Tetanus vaccine: Indications, side effects and contraindications.

Effects Tetanus vaccine Side Tetanus vaccine: Tetanus is an acute infectious disease caused by clostridium tetani, and characterized by intermittent tonic spasms of the masseters; resulting in what is commonly known as lock jaw. Worldwide tetanus causes almost 50,000 deaths annually. Generally the elderly patients and patients with significant burn injuries and surgical wounds are the most susceptible of developing tetanus. Infections may also be seen post partum in the uterus known as maternal tetanus and in new borns near the umbilical region known as tetanus neonatroum. Clinically the disease does not confer immunity. Tetanus is a preventable disease of great significance particularly the neonatal form in developing countries. The manifestations of tetanus are caused by an exotoxin (tetanospasmin) elaborated by clostridium tetani, a gram positive anaerobic spore forming bacillus. Tetanus may follow trivial or even inapparent wounds if the oxygen content of the injured tissue is low.the toxin may enter the CNS along the peripheral motor nerves or maybe blood borne to the nervous tissue. The incubation period ranges from 2 to 50 days.The primary immunization against tetanus with either the fluid or absorbed toxoid is superior to giving antitoxin at the time of injury. Routine diphtheria, tetanus, pertussis (DPT) immunizations and booster recommendations are given. These vaccines are toxoids prepared from corynebacterium diptheriae and clostridium tetani, respectively. The whole cell pertussis vaccine is composed of formaldehyde treated bacterial cell wall fragments from bordetella pertussis and combined with D and T. acellular pertussis vaccines consisting of the semipurified or purified components of the pertussis bacteria combined with D and T are primary series of vaccinations at 2, 4 and 6 months of age and booster vaccines the 4th and 5th doses at 15 to 20months and 4 to 6 years. Adverse events after immunization that usually contraindicate further use of pertussis vaccine include encephalopathy within 7 days, a convulsions with or without fever, within 3 days. Persistent, severe, inconsolable screaming and crying for over 3 hrs. collapse or shock like state within 48hrs; temperature of >40.5degress(104.9 F) unexplained by another cause within 8hrs; and immediate severe anaphylactic reaction to the vaccine. With the exception of encephalopathy for which comparative is unknown all these reaction appear to occur less frequently with DTaP than DTwP. The initial series of three primary doses of DTP is followed by a booster at age 15 to 20 months and another at 4 to 6 yrs. Subsequent routine tetanus booster which are recommended for both adults and children should be administered every 10 yrs. The use of adult type tetanus and diphtheria toxoids adsorbed TD is preffered for these boosters, and studies are underway to assess the use of DTaP in adolscents and adults. Because adverse reactions to toxoids may occur, more frequent Td boosters are unwarranted. At any interval after initial immunization, immunity can be reestablished by a single booster, however after an interval of >10yrs from the last injection of tetanus toxoid the rate of antibody rise to the booster response may somewhat be slower.