COMMUNICABLE DISEASE MANUAL POLICIES / PROCEDURES
TETANUS (Lockjaw)
OBJECTIVE:
Control and management of Tetanus
DESCRIPTION:
Tetanus, by clinical case definition, is an acute neurological disease with
severe “onset of hypertonia and/or painful muscular contractions (usually of the
muscles of the jaw and neck) and generalized muscle spasms without other
apparent medical cause”. This disease is caused by a potent neurotoxin
produced by the clostridium tetani bacillus in a contaminated wound. (Those
with devitalized tissue and deep puncture trauma are at greatest risk). The
organism is a normal inhabitant of soil, animal, and human intestines. The
incubation period is 3 days to 3 weeks - the average being 8 days. It is usually
5-14 days in neonates. Regardless of immunization status, all wounds need to
be properly cleansed and debrided. Wounds need to receive prompt surgical
treatment to remove all devitalized tissue and foreign material as an essential
part of tetanus prophylaxis. Sterilization of hospital supplies will prevent the
infrequent instances of tetanus. Tetanus is not transmitted or communicable
from person-to-person. (See Tetanus Timeline)
EQUIPMENT:
MDSS User Manual and disease specific form found in MDSS. Also MDCH
Web site at www.michigan.gov/mdch, www.michigan.gov/cdinfo and CDC
Web site at www.cdc.gov/ncidod/diseases.
POLICY:
Legal Responsibility: Michigan's communicable disease rules of Act No. 368 of
the Public Acts of 1978, as amended, being 333.5111 of the Michigan
Compiled Laws. Follow-up time within 72 hours post referral and enter
into MDSS within 24 hours of receipt of referral
PROCEDURE:
A.
B.
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Case Investigation
1.
Referral received per phone call, laboratory results, or
automatically through MDSS. Document all case follow up
activities.
2.
Contact MD and/or client to start process of completing disease
specific form in MDSS. If case meets clinical case definition,
notify MDCH Immunization Vaccine Preventable Disease (VPD)
at 517-335-8159 and send MDCH Fax Notification of Serious
Communicable Disease.
3.
Assess DPT, DT or Td immunization status.
Laboratory Confirmation:
1.
There are no laboratory findings characteristic of tetanus. The
diagnosis is entirely clinical and does not depend upon
bacteriologic confirmation.
2.
Clostridium tetani is recovered from the wound in only 30% of
cases, and not infrequently, it is isolated from patients who do
not have tetanus.
3.
C.
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Sera collected before TIG is administered can demonstrate
susceptibility of a patient to the disease.
Immunity/Susceptibility:
1.
Susceptibility to tetanus is general. Immunity is conferred by
active immunization with tetanus toxoid and persists for ten (10)
years after full immunization. Booster doses of tetanus toxoid
(given combined with diphtheria toxoid in the form of Td) are
indicated every ten (10) years.
2.
Because of waning antitoxin titers, most individuals have
antitoxin levels below optimal levels ten (10) years after the last
dose of tetanus antitoxin.
3.
Serologic studies of the U.S. population demonstrate an
excellent correlation between vaccination coverage and
immunity to tetanus among children. However, antibody levels
decline over time, and one-fifth of older children (10-16 years of
age) do not have protective antibody levels. Immunity levels are
lowest among the elderly.
A national population-based
seroprevalence survey found that 72% of adults > 70 years of
age lacked protective levels of tetanus antibodies (>0.15 IV/ml)
[Gergen PJ, et al. A population-based serologic survey of
immunity to tetanus in the United States. N Engl J Med
1995:332:761-6.]
Control Measures:
1.
Prompt recognition of tetanus is important because
hospitalization may be required. Prompt administration of
tetanus toxoid and TIG may decrease the severity of the
disease. Because tetanus is a rare disease, public health
authorities may be consulted on clinical management issues.
2.
If clinical case definition is met (clinically compatible, reported by
a health care professional), regard as true tetanus case.
3.
Provide case treatment information, if needed, to care provider.
Follow current Red Book guidelines.
4.
Assure household members that tetanus is not transmissible
person-to-person.
5.
Educate household members and general public in managing
future wounds. An excellent Question and Answer Tetanus
Information Sheet from the Immunization Action Coalition is
included with your Fact Sheets in this policy.
6.
Promote immunization of Td for adolescent girls and women of
childbearing age and other adults when Td vaccine is indicated.
Utilize current immunization schedule for children.
E.
Complete case investigation using disease specific forms located in
MDSS. (See MDSS User Manual for entry instructions.)
1.
Follow-up with the case or provider one (1) month after the onset
of disease to determine clinical outcome/patient status
(Recovered, Convalescing, or Died). Also collect any previously
missing information for the Tetanus Surveillance Worksheet,
with special attention to the following:







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2.
Number of days hospitalized;
Number of days in ICU;
Number of days received mechanical ventilation;
Post-wound therapy (Tetanus toxoid and Tetanus
Immune Globulin);
Age at onset;
Circumstances of any antecedent injury;
Tetanus toxoid vaccination history.
In the event of death, obtain and send copies of hospital
discharge summary, death certificate, and autopsy report to
MDCH Immunization Division.
Address:
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Michigan Department of Community Health
Immunization Division
Attn: Immunization Coordinator
201 Townsend Street
PO Box 30195
Lansing MI 48913
Refer to current Red Book, current Control of Communicable
Diseases Manual, current Epidemiology and Prevention of Vaccine
Preventable
Diseases,
and
VPD
Guidelines
at
www.michigan.gov/immunize.