Vaccination schedules used for preventing neonatal and/or maternal tetanus and duration of vaccine-induced protection Review of published reviews 1. Introduction

Tetanus is caused by a neurotoxin produced by the gram-positive bacterium Clostridum tetani which forms spores. Tetanus begins when spores are introduced into damaged tissue. The toxin blocks inhibitory neurotransmitters in the central nervous system and causes the muscular stiffness and spasms typical of generalized tetanus. The disease may affect any age group, and case-fatality rates are high even where modern intensive care is available. The overall tetanus case-fatality rate varies between 10% and 70%, depending on treatment, age and general health of the patient. Without hospitalization and intensive care, fatality is almost 100% among the oldest and the youngest patients. In settings with optimal care, it may be reduced to 10–20%. The overwhelming majority of tetanus cases are birth-associated and occur in developing countries among newborn babies or in mothers following unclean deliveries and poor postnatal hygiene. [1]