Tetanus

Question 1

True or false: tetanus is nationally notifiable?

Answer 1

True - routine.

Question 2

Which organism causes tetanus?

Answer 2

Clostridium tetani

Anaerobic, spore forming bacteria 🡪 neurotoxin causes disease. Non-toxigenic strains reported; do not cause tetanus.

Question 3

Where is C. tetani typically found?

Answer 3

Environment - spores present in soil, intestinal tracts of animals (e.g., horses), contaminated heroin.

Question 4

How is tetanus transmitted?

Answer 4

• Soil-contaminated wound (usualy)
• Highest risk - deep/penetrating, bites, compound #, foreign bodies, burns, but also occur with trivial wounds.

Necrotic tissue is a risk factor.

Question 5

How is neonatal tetanus usually acquired?

Answer 5

Infection of umbilical stump (in infant without passive immunity from maternal antibodies)

Question 6

What are the clinical features of tetanus?

Answer 6

• Acute severe neurological illness
• Trismus (lockjaw)
• Opisthotonus - extensive painful muscle spasms (neck, back, limbs)
• Autonomic dysfunction

Question 7

What are the clinical features of neonatal tetanus?

Answer 7

• Weakness
• Rigidity
• Inability to suck
• Spasms

Question 8

What is the CFR for tetanus?

Answer 8

10 - 80%

Question 9

Which groups are high-risk for tetanus?

Answer 9

• Infants and elderly - highest mortality
• IVDU (independent RF)

Question 10

What are the case definitions for tetanus?

Answer 10

Confirmed only:
* Isolation from wound OR
* Clinical

Question 11

How is tetanus diagnosed?

Answer 11

• Clinical features diagnostic
• Lab - wound swab/surgical specimen culture

Then need to do mouse testing for tetanus toxin (inoculate culture filtrate into small mice, some of which have had antitoxin 1h before, observe for paralysis

Question 12

What is the incubation period for tetanus?

Answer 12

3 - 21 days (usually)

Range 1d to several months

Question 13

What is the infectious period for tetanus?

Answer 13

N/A - no person-person transmission.

Spores viable in environment for years; resistant to drying, heat, antiseptics.

Question 14

What is the outbreak definition of tetanus?

Answer 14

Rare.
O > E

Question 15

How are outbreaks of tetanus managed?

Answer 15

N/A

Question 16

How is tetanus prevented?

Answer 16

Vaccination:
* NIPS = DTPa - 2, 4, 6, 18mo and 4 yrs
* Booster dTpa 12-13 years (yr 7)
* Pregnant women - dTpa each pregnancy
* 50y and 65y if last dose >10 years ago
* Adolescents/adults unvaccated - 3 dose course + 2x boosters at 10 year interval
* Post tetanus-prone wound (any wound other than clean cut) - child < 10yo (DTPa)l; >= 10yo if last dose 5+ years ago (dT / dTpa); uncertain vax hx or humoral deficiency - vax + Ig

Question 17

What resources are available for public health management of tetanus?

Answer 17

No SoNG.
DH protocol.

Question 18

How are cases of tetanus managed?

Answer 18

• Interview - vax, source (wound, animal bite, IVDU, pregnancy, surgical/dental), recent wound management
• Treatment - supportive, ICU, vax + Ig
• Isolation/Exclusion - N/A
• Education - wound care, avoid future exposure

Question 19

How are contacts of tetanus managed?

Answer 19

N/A

Question 20

What exclusion is required for tetanus cases or contacts?

Answer 20

N/A

Question 21

What environmental management is required for tetanus?

Answer 21

N/A

Question 22

True or false: tetanus is rare in Australia?

Answer 22

True - widespread vaccination.

Question 23

In Australia, which groups are most likely to get tetanus?

Answer 23

Older unimmunised people or who have waning immunity.

Question 24

True or false: tetanus is still prevalent in many countries?

Answer 24

True.

Question 25

How many countries have not achieved tetanus elimination status?

Answer 25

11

Question 26

How many neonatal deaths of tetanus occurred in 2018?

Answer 26

25,000
(97% reduction since 1998)