• 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.