Prevention and Control of Clostridium tetani infections

Prevention and Control

◗ Active immunization

Tetanus is completely preventable by active immunization.

·           Active immunization by vaccination with tetanus toxoid is the key to preventing tetanus.

·           Vaccination is carried out by toxoids, which are available either as plain toxoid or adsorbed on aluminum hydroxide or phosphate.

·           The toxoid is given alone or in combination with diphtheria toxoid and acellular pertussis (whooping cough) (DTaP or triple) vaccine.

Immunization for prevention  of neonatal tetanus:

Neonatal tetanus is prevented by increasing immunization in women of childbearing age, especially pregnant women, and by improving maternity care. For previously unimmunized preg-nant women, tetanus toxoid is given twice during pregnancy, 4–6 week apart, preferably in the last two trimesters and again at least 4 weeks before delivery. Maternal antitetanus antibodies are passed to the fetus, and this passive immunity is effective for many months after birth of the child.

◗ Passive immunization

Human TIG is used for passive immunization. In countries where TIG is not available, ATS is also used for the purpose. Passive immunization is carried out by intramuscular administration of 250–500 IU of TIG or by subcutaneous or intramuscular injections of 1500 units of ATS. Passive immunization is recommended for:

·           nonimmunized individuals and

·           for those whose immunization status is uncertain when-ever a wound is contaminated or likely to have devitalized tissue.

◗ Combined immunization

Secondary prevention of tetanus is achieved postexposure through appropriate wound cleansing and debridement, and combined immunization. Combined immunization is carried out by simultaneous administration of (a) human TIG or the ATS and (b) tetanus toxoid. It is indicated if the patient has not been previously immunized with a series of at least three doses of toxoid.