Module 10: Tetanus, Diphtheria, and Pertussis

Tetanus

- Toxin produced by Clostridium tetani

- Bacterium enters body through a wound from an acute trauma

- Spores found in soil, dust, and feces: resistant to heat and antiseptics

- Toxin binds to central nervous system, prevents muscle relaxation

- Incubation period: 3-21 days

- Examples of Acute Trauma: tissue injury, puncture wound, lacerations, abrasions, chronic wounds, injection drug use

- An estimated 45% are from indoor injuries

Tetanus Presentation

Tetanus Complications

- Laryngospasm
- Fractures
- Hypertension
- Nosocomial infections
- Pulmonary embolism
- Pneumonia
- Death (11%)

Diphtheria

- Bacterial disease caused by Corynebacterium diphtheriae: aerobic, gram-positive bacillus

- Strains could be toxin or nontoxin producing

- Transmission by respiratory droplets or skin lesions

- Incubation period: 2-5 days

- Most complications attributable to toxin: myocarditis, neuritis

- Death rate: 5%-10%

Diphtheria Presentation

- Disease can involve almost any mucous membrane
- Respiratory: pharynx and tonsils affected, malaise, sore throat, hoarseness, anorexia, fever, bluish-white membrane formation on tonsils, edema, bull neck
- Non-respiratory: scaling rash, ulcers

Pertussis (Whooping Cough)

- Bacterial disease caused by Bordetella pertussis: aerobic gram-negative rod

- Produces several toxins and biologically active components

- Transmitted through respiratory droplets or contact with airborne droplets (highly contagious): attaches to the cilia of respiratory epithelial cells

- Toxins cause inflammation, which interferes with clearing of pulmonary secretions.

Pertussis Clinical Presentation

Paroxysmal State 1-6 Weeks

- Infectious from catarrhal stage through 3rd week of paroxysms
- Seizures, hypoxia, rib fractures, vomiting, dehydration
- Most common complication: secondary bacterial pneumonia
- Frequently occurs at night, leads to insomnia
- On average, 15 episodes per 24-hour period
- Whoop may not be present in infants less than age 6 months or in mild disease

Vaccines

DTaP Recommendations

Tdap Recommendations

Review

DTaP/ Tdap Contraindications and Precautions

Td/Tdap boosters are administered every 10 years

- True

Which of the following vaccines are recommended for persons older than 10 years?

- Td
- Tdap

The whooping cough associated with pertussis occurs in this stage of disease:

- Paroxysmal

Which of the following vaccines is used as a booster every 10 years?

- Td

Which of the following is the most common type of tetanus?

- Generalized

What is the recommended timing for Tdap during pregnancy?

- 27-36 weeks

DTaP is recommended to be administered using which of the following schedules?

- 2, 4, 6, 12-15 months, 4-6 years