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Tetanus is an acute, potentially fatal disease of the central nervous system. It is caused by a neurotoxin produced by a bacterium, Clostridium tetani, the spores of which are commonly found in soil, and widespread in the environment worldwide. Tetanus is found throughout the world but is particularly prevalent in: China, India, throughout Africa, and in certain South American countries including Peru, Colombia and Ecuador. People of all ages can contract tetanus but the disease is more common in newborn babies (neonatal tetanus), particularly common in rural areas, when the umbilical stump becomes infected, and usually proves fatal.

How is contracted?
The disease is spread through open cuts and wounds that have been contaminated with spore containing soil, street dust, human faeces or by injecting drug use, and occasionally through abdominal surgery. It is not contagious.

Signs and symptoms
There are three main types of tetanus but ‘generalised tetanus’ accounts for about 80% cases. The incubation period ranges from 3 to 21 days, usually about 8 days, and the tetanus toxin spreads through the bloodstream and can cause serious damage to the nervous system [45]. In general the further the injury site is from the central nervous system, the longer the incubation period. Early symptoms of the disease include lockjaw, difficulties swallowing and muscle spasms. The disease can spread to affect more muscles in the body including the respiratory muscles. This can cause difficulties with breathing and death can occur unless supportive treatment is given. 

Most people survive the infection, although spasms continue for 3-4 weeks and complete recovery may take months [45]. Fatality rates vary from 10–90% and are highest in infants and the elderly [46]. In general, the shorter the incubation period, the higher the chance of death [45].

Treatment for tetanus usually involves hospitalisation, and administration of antitoxins and antibiotics. Those infected will often require intensive care until the effects of the disease wear off, including the use of a ventilator to assist with breathing and help prevent suffocation. 

Recommendations for travellers
The best form of prevention is through vaccination. In the national immunisation programme, individuals should receive a vaccination schedule of at least five doses of tetanus-containing vaccine, as part of a national immunisation programme. Travellers to areas at risk may be recommended a single course injection of a combination vaccine which also covers against diphtheria and polio. Travellers should ensure that they have had a primary course of vaccine and receive a booster every 10 years with continued travel to high risk areas.

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Tetanus vaccination. Here’s the point...

Without treatment, complications of tetanus are likely to develop, which can be fatal. However, vaccination and improvements in treatment mean deaths from tetanus are now rare in the UK. In England and Wales in 2011, there were only three recorded cases of tetanus. However, the risk to unvaccinated travellers may be increased if adequate treatment is not readily available.