Info

1. 5 years or less since last dose

No

No

No

No

2. 5 to 10 years since last dose

No

No

Yes

No

3. more than 10 years since last dose

Yes

No

Yes

No

Neonatal tetanus can be prevented by immunizing expectant mothers. Their infants are then protected by antitoxin crossing the placenta. Since 1989, the World Health Organization has been attempting to eliminate neonatal tetanus. In 1997, there were an estimated 277,400 neonatal deaths from tetanus, as compared with 490,000 in 1994. The decrease in deaths largely resulted from immunizing millions of expectant mothers in developing countries against tetanus and educating them in the care of the severed umbilical cord.

Tetanus is treated by administering tetanus antitoxin, which is antibody against tetanospasmin, to neutralize any of the toxin not yet attached to motor nerve cells. The antitoxin of choice is tetanus immune globulin (TIG), human gamma globulin with a high titer of tetanus antitoxin, which is prepared from blood of humans immunized with tetanus toxoid. This antitoxin generally does not cause hypersensitivity reactions in humans and is much more effective than the antitoxin formerly used which was derived from the blood of horses immunized with toxoid. TIG, however, cannot neutralize tetanospasmin that is already bound to nerve tissue. This explains why tetanus antitoxin is often ineffective in treating the disease. In addition to antitoxin treatment, the wound is thoroughly cleaned of all dead tissue and foreign material that could provide anaerobic conditions. An antibacterial medication such as metronidazole is given to kill any actively multiplying Clostridia and thereby prevent the formation of more tetanospasmin. Antibacterials do not kill endospores or nongrowing bacteria, however. ■ hyperimmune globulin, p. 420

Table 27.4 describes the main features of tetanus.

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