TETANUS

Last updated: 06 September 2004

1. Reason for surveillance

• To identify failures in immunisation and so inform better prevention strategies.

2. Case definition

A confirmed case requires

• Laboratory definitive evidence, or

• Clinical evidence.

Laboratory definitive evidence
Isolation of Clostridium tetani from a wound in a compatible clinical setting and prevention of positive tetanospasm in mouse test from such an isolate using specific tetanus antitoxin.

Clinical evidence
A clinically compatible illness without other apparent cause.

Epidemiological evidence
Not applicable.

3. Notification criteria and procedure

Tetanus is to be notified by:

• Hospital CEOs on clinical diagnosis (ideal reporting by telephone or routine mail)

• School principals and directors of child care facilities (ideal reporting by telephone on same day of notification).

Only confirmed cases should be entered onto NDD.

4. The disease

Infectious agent
Neurotoxin produced by the bacillus Clostridium tetani.

Mode of transmission
Tetanus is transmitted by spores introduced into the body, usually through a puncture wound. The presence of necrotic tissue and/or foreign bodies favours growth of the anaerobe that produces the neurotoxin. Tetanus is not directly transmitted from person-to-person.

Timeline
The typical incubation period is 3 to 21 days, average 10 days.

Clinical manifestations
The usual clinical presentation is acute onset of hypertonia and/or painful muscular contractions (usually of the muscles of the jaw and neck) and generalised muscle spasms without other apparent medical cause; with or without history of injury. The case-fatality rate can vary from 10 to 90 percent, being highest in infants and the elderly.

5. Managing single notifications

Response time
Investigation
Within 3 days of notification of a confirmed case begin follow-up investigation.

Data entry
Within 5 working days of notification enter confirmed cases on NDD.

Email deidentified case details to the Communicable Diseases Branch, including results of investigations, within 5 working days of notification.

Response procedure
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:

• Confirm the onset date and symptoms

• Find out if the case or relevant care-giver has been told what the diagnosis is before beginning the interview

• Seek the doctor's permission to contact the case or relevant care-giver

• Review case management

• Identify contributing factors.

Case management
Investigation and treatment
Treatment is supportive. Ascertain tetanus immunisation history.

Education
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission.

Exposure investigation
Interview the case or next of kin about possible sources of infection, including: puncture wounds contaminated with soil, dust or animal or human faeces; burns; trivial wounds; use of injecting drugs; body piercing or surgical procedures. Ascertain whether preventative measures were taken, including post-exposure prophylaxis.

Isolation and restriction
None

Environmental evaluation
None