Throughout the world there are thought to be at least 1 million cases each year. In many developing countries the mortality rate can be as high as 50% which makes Tetanus the most common vaccine preventable cause of death among newly born infants. Cover against this disease should be considered for all travellers particularly those who will be undertaking an adventure style holiday.
Mode of Infection
The bacteria (Clostridium tetani) is held in soil and animal faeces and gains entry to the human through a laceration on the skin. Deep puncture wounds are usually high risk and need to be treated seriously, however in a number of cases the initial wound may be inapparent. The incubation period is usually one week to 10 days though this can be significantly longer.
The initial clinical sings and symptoms include muscular spasms (particular of the jaw muscles – trismus) associated with neck pains and a sore throat. Full neck spasm may follow with difficulty eating or swallowing and spasms throughout the body. Rapid heart rate with a fluctulating blood pressure and excessive secretions combine to make this a most serious illness. Respiratory obstruction and paralysis of the diaphragm may lead to complete lung collapse.
A localised form of the disease has also is also recognised. Although not usually severe, urgent treatment is required to prevent dissemination. Up to 50% of patients can potentially die from this condition – even with excellent medical care.
The disease is found throughout the world. With disease reports more prevalent in developing regions with the highest proportion showing in Africa and Asia.
The disease is not transferable between humans, but occurs through contact with infected soil or animal faeces, for example, in a neonate when a contaminated dressing is placed against the umbilicus following birth.
High dose penicillin, anti toxin serum and artificial ventilation may all be required to control and care for infected patients. It should be remembered that these patients also require active vaccination against tetanus as the disease does not protect against further attacks.
Vaccination remains the best and most cost-effective preventative measure with long lasting immunity.
Vaccination provides cover for a period of 10 years and possibly longer.