Tetanus and Tetanus Neonatorum

Generalities
Agent	- Bacteria: clostridium tetani or tetanus bacillus - Toxin producer
Incubation period	- 3-21 days (1 day to several months), and commonly 10 days - Tetanus Neonatorum: 6 days (3-28 days)
Period of transmissibility	No person-to-person transmission
Reservoir	- Intestines of horses and animals, and humans - Tetanus spores are ubiquitous in environment and soil
Modes of transmission	- Skin entry: Introduction of spores through puncture wound contaminated with soil, street dust or animal or human feces - Rarely by injectable contaminated drugs - Tetanus Neonatorum: 1) During delivery: introduction via the umbilical cord of tetanus spores through the use of an unclean instrument to cut the cord; 2) After delivery: by dressing the umbilical stumps with substance heavily contaminated with tetanus spores
Clinical presentation	- Muscle contraction, trismus (masseter contraction), neck/ trunk spasms, opisthotonos - Case fatality from 10% to 90% depending on availability of intensive care - Tetanus Neonatorum: Few days after birth the infant develops progressively trismus, generalized stiffness, spasms, convulsions and opisthotonos. Typically, an infant who sucks and cries well for the first few days after birth, and then shows progressive difficulty and inability to feed. Complications: 80% as case fatality, 5-20% of mental retardation among survivors
Resources
Case definition	- MOPH circular no. 53 (2007) - MOPH circular no. 108 (2006): Tetanus Neonatorum
Forms	- General reporting form - Tetanus investigation form - Tetanus Neonatorum investigation form: Ar, Fr
Data	Refer to "Surveillance data" webpage