VPD Surveillance Manual, 5th Edition, 2011 Tetanus: Chapter 16-116

Tetanus is an acute, potentially fatal disease that is characterized by generalized increased rigidity and convulsive spasms of skeletal muscles. Tetanus is caused by the spore-forming bacterium Clostridium tetani. C. tetani spores (the dormant form of the organism) are found in soil and in animal and human feces. The spores enter the body through breaks in the skin, and germinate under low-oxygen conditions. Puncture wounds and wounds with a significant amount of tissue injury are more likely to promote germination. The organisms produce a potent toxin tetanospasmin which is absorbed into the bloodstream. The toxin then reaches the nervous system, causing painful and often violent muscular contractions. The muscle stiffness usually first involves the jaw (lockjaw) and neck, and later becomes generalized. Tetanus is a noncommunicable disease—it is not transmitted from one person to another. II. Background In the United States, the reported mortality due to tetanus has declined at a constant rate since the early 1900s, and documented tetanus incidence has declined since the mid- to late 1940s, when national reporting of tetanus cases began (Figure 1). In 2009, a total of 19 tetanus cases and 2 deaths were reported to the national tetanus surveillance system. Several factors hav