Tetanus-diphtheria (Td)
Tetanus
This painful disease, which often results in death, was not uncommon in the United States in the nineteenth century. Wound management improved, and then in 1924 the first tetanus vaccine was produced. Up to that point, as many as 1500 persons contracted tetanus each year. A marked decrease in deaths occurred between the early 1900s and the late 1940s, when 500 to 600 cases were reported each year, causing 180 deaths. After the 1940s, the tetanus rates fell steadily, averaging fewer than 70 cases and 15 deaths per year. An all-time low of 36 cases was reported in 1996.
Tetanus in the newborn period occurs when mothers do not have tetanus antibodies to pass to their fetuses. Often the umbilical stump is infected because of improper cord care. The tetanus death rate in newborns is 95 percent without treatment. In the U.S. in 1900, 64 out of 100,000 infants less than 1 year of age died of tetanus. Since 1989, only two cases of tetanus in newborns have been reported in the U.S., but worldwide 270,000 newborns and 30,000 mothers still die annually.
Unfortunately, because the tetanus spores are ever present in the earth, we will never eradicate the disease. But the availability of the tetanus vaccine enables us to prevent persons from contracting the disease.
What is tetanus, and how is it spread?
Tetanus spores, which are scattered all over the earth, are so tough that they easily tolerate being sprayed with antiseptics or being heated to 250 degrees Fahrenheit for 10 to 15 minutes. They live in soil and street dust, and even in the bowels and stools of many domestic and farm animals. Tetanus is not contagious. One person cannot catch it from another person.
Occasionally a susceptible person gets a puncture wound, a dental or ear infection, or an animal bite, and the wound is contaminated with tetanus spores. In the wound, the spore germinates and begins to produce a poison. The poison blocks the nerve impulses that allow muscle relaxation, so the result is excruciating muscle spasms. The muscle spasms are so strong they can crack thighbones and vertebrae. The spasms also prevent the essential processes of swallowing and breathing. The most common form of death from tetanus is suffocation, because its victims cannot breathe.
Almost all reported cases of tetanus are in persons who either were never vaccinated or did not receive a booster within the ten years prior to the wound. From 1982 to 1997 in the U.S., two-thirds of the persons who developed tetanus were 50 or older.
This information is excerpted from the book Vaccinating Your Child: Questions and Answers for the Concerned Parent (Peachtree Publishers, Ltd., 2000). The book’s authors are Dr. Sharon G. Humiston, a pediatrician and clinical researcher at the CDC and the University of Rochester, and Cynthia Good, an award-winning journalist and host of the television show “Good for Parents”.
