Tetanus is caused by a potent neurotoxin produced by Clostridium tetani, a spore forming bacteria which are widespread in environment and soil as well as in house dust and faeces.   Spores can enter even a smallest wound where under anaerobic conditions neurotoxin is formed in the body which is transported up the nerves, binding irreversibly to neurons where inhibition of neuronal transmitters leads to spastic or rigid paralysis. This is often fatal due to cardiovascular or respiratory failure. Tetanus is now a rare disease in the western world with approximately 10 cases per year reported in the UK, although an increase in tetanus is associated among the elderly and intravenous drug users. However, tetanus is still a problem in developing countries, particularly as neonatal tetanus, which is responsible for highest mortality among the vaccine presentable diseases.

Tetanus is a non contagious disease and vaccination is known to provide protection by production of antibodies to the toxin. The vaccine is produced from chemically inactivated toxin, known as toxoid, using a traditional method developed in the 1940’s.  It is presented singly or in combination with other bacterial and/or viral antigens to form part of the primary immunisation of children (e.g. DTaP or DTwP in combinations with IPV, Hib and/or HepB). Tetanus toxoid is also included in vaccines for reinforcement of immunity of adults, where it may be presented in reduced antigen form often presented together with Diphtheria and IPV.

As part of therapeutic intervention, human Tetanus immunoglobulin is available but it must be given within a few hours of diagnosis, as once the toxin binds to the cell receptor, toxicity is non reversible.