Study on Tetanus: U.S. and Global
Tetanus is an acute neuromuscular disease that occurs as a result of infection by the bacteria Clostridium tetani, a gram-positive, obligate anaerobic bacillus that is resilient to high temperatures and common disinfectants, and their spores are found worldwide, most commonly in soil and animal feces. It is caused by the infection of C. tetani and can be contracted through breaks in the skin through clean superficial wounds, surgical procedures, insect bites, dental infections, compound fractures, chronic sores, intravenous drug use, and intramuscular injections.
In the United States, there are no specific hospital lab tests — not including the ELISA blood test, which can be used to identify various antibodies — that can confirm a case of tetanus, which means a majority of cases must be diagnosed by potentially lengthy processes of asking patients if they have recently sustained any cuts, scrapes, punctures, trauma, and a clinical examination of any signs or symptoms.1
An appropriate measure to address the lack of hospital testing in the United States would be through the use of a Tetanus Quick Stick (TQS), primarily used in French-speaking countries, both developed and developing, to determine adequate immunization against tetanus in ER patients presenting with tetanus-prone wounds.2 The TQS can produce reliable results within 10 minutes using a drop of blood, is easy to use following a brief training, and is appropriate and cost-effective to use in the ER for patients who have tetanus-prone wounds who do not remember or cannot give their tetanus immunization history (e.g., unconscious) and in patients who report incomplete vaccination histories.3
In the United States, 29 cases of tetanus were reported, with a case-fatality rate of 13.2%.4 According to the National Health Interview Survey, only 63.4% of adults over 19 years of age reported having a tetanus toxoid-containing vaccination within the past 10 years.5 With over 30% of the United States population not reporting an up-to-date tetanus vaccination, it could be cost-effective to implement the TQS in the ER by saving upwards of $3 per person exhibiting tetanus-prone wounds and symptoms and increase chances of survival from tetanus related complications.3
On a global scale, in 2019, the Global Burden of Disease study reported over 73,000 total tetanus cases, and another study estimated 30 million children did not complete their primary doses containing the tetanus vaccine.6,7 Tetanus is more likely to occur in developing countries where vaccination rates are low, so the benefits of a TQS would be much higher in places where tetanus vaccination rates are low but susceptibility is high. One final recommendation would be to vaccinate mothers and newborns as early as possible so that the high rates of neonatal tetanus cases can be mitigated in developing countries.7
References
National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Diagnosing and treating tetanus (lockjaw) | CDC. Centers for Disease Control and Prevention Website. Accessed Mar 3, 2023 from https://www.cdc.gov/tetanus/about/diagnosis-treatment.html. Updated 2022a, August 29..
Martín-Casquero, T, Ruescas-Escolano, E, Tuells, J. Use of the tetanus quick stick (TQS) test in the emergency services. Medicina Clínica (English Edition). 2019;153(10):394–401. https://www.sciencedirect.com/science/article/pii/S2387020619304541. doi: 10.1016/j.medcle.2019.06.016.
Hatamabadi, HR, Abdalvand, A, Safari, S, et al. Tetanus quick stick as an applicable and cost-effective test in assessment of immunity status. Am J Emerg Med. 2011;29(7):717–720. Accessed Mar 3, 2023. doi: 10.1016/j.ajem.2010.01.046.
Mcelaney, P., Iyanaga, M., Monks, S., & Michelson, E. (2019). The Quick and Dirty: A Tetanus Case Report. Clinical practice and cases in emergency medicine, 3(1), 55–58. https://doi.org/10.5811/cpcem.2019.1.41301.
National Institutes of Health. (2017). National Health Interview Survey: Estimated proportion of adults aged ≥19 years who in the past 10 years received any tetanus vaccination and Tdap vaccination, by race/ethnicity and overall by age group. National Institutes of Health. Accessed from https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html#tetanus.
Causey, K., Fullman, N., Sorensen, R. J. D., Galles, N. C., Zheng, P., Aravkin, A., Danovaro-Holliday, M. C., Martinez-Piedra, R., Sodha, S. V., Velandia-González, M. P., Gacic-Dobo, M., Castro, E., He, J., Schipp, M., Deen, A., Hay, S. I., Lim, S. S., & Mosser, J. F. (2021). Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet (London, England), 398(10299), 522–534. https://doi.org/10.1016/S0140-6736(21)01337-4.
GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9.
Durbacă S. Antitetanus and antidiphtheria immunity in newborns. Roum Arch Microbiol Immunol. 1999;58(3–4):267–272.
*I used a lot of this information from a group project, utilizing only my own writing and sources of information to create.