Disease Description: Tetanus, an acute disease caused by Clostridium tetani, is characterized by muscle rigidity and painful spasms, often starting in the muscles of the jaw and neck. Severe tetanus can lead to respiratory failure and death. The disease is caused by a neurotoxin produced by anaerobic tetanus bacilli growing in contaminated wounds.
Diphtheria is an acute bacterial disease caused by toxigenic strains of Corynebacterium diphtheriae. Early symptoms of respiratory diphtheria include malaise, sore throat, difficulty in swallowing, loss of appetite, and a mild fever (rarely >101o F). Extensive pharyngeal membrane formation may result in life-threatening or fatal airway obstruction. Diphtheria toxin can cause serious systemic complications, including inflammation of the heart and neuropathies, if it is absorbed from the site of infection. The case-fatality rate of respiratory diphtheria is 5%-10%.
Risk to Travelers: Tetanus can occur anywhere in the world in inadequately vaccinated persons. Travelers to countries with endemic diphtheria are at a higher risk of disease following exposure to toxigenic C. diphtheriae if they are inadequately immunized or not up-to-date with diphtheria booster immunizations.
Prevention - Vaccine: Persons who have received primary immunization for tetanus, diphtheria, and pertussis should receive booster doses of tetanus toxoid and diphtheria containing vaccines at minimum of ten year intervals. Adults who have not yet received a dose of Tetanus, Diphtheria, acellular Pertussis (Tdap) may receive this one time instead of Td when they are due for their next booster. This would be particularly advisable for persons caring for young children.
Vaccine Adverse Effects: Local reactions (redness and induration with or without tenderness) are common after the administration of vaccines containing diphtheria or tetanus antigens. Anaphylactic and other serious adverse events are rare after receipt of preparations containing diphtheria, tetanus or pertussis components, or a combination of these.
Vaccine Contraindications: An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a contraindication to further vaccination with Td or Tdap.
Vaccine Booster Recommendations: Tetanus and diphtheria booster dose is recommended every 10 years. A single dose of adolescent/adult formulation Td that includes acellular pertussis vaccine (Tdap) is recommended to replace one Td booster dose for persons 11-64 years of age.
Information adapted from CDC Health Information for International Travel (the Yellow Book), http://www.cdc.gov/travel/yellowbook/2010/table-of-contents.htm