Tetanus
 
Current Case Definition for Surveillance
The clinical case definition of tetanus is: "Acute onset of
hypertonia and/or painful muscular contractions (usually of the
muscles of the jaw and neck) and generalized muscles spasms without
other apparent medical cause." Cases meeting the clinical case
definition, as reported by a health care professional, are considered
confirmed.
Photo Courtesy of the Centers
for Disease Control
Immunization
Although passive immunization with tetanus antitoxin was used during
World War I, tetanus toxoid was first produced in 1924, used extensively
in the armed services during World War II, and introduced into routine
childhood immunization in the late 1940's. Essentially all recipients
achieve protective antitoxin levels after completing a series of
four properly spaced doses of toxoid (or three doses in those seven
years old or older). Most persons have antitoxin levels that approach
the minimal protective level by ten years after the last dose; thus,
routine boosters are recommended every ten years. Cases of tetanus
in fully immunized persons whose last dose of toxoid was within
the last 10 years are extremely rare.
In Maryland, tetanus immunization is required by law for entry
into pre-school programs, and kindergarten through grade twelve.
Based on the 1998/99 retrospective kindergarten survey, an estimated
78% of children in Maryland had received four doses of DTP by 24
months of age, (compared to 60% in the 1988/89 survey).
Historical Trends (see graphs below)
The maximum number of tetanus cases ever reported during any one
year in Maryland was 43 in 1928. There has been a steady decline
in the five-year mean tetanus rates since 1928. From 1967 to 1998
no more than three cases per year have been reported in Maryland,
with only 36 cases for the thirty-year period. Although tetanus
has been a relatively rare disease in Maryland, even in the pre-vaccine
era, the case fatality rate remains approximately 30% (in the United
States). Almost all reported cases of tetanus in the United States
are in persons who either have never been vaccinated or who completed
a primary series but have not received a booster in the preceding
10 years.
Figure
1. Five Year Mean Tetanus Rates. Maryland, 1918-1988.
Table of Contents
Center for Immunization Home
Page
|
are PDF. Download