
2013 due to a concerted effort to ensure that pregnant moth-
ers and infants are properly vaccinated. Interestingly, tetanus
is the only disease prevented by vaccine that is infectious but
is not contagious.

Importance in a Deployed Setting
Deployed military personnel should be properly vaccinated
against tetanus with booster doses at appropriate intervals.
Source: CDC; https://phil.cdc.gov/Details.aspx?pid=6372 When providing medical care to host nation populations, tet-
anus must always be considered in wound management, es-
booster has not occurred within 10 years, the vaccine should pecially in those who are unimmunized or underimmunized.
be administered. For a “dirty or contaminated wound,” if the
patient has an incomplete or unknown vaccination history, Disclaimer
both the tetanus vaccine and tetanus immune globulin (TIG) The views expressed in this publication are those of the au-
should be administered. For patients with dirty wounds in thor, and do not reflect the official policy or position of the
whom tetanus vaccinations are up to date or those who have Department of the Army, Department of Defense, or the US
had a tetanus booster in the past 5 years, neither tetanus vac- Government.
cine nor TIG is required in wound management. All wounds
should be cleaned, with necrotic tissue debrided. All patients Disclosure
with HIV infection or immunodeficiency should receive TIG if The author has nothing to disclose.
the wound is contaminated (Table 1).
Bibliography
TABLE 1 Tetanus Wound Management American Academy of Pediatrics. Tetanus. In: Kimberlin DW,
Clean, Minor Wounds All Other Wounds* Brady MT, Jackson MA, et al, eds. Red Book: 2018 Re-
port of the Committee on Infectious Diseases. 30th ed. Elk
Vaccination history Tdap or Td † TIG Tdap or Td † TIG Grove Village, IL: American Academy of Pediatrics; 2018:
Unknown or fewer Yes No Yes Yes 793–798.
than 3 doses Centers for Disease Control and Prevention. Tetanus. In:
3 or more doses No ‡ No No § No Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and
*Such as, but not limited to, wounds contaminated with dirt, feces, Prevention of Vaccine-Preventable Diseases. 13th ed.
soil, and saliva; puncture wounds; avulsions; and wounds resulting Washington, DC: Public Health Foundation; 2015.
from missiles, crushing, burns, and frostbite.
†Tdap is preferred to Td for adults who have never received Tdap. Finkelstein P, Teisch L, Allen C, et al. Tetanus: A potential
Single antigen tetanus toxoid (TT) is no longer available in the United public heath threat in times of disaster. Prehosp Disaster
States. Med. 2017;32:339–342.
‡Yes, if more than 10 years since the last tetanus toxoid-containing
vaccine dose.
§Yes, if more than 5 years since the last tetanus toxoid-containing Recommended Internet
vaccine dose. https://www.cdc.gov/tetanus/clinicians.html
Source: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html
Keywords: prophylaxis; tetanus; vaccines
For those showing symptoms of the disease, care is supportive
in nature, in an intensive care unit if available, as intubation

138 | JSOM Volume 18, Edition 4 / Winter 2018