Tetanus is not communicable but acquired through environmental exposure to the spores of the Gram positive, spore-forming bacillus Clostridium tetani, which may infect human wounds and cause disease by production of an exotoxin (tetanospasmin).
The disease occurs worldwide, it is sporadic in high-income countries with universal access to well accepted immunization programs; it is more common in agricultural regions and in low-income countries where contact with animal excreta is more likely and immunization program inadequate.
Neonatal tetanus (NNT) following unclean deliveries and poor postnatal hygiene is still responsible for the majority of tetanus cases and deaths; the majority of NNT occur in poor Asian and African countries, in high-income countries the disease is extremely rare.
Three forms of clinical disease can be distinguished: the most common form is generalized tetanus, whereas local tetanus and cephalic tetanus are rare. Neonatal tetanus is a form of generalized tetanus in newborns.
The case fatality rate of tetanus is high, 10-90% depending on age, immune- and immunization-status and form of disease.
Efficacy of tetanus toxoid vaccines is between 90 and 100%.
Following the integration of tetanus vaccine (as DTP combination vaccine) into the immunization schedule recommended by WHO´s Expanded Immunization Programme, the global DTP coverage increased worldwide from 25 % in 1980 to 85% in 2008. In the same period, tetanus cases and deaths decreased inversely.
A similar development occurred with NNT: in 2008 the global coverage of TT2 (2 doses of tetanus toxoid administered to women of childbearing age or during early pregnancy) increased to 75%. 60 000 TNT cases were reported, a 92% decrease compared to 1980.