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Tetanus

Tetanus is a vaccine preventable disease caused by a bacterial spore which can be found in the intestines of animals and in the soil. It is an often fatal disease which affects all age groups. A person infected with the tetanus bacterium experiences painful muscle contractions that begin in the neck (hence the popular name "lockjaw") and then continue down to involve the muscles of the torso. The National Advisory Committee on Immunization (NACI) recommends immunization against tetanus.

About Tetanus

Agent of disease

Tetanus is caused by a neurotoxic spore (a powerful poison that act on nerves of the spinal cord) produced by the tetanus bacterium Clostridium tetani.

Symptoms

Once an individual is infected with tetanus, it can take 3 days to 3 weeks to develop symptoms. Symptoms begin with stiffness in the jaw and neck and difficulty swallowing. The individual then experiences stiffening of the muscles in the arms, legs and stomach accompanied by painful muscle contractions or spasms. The muscle spasms can be so intense that bones may break. Further complications include breathing problems, lung infections, coma and death. Death is highest in infants and the elderly and death rates vary between 10 and 90% depending primarily on the availability of intensive care resources.

Period of communicability

Tetanus can not be transmitted from person-to-person.

How it is transmitted

Tetanus spores contaminating soil, dust or faecal matter enter the human body through a puncture wound, laceration or burn. C. tetani does not require oxygen to survive; therefore, the presence of dead tissues or a foreign object provides the most favourable condition for the growth and production of the neurotoxin.

Worldwide Distribution

Occurrence is worldwide. Cases are sporadic and relatively uncommon in industrialized countries. In many developing countries in Asia, Africa and South America, the disease remains an important cause of death.

Prevention and control

Tetanus can be prevented by immunization.

  1. Immunization of all children is recommended at 2, 4, 6 and 18 months of age with a booster dose at 4 to 6 years of age.
  2. Teenagers and adults should receive a tetanus booster every 10 years (recommended at 15, 25, 35, 45 years, etc).
  3. In cases where an individual has been injured and suspected of not having sufficient immunity to the bacteria, a vaccine and antitoxin can be administered.

For further information about the immunization, please refer to the most recent version of the Canadian Immunization Guide.

Epidemiology of Tetanus in Canada

Tetanus is rare in Canada. During the 1920s and 1930s, 40 to 50 deaths from tetanus were reported annually. With the introduction of tetanus toxoid in Canada in 1940, morbidity and mortality rapidly declined (see Figure 1). Between 1980 and 2008, the number of cases reported annually ranged from 1 to 10, with an average of 4 per year. During this period, persons ≥60 years of age accounted for 48% of the cases. No cases were reported among neonates. The immunization status of most of the reported cases was not known. Only five deaths have been reported since 1980, with the last death reported in 1997.

Figure 1. The number of deaths and the number of cases of tetanus, by year, Canada, 1921-2008.

Figure 1 The number of deaths and the number of cases of tetanus, by year, Canada, 1921-2008.

Figure 1 - Text Equivalent

Tetanus Surveillance in Canada

In Canada, national surveillance of mumps is through the Canadian Notifiable Disease Surveillance System (CNDSS).

Tetanus Data

The following two tables contain recent data on the number of reported cases and incidence of tetanus in Canada from 2005 to 2010. Data from 2009 and 2011 are preliminary. For further surveillance data, please see the Notifiable Diseases On-Line webpage as well as the Publications section below.

Table 1. Reported cases of tetanus in Canada by year and age group, 2005 to 2011.
Year All Ages Less than 1 1 to 4 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 39 years 40 to 59 years 60 years or Greater Age Unspecified

*Data obtained from the Canadian Notifiable Disease Surveillance System.
†Preliminary data

2005* 4 0 0 0 0 0 0 0 2 1 1 0
2006* 2 0 0 0 0 0 0 0 0 1 1 0
2007* 6 0 0 1 0 0 0 0 2 1 2 0
2008* 1 0 0 0 0 0 0 0 0 1 0 0
2009 2 0 0 0 0 0 0 0 0 0 2 0
2010 0 0 0 0 0 0 0 0 0 0 0 0
2011 2 0 0 0 0 0 0 0 0 1 1 0
Table 2. Reported incidence per 100,000 population of tetanus in Canada by year and age group, 2005 to 2011.
Year All Ages Less than 1 1 to 4 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 39 years 40 to 59 years 60 years or Greater Age Unspecified

*Data obtained from the Canadian Notifiable Disease Surveillance System
†Preliminary data

2005* 0.0124 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0442 0.0103 0.0174 0.0000
2006* 0.0061 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0101 0.0169 0.0000
2007* 0.0182 0.0000 0.0000 0.0555 0.0000 0.0000 0.0000 0.0000 0.0445 0.0101 0.0325 0.0000
2008* 0.0030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0100 0.0000 0.0000
2009 0.0059 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0304 0.0000
2010 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000
2011 0.0058 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0098 0.0143 0.0000

Tetanus Resources

Case Definitions

Publications

Guidelines and Recommendations