Tetanus

Tetanus is an acute infectious disease caused by spores of the bacterium Clostridium tetani, characterized by muscle spasms. The disease is also commonly known as 'lockjaw' due to its characteristic presentation involving jaw muscle contraction. The spores are ubiquitous in the environment and can survive for years due to their resistance to heat and most antiseptics. Infection occurs when spores enter the body through breaks in the skin, typically via deep cuts, wounds, or burns.

The hallmark presentation involves painful muscle contractions that typically begin in the jaw muscles and progress to the rest of the body in a descending pattern. Each spasm usually lasts for several minutes and may occur frequently for three to four weeks. Severe spasms can cause bone fractures and muscle tears. Additional symptoms include fever, sweating, headache, difficulty swallowing, elevated blood pressure, and tachycardia. The incubation period ranges from 3 to 21 days following infection, with most cases developing within 14 days. Recovery may take several months, and approximately 10% of cases prove fatal. In neonatal tetanus, symptoms include muscle spasms often preceded by the newborn's inability to suck or breastfeed and excessive crying.

Tetanus remains an important public health problem in many parts of the world, particularly in low-income countries and districts where immunization coverage is low and unclean birth practices are common. In 2018, approximately 25,000 newborns died from neonatal tetanus, representing a 97% reduction from the 787,000 estimated deaths in 1988. As of July 2023, 11 countries have not yet achieved Maternal and Neonatal Tetanus Elimination status. Nearly all cases occur in individuals who have never been vaccinated or adults who have not maintained current booster status. Adolescent and adult males undergoing circumcision face increased risk in certain settings.

Transmission occurs through exposure to Clostridium tetani spores, which are found ubiquitously in the environment, particularly in soil, ash, intestinal tracts and feces of animals and humans, and on surfaces of skin and rusty tools such as nails, needles, and barbed wire. The bacteria enter the body through breaks in the skin, including deep cuts, puncture wounds, or burns. Neonatal tetanus specifically results from infection of the umbilical stump when nonsterile instruments are used to cut the cord, contaminated materials are applied to the stump, or deliveries occur with unclean hands or on contaminated surfaces. The disease does not spread between people.

All unvaccinated or inadequately vaccinated individuals are susceptible to tetanus. The disease is particularly common and serious in newborn babies and pregnant women who have not been sufficiently immunized with tetanus-toxoid-containing vaccines. Neonatal tetanus risk is highest in settings where unclean birth practices prevail, including use of nonsterile instruments for umbilical cord cutting, application of contaminated materials to the stump, and deliveries by individuals with unclean hands or on contaminated surfaces. Adolescent and adult males undergoing circumcision represent a population with increased tetanus risk in certain geographic contexts.

Tetanus is preventable through immunization with tetanus-toxoid-containing vaccines, which are incorporated into routine immunization programs globally and administered during antenatal care contacts. WHO recommends receiving six doses of tetanus-toxoid-containing vaccine throughout life, consisting of a three-dose primary series beginning as early as 6 weeks of age with minimum 4-week intervals between doses, followed by three booster doses administered during the second year of life, at 4-7 years of age, and at 9-15 years of age. Maintaining elimination requires continued strengthening of routine immunization activities for both pregnant women and children. Individuals who recover from tetanus do not develop natural immunity and require immunization to prevent reinfection.

Tetanus surveillance relies on clinical case definitions due to the absence of routine laboratory confirmation requirements. The WHO definition for confirmed neonatal tetanus requires an illness occurring in an infant who demonstrated normal ability to suck and cry in the first two days of life but lost this ability between days 3 and 28, becoming rigid or experiencing spasms. Non-neonatal tetanus surveillance requires at least one documented symptom consistent with tetanus. The global surveillance target defines elimination as less than one neonatal tetanus case per 1,000 live births in every district. Maintaining elimination status requires sustained high immunization coverage and safe birth practices.

1. 1 WHO Health Topics. Tetanus.
2. 2 WHO Fact Sheet. Tetanus.
3. 3 WHO Q&A. News.
4. 4 Wikidata. tetanus.
5. 5 Wikipedia. Tetanus - Wikipedia.

ICD-10

ICD-11

Total cases

1K

Peak month

2023-06

Coverage

3 reporting countries · 2000-01-01 → 2026-05-09