3/30/13 Tetanus in Emergency Medicine

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Tetanus in Emergency Medicine

Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Rick Kulkarni, MD more...

Updated: Sep 20, 2011

Background
Tetanus is an illness characterized by an acute onset of hypertonia, painful muscular contractions (usually of the
muscles of the jaw and neck), and generalized muscle spasms without other apparent medical causes.

Although records from antiquity (5th century BC) contain descriptions of tetanus, it was Carle and Rattone in 1884
who first produced tetanus in animals. This was accomplished by injecting them with pus from a fatal human
tetanus case. During that same year, Nicolaier produced tetanus in animals by injecting them with soil. In 1889,
Kitasato isolated the organism from an infected human, showed that it produced disease when injected into
animals, and reported that the toxin could be neutralized by specific antibodies. In 1897, Nocard demonstrated the
protective effect of passively transferred antitoxin. Passive immunization in humans was used for treatment and
prophylaxis during World War I. Tetanus toxoid was developed by Descombey in 1924. It was first widely used
during World War II.

Despite widespread immunization of infants and children in the United States since the 1940s, tetanus still occurs
in the United States. Currently, tetanus is a severe disease primarily of older adults who are unvaccinated or
inadequately vaccinated. Worldwide, most reported cases of tetanus are the neonatal type. The last reported case
of neonatal tetanus in the United States was in 1998; this was only the second case since 1989, and neither of
the mothers had ever received tetanus vaccinations.

For more information, see Medscape's Vaccine Resource Center.

Contributor Information and Disclosures

Author
Daniel J Dire, MD, FACEP, FAAP, FAAEM Clinical Professor, Department of Emergency Medicine,
University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of
Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy
of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics,
American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

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3/30/13 Tetanus in Emergency Medicine

Specialty Editor Board

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine,
Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency
Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct
Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical
Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of
Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic
Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center
College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency
Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor,
Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of
Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic
Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess
Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School;
Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency
Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency
Medicine

Disclosure: Nothing to disclose.

Chief Editor
Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance,
Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of
Emergency Medicine, American College of Emergency Physicians, American Medical Association, American
Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors
The authors and editors of Medscape Reference gratefully acknowledge the medical review of this article by
Joseph U Becker, MD.

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