Dirty wounds can become infected with the spores of Cl. tetani anywhere in the world. More common in agricultural regions and in areas where contact with animal excreta is more likely and immunization is inadequate.

Causative agent: Clostridium tetani. The disease is caused by the action of a potent neurotoxin produced by the bacterium in dead tissue e.g dirty wounds.

Transmission: Exposure to the spores of Clostridium tetani.

Incubation period: Usually 3 – 21 days, average 10 days.

Sign & Symptoms

The disease is characterized by painful muscular contractions, primarily of the masseter and neck muscles, secondarily of trunk muscles. A common first sign suggestive of tetanus is abdominal rigidity, sometimes confined to the region of injury.

Muscle spasms, initially muscles of mastication causing trismus or lockjaw which results in a characteristic facial expression – risus sardonicus.

Trismus can be followed by sustained spasm of the back muscles (opisthotonus) and by spasms of other muscles.

Mild external stimuli may trigger generalized, titanic seizures, which contribute to the serious complications of tetanus.


Fatality rate ranges between 10% to over 80%. Dysphagia and aspiration pneumonia lead to death.


Specific treatment

TIG im in doses of 3000 – 6000IU or Tetanus antitoxin, in a single large dose given iv after sensitivity testing.

i.v metronidazole in large doses given 7-14 days.

Prevention & Precautions

All travelers should be up to date with the vaccine.

Type of vaccine: Tetanus toxoid

Number of doses: At least three, given i.m

Schedule: 6, 10 and 14 weeks of age or schedule according to national immunization program

Booster: 3-4 years of age. Td booster every 10 years

Contraindications: Adverse reaction to a previous dose.

Adverse reactions: Mild local or systemic reaction is common

Before departure: As long as possible. Some protection after second dose

Recommended for: All but particularly aid/health care workers


Last Reviewed : 26 April 2012
Writer : Dr. Norhayati bt. Rusli
Accreditor : Dr. Alias b. Abdul Aziz
Reviewer : Dr. Muhaini Othman