Abstract
IntroductionThe causative agent of tetanus, Clostridium tetani is widespread in the environment throughout the world and cannot be eradicated. To reduce the number of cases of tetanus efforts are focussed on prevention using vaccination and post-exposure wound care.Sources of dataMedline, Pubmed and Cochrane databases; World Health Organization and United Nations Children's Fund publications.Areas of agreementThe maternal and neonatal tetanus elimination initiative has resulted in significant reductions in mortality from neonatal tetanus throughout the world.Areas of controversyAlthough there are few data available it is likely that large numbers of children and adults, particularly men, remain unprotected due to lack of booster immunization.Areas timely for developing researchIt remains unclear how HIV and malaria affect both responses to vaccination and transplacental transfer of antibodies or how this might affect timing of vaccination doses.
Highlights
The causative agent of tetanus, Clostridium tetani is widespread in the environment throughout the world and cannot be eradicated
Tetanus is caused by a potent neurotoxin produced by the bacterium Clostridium tetani
As tetanus spores are present throughout the world, and are resistant to heat and chemicals,[7] unvaccinated individuals sustaining wounds contaminated with C tetani spores are always at risk of the disease and herd immunity plays no part in tetanus prevention
Summary
Tetanus is caused by a potent neurotoxin produced by the bacterium Clostridium tetani. The toxin is taken up from motor endplates and undergoes retrograde transport into the central nervous system.[3,4,5] The precise mechanism by which it crosses the synapse is still unclear but the N-terminal of the heavy chain mediates light chain entry into the pre-synaptic inhibitory neurone and where it cleaves synaptobrevin (vesicle associated monophosphate 2).[6] This molecule is necessary for pre-synaptic docking and subsequent neurotransmitter release of synaptic vesicles the tetanus toxin disinhibits the motor neurones This results in unrestrained alpha motor neurone discharge and muscle contraction. As tetanus spores are present throughout the world, and are resistant to heat and chemicals,[7] unvaccinated individuals sustaining wounds contaminated with C tetani spores are always at risk of the disease and herd immunity plays no part in tetanus prevention Due to their continued presence in the environment, complete eradication is unlikely and cases will continue to occur. At that point an estimated 800 000 neonates a year were affected by the disease with a mortality rate of 6.7 per 1000 live births.[14]
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