Medical Microbiology

Clostridium 249

Epidemiologyandprophylaxis.Tetanusisnowrareindevelopedcountries

duetowidespreadvaccinationpracticewithincidenceratesofapproximately

onecasepermillioninhabitantsperyear.Thefrequencyofoccurrenceis

muchhigherindevelopingorunderdevelopedcountries.Worldwide,about

300000 personscontracttetanuseveryyear,withalethalityrateofapproxi-

mately 50 %.Thus,theimportanceoftheactivevaccinationasaprotective

measurecanhardlybeoverstated(seep. 33 forvaccinationschedule).A

doseofTdshouldbeadministeredonceevery 10 yearstosustainprotection

(p.33).Aboostershotisalsorequiredincaseofsevereinjuryifthepatient’s

lastinoculationwasadministeredlongerthanfiveyearsbefore,andincaseof

minorinjurylongerthan 10 years.Humantetanusimmunoglobulin(250IU)

Tetanus

Fig.4. 8 aOpenlower-legfracturefollow-

ingatrafficaccident;theportalofentry

ofC.tetani.

bRisussardonicus:fullymanifestcaseof

tetanusinapatientwithlower-legfracture.

Patientwasnotvaccinated.

4

Kayser, Medical Microbiology © 2005 Thieme