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What is the history of Tetanus in America and other countries?


The first clinical description of tetanus disease dates back to records from 5th century BC, however it was 1884 before experiments with tetanus were published and reported on within the medical community. In 1884, two Italian scientists were able to cause tetanus infections in animals by injecting them with pus originating from a case of fatal human tetanus disease.1 Also in 1884, German physician Arthur Nicolaier induced tetanus in mice by injecting them with tetanus contaminated soil.2

In 1889, Japanese bacteriologist and physician Kitasato Shibasaburo isolated the tetanus bacteria from a human victim of the disease, confirmed its ability to cause the disease when injected into animals, and proved that the bacteria could only reproduce in environments that did not contain oxygen.34

Following isolation of the tetanus bacteria, pharmaceutical companies began developing anti-serums against tetanus. By the early 1900’s, several pharmaceutical companies had tetanus anti-serums available for use against tetanus. Anti-serums were often produced in horses, and when antibodies developed, the horses were bled to harvest the serum antitoxins for use in the treatment of tetanus disease. 5

In World War I, soldiers were often administered tetanus anti-serums for both the prevention of as well as for the treatment of tetanus disease. World War I battles were frequently fought in fields and trenches, and soldiers often sustained shrapnel wounds which enhanced the risk of tetanus disease. Due to the significant risk of tetanus disease among enlisted men, military physicians felt it necessary to use tetanus anti-toxins and even experimented on soldiers using varying strengths and numbers of doses in the hopes of both treating and preventing tetanus disease in the battlefield. As a result, many soldiers suffered from serum sickness and even allergic reactions from the use of tetanus anti-serums.6 The first vaccine targeting tetanus disease, the tetanus toxoid (TT), was developed in 19247 but did not become commercially available until 1938.8

Significant decreases in mortality rates from tetanus disease in the United States have been noted by public health officials since the early 1900’s, however, the disease did not become nationally notifiable until 1947.9 In 1948, there were 601 cases of tetanus reported in the U.S., the highest number of cases ever reported in a single year.10 After the 1940s, the incidence of tetanus disease declined steadily and by the mid-1970s, an average of 50–100 cases (~0.05 cases per 100,000) were reported annually.11

Between 1982 and 1984, there were a total of 253 reported tetanus cases in the United States. Of the 224 reported cases where age demographic information was provided, 159 cases (71 percent) occurred in adults 50 years of age and older, while 56 cases (25 percent) occurred in adults 20 to 49 years of age. 6 cases were reported in persons under the age of 19, including 3 cases of neonatal tetanus. 26 percent of individuals who developed tetanus died and all deaths occurred in persons over the age of 30, with the majority of deaths (52 percent) occurring among adults 60 years and older. 11 individuals who developed tetanus disease had previously received at least three doses of tetanus toxoid vaccine. Of the 56 individuals who received wound debridement following the injury but prior to the onset of tetanus, 55 were considered candidates to receive both the tetanus immune globulin (TIG) and the recommended tetanus-diphtheria (Td) vaccine, yet healthcare providers failed to administer the recommended TIG in all cases and administered Td vaccine in only 40 percent of the cases.12

In 1987 and 1988, there were 101 reported cases of tetanus disease (48 cases in 1987 and 53 in 1988). Age demographics were reported in 99 cases, with 67 cases occurring in adults 50 years of age and older and 6 cases reported in children under 20 years of age. The case fatality rate was reported at 21 percent. Of the 48 cases where vaccine status was known, 29 reported no prior tetanus vaccination. In the tetanus cases involving persons under the age of 20, half (3 out of the 6 cases) had received at least 3 doses of tetanus toxoid vaccine. In the 14 cases where wounds were serious enough to warrant wound debridement, health care providers failed to administer the recommended tetanus immune globulin (TIG) in all cases and administered Td vaccine in only 8 cases (57 percent).13

Between 2001 and 2008, there were a total of 233 reported cases of tetanus disease (average of 29 cases per year). Of the 197 cases where outcomes were known, 26 (13.2 percent) were fatal. Vaccination status was known for 92 out of the 233 cases (39.5 percent). 55 individuals (59.3 percent) reported receiving at least one dose of a tetanus toxoid vaccine (TT), with 24 (26.1 percent) reported having received at least 4 or more doses. Of the 195 cases where medical information was known, 30 cases (15.4 percent) occurred in individuals with diabetes. In 176 cases where data was known in regards to injection drug use, 27 cases (15.4 percent) involved injection drug users. One third of persons with an acute wound sought medical treatment, however, fewer than 4 percent received the recommended treatment protocol of either tetanus toxoid (TT) vaccine or TT vaccine in combination with TIG.14

From 2009 through 2015, there were an average of 28 tetanus cases and less than 3 deaths each year. Tetanus cases occurred most frequently among adults between the ages of 20 and 29, however all tetanus related deaths were reported in persons over the age of 55.15 In 2018, there were 20 cases of tetanus reported in the United States.16

According to the World Health Organization (WHO), there were 12,476 reported cases of tetanus worldwide in 2017.17 Of these reported cases, 2,266 were reported as neonatal tetanus. Neonatal tetanus can occur during a childbirth that takes place under unsanitary conditions and neonatal tetanus fatality rates are much higher, especially in developing countries.18

IMPORTANT NOTE: NVIC encourages you to become fully informed about Tetanus and the Tetanus vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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References

1 CDC Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

2 Brightman C Tetanus: an ever-present infection risk Trends in Urology & Men’s Health May/June 2018; p 29-31

3 CDC Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

4 Brightman C Tetanus: an ever-present infection risk Trends in Urology & Men’s Health May/June 2018; p 29-31

5 Smithsonian The Antibody Initiative-Battling Tetanus No Date

6 Ibid

7 CDC Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

8 CDC Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Apr. 27, 2018 / 67(2);1–44

9 CDC Surveillance Manual – Chapter 16 – Tetanus – Background Nov. 17, 2017

10 CDC Reported incidence of notifiable diseases in the United States, 1952 MMWR Oct. 26, 1953 1 (54); 1-10

11 CDC Reported morbidity and mortality in the United States annual summary 1980 MMWR Sep. 1981; 29(54); 1-144

12 CDC Current Trends Tetanus -- United States, 1982-1984 MMWR Oct. 04, 1985; 34(39);602,607-11

13 CDC Current Trends Tetanus -- United States, 1987 and 1988 MMWR Jan. 26, 1990; 39(3);37-41

14 CDC Tetanus Surveillance --- United States, 2001—2008 MMWR Apr. 1, 2011; 60(12);365-369

15 CDC Surveillance Manual – Chapter 16 – Tetanus – Background Nov. 17, 2017

16 CDC National Notifiable Diseases Surveillance System, Weekly Tables of Infectious Disease Data. Table 2q - 2018 – Week 52.  Atlanta, GA. CDC Division of Health Informatics and Surveillance. 

17 WHO Tetanus – 2017 Global Figures Nov. 2, 2018

18 WHO Neonatal Tetanus – 2017 Global Figures Nov. 2, 2018


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