Current Topics in Tetanus

Remarkable decrease in the incidence of tetanus during the past 40 years in Japan depends on the decrease of neonatal tetanus resulted from the popularization of hospital delivery and on the decrease among the young who received primary vaccination. Today, approximately 50 fatal cases of tetanus are annually reported in Japan. Most of these cases are elderly, previously nonimmunized patients who did not experience primary vaccination in their youth. Death from tetanus results most commonly from such complications as pneumonia, cardiovascular instability, renal failure, gastrointestinal hemorrhage, and etc. during the long course of intensive care, while, recently, death from asphyxia is rare. Sympathetic overactivity is a characteristic syndrome whose features include labile hypertension, tachycardia, arrythmia, profuse sweating and pyrexia. This syndrome is still resistant to conventional therapy and is one of the major causes of death. Prophylaxis treatment in the wounded patients, particularly in the elderly, nonimmunized patients who have tetanus-prone wounds has to be emphasized