Copyright © 2017 American Academy of Pediatrics. From: Tetanus Red Book® 2015, 2015 Figure Legend: Tetanus is caused by a neurotoxin from the anaerobic bacterium Clostridium tetani and is characterized by muscle spasms that often are worsened by noise or other external stimuli. The muscle spasms can progress from mild to severe over a 1-week period. Severe spasms subside over a period of weeks if the patient survives. The clinical manifestations of tetanus include localized tetanus (local muscle spasm in areas contiguous with the infected wound), cephalic tetanus (dysfunction of the cranial nerves in association with a wound on the head or neck), and generalized tetanus (full body involvement). Neonatal tetanus remains prevalent in areas of the world where mothers have not been vaccinated and local umbilical cord care is poor. The diagnosis is made clinically, and treatment includes the use of human tetanus immune globulin, oral antimicrobial agents (metronidazole or penicillin) for 10 to 14 days, and other supportive measures (eg, ventilatory support, decreased external stimuli such as loud noises). In addition, all infected wounds should be cleaned properly and debrided. Tetanus is prevented best through immunization with tetanus toxoid. Tetanus toxoid is available: (1) in combination with diphtheria toxoid and acellular pertussis vaccine (DTaP) to provide basic immunity against tetanus, diphtheria, and pertussis; (2) as part of a double antigen (DT) for children up to 6 years of age who cannot receive the pertussis component of the DTaP; and (3) as a single antigen (tetanus toxoid [TT]) or Tdap vaccine to immunize pregnant women and women of childbearing age to prevent tetanus in their newborns. DT must be replaced with Td or Tdap, which has a reduced diphtheria toxoid content, for patients older than 7 years to lessen the adverse effects associated with the use of the higher-dose diphtheria toxin. For most indications, TT is administered in combination with a diphtheria toxoid-containing preparation. Courtesy of H. Cody Meissner, MD, FAAP Date of download: 10/16/2017 Copyright © 2017 American Academy of Pediatrics. All rights reserved.