How is Tetanus Prevented?
Due to the severity of the disease and because there is no completely effective treatment to cure the infection, the prevention of tetanus is the basis for controlling the disease. Its prevention is based on the early treatment of the wound (cleaning and disinfection) and the administration of a tetanus vaccine.
Effective prophylaxis combined with the high mortality of the disease justifies that prophylactic measures are taken despite the fact that the incidence and prevalence of it are not at all high.
It has a high mortality (even higher in newborns) and low morbidity. It is responsible for more than one million deaths annually, most of which correspond to developing countries. Its incidence is related to the sociocultural and hygienic-sanitary conditions and the immune status of the population, which explains the high incidence in those countries, as opposed to the low figures observed in the industrialized countries (less than 0.2 per 100,000 inhabitants/year).
The main reservoir is the intestinal tract of men and some animals (usual flora of herbivores and some non-herbivores such as rat, guinea pig, cat, dog, and even chicken), it is a very widespread microorganism, and it is common to detect their spores on soil and in the domestic dust. It is transmitted by direct or indirect contact with the floor and in 15% to 30% the entrance door goes unnoticed, although it is those wounds with greater tissue necrosis that imply greater risk (lacerations, puncture wounds, burns, etc.). The presence of infections and foreign bodies favors the multiplication of the microorganism. The entire population is susceptible to infection, and in addition, the condition does not confer immunity. Tetanus is not transmitted from person to person, but by contamination through the environment, although there is a possible form of transmission between humans through syringes of drug addicts by a parenteral route.
The time that elapses between the entry of the microorganism in the host and the appearance of the symptoms (incubation period) is from 3 to 21 days (8 days on average). In neonatal tetanus, symptoms appear between days 4 and 14 of birth (7 days on average).
Almost all cases of tetanus occur in people who are not immunized or who have inadequate immunization. Despite the fact that in industrialized countries, the organisms responsible for public health require the inclusion of tetanus vaccine in the childhood immunization schedule, the booster doses in adulthood are not usually administered. Therefore, the promotion of vaccines and the prevention of tetanus is a fundamental function that falls on all health professionals in the field of Primary/Specialized Care as well as in the working environment (occupational health, Mutuals or Prevention Services), which must be coordinated to achieve full coverage of the population, carrying out prevention programs and action procedures in case of accidental exposure.
Pre-exposure Prophylaxis
In many countries, the schedule of childhood vaccination includes the tetanus vaccine with doses of DTP (diphtheria, tetanus and whooping cough) at 2, 4, 6 and 18 months, and a booster dose with TD (without pertussis) at 4 years and another with TD (adult vaccine) at 14 years old. From there, a booster dose is recommended every 10 years for all adults and revaccination in case of more than 10 years of the last dose.
All partially or not immunized adults should be vaccinated, as well as those who are recovering from tetanus. The vaccination regimen in the adult consists of three doses, the second with an interval of 4-8 weeks and the third at 6-12 months of the first one; the delay in complying with the guidelines does not require the beginning of the program. Adults with an uncertain history of primary vaccination should receive all three doses. The use of the combined adsorbed toxoid of tetanus and diphtheria for adults is recommended.
Post-exposure prophylaxis
In the case of potentially infected wounds, the behavior to follow will depend on the vaccination status of the individual and the nature of wound.
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