eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Tetanus: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 23, 2009

Follow-up

Further Inpatient Care

  • Patients with tetanus typically require intensive care.

Transfer

  • The patient should be transferred if the necessary services are not locally available.

Deterrence/Prevention

  • Tetanus is completely preventable by active immunization.
  • Immunizations for children include tetanus toxoid, usually in the form of diphtheria, tetanus, and acellular pertussis vaccine. The immunizations are recommended at age 2 months, 4 months, 6 months, 12-15 months, and 4-6 years. A tetanus, diphtheria, and pertussis (Tdap) booster dose is administered at age 11-12 years and thereafter every 10 years.
  • For the primary immunization of adults, tetanus toxoid is administered as 2 doses 4-6 weeks apart, with a third dose 6-12 months later. Booster doses are administered every 10 years or at the time of major injury if it occurs more than 5 years after a dose.
  • Passive immunization should be used in nonimmunized individuals and those whose immunization status is uncertain whenever a wound is contaminated or likely to have devitalized tissue. TIG is used for passive immunization.

Complications

  • Airway obstruction is common.
  • Urinary retention and constipation may develop because of sphincter spasm.
  • Respiratory failure and cardiac failure are late life-threatening events.4
  • Fractures may result from sustained spasms.
  • Seizures can occur.
  • Pulmonary emboli may develop.
  • Bacterial superinfections are possible complications.
  • Dehydration can develop.

Prognosis

High mortality rates are associated with the following:

  • Short incubation period
  • Early onset of convulsions
  • Delay in treatment
  • Contaminated lesions of the head and the face
  • Neonatal tetanus

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis in the appropriate context
  • Failure to provide adequate supportive care
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Sonali Ray, MD, to the development and writing of this article.



More on Tetanus

Overview: Tetanus
Differential Diagnoses & Workup: Tetanus
Treatment & Medication: Tetanus
Follow-up: Tetanus
References
Further Reading
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References

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Further Reading

An interesting online case is available at the Gorgas Course in Clinical Tropical Medicine.

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Keywords

tetanus, abscesses, airway obstruction, burns, cephalic tetanus, Clostridium tetani, C tetani, compound fractures, contaminated crush injury, decubitus ulcers, disease of the seventh day, frostbite, gangrene, generalized tetanus, hyperreflexia, hyperthermia, laryngeal spasm, localized tetanus, lockjaw, middle ear infections, neonatal tetanus, opisthotonus, rhabdomyolysis, septic abortion, synaptobrevin, tetanospasmin, tetanus neonatorum, trismus, urinary retention

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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