Tetanus--A Tale of 50 Years.

group with otorrhea (26.3%). The average incubation period – recorded in 78 cases where the information was available – was 13.4 days with maximum deaths observed in cases with incubation period < 7 days. Besides short incubation period, onset of spasms within 24 hours of illness, severe spasms and temperature >99 oF within 24 hours of admission were the factors associated with grave prognosis. Most (96.8%) deaths occurred within first week of admission. No significant difference in mortality was recorded with different dosage schedules of anti-tetanus serum (ATS) while the use of penicillin was associated with improved outcome. Historical background and past knowledge: After Hippocrates’ primeval description of tetanus in medical literature, no significant advancement in understanding occurred till the early 19th century [2]. The causative agent of tetanus was identified by Rossenbach [3] but isolation of Clostridium tetani is credited to Kitasato in 1889 [4]. This gram-positive, spore-forming, motile, anaerobic bacillus constitutes the normal intestinal flora of animals. As the spores are ubiquitous and persist for long time in the soil, these can easily contaminate wounds. Thus, any nonor partially-vaccinated individual is vulnerable to develop tetanus. In 1897, Edmond Nocard established the role of tetanus anti-toxin in inducing passive immunity in humans. Nearly three decades later, tetanus toxoid – developed by Descombey in 1924 – was widely used during World War II. The use of tetanus toxoid as a combined vaccine in the form of DPT (Diphtheria, Pertussis and Tetanus) was licensed in 1949. In the prevaccination era, the true burden of tetanus was largely unknown as most neonatal births and deaths occured at home without an account of the either event.