Tetanus Clinical Presentation and Management

Initial Presentation and Progression

The incubation period from injury to symptom onset varies from 3 to 21 days (median: 7 days), with extremes of 1 day to several months, according to the Centers for Disease Control and Prevention 1, 2
Shorter incubation periods are associated with more severe disease and poorer prognosis, as reported by the Centers for Disease Control and Prevention 2
Longer incubation periods are associated with injuries furthest from the central nervous system, as noted by the Centers for Disease Control and Prevention 2

The disease course is usually intense for ≥4 weeks before subsiding, according to the Centers for Disease Control and Prevention 2
The convalescent period is typically protracted, as reported by the Centers for Disease Control and Prevention 2
Long-term neurologic sequelae and intellectual and behavioral abnormalities might follow recovery, as noted by the Centers for Disease Control and Prevention 2
The case-fatality ratio for tetanus is highest in infants and the elderly, according to the Centers for Disease Control and Prevention 2
Mortality can be as high as 100% without high-quality medical care, but remains approximately 10–20% even in modern healthcare facilities, as reported by the Centers for Disease Control and Prevention 2, 3
The case-fatality ratio for reported tetanus in the United States declined from 18% (1998-2000) to 8.0% (2001-2016), according to the Centers for Disease Control and Prevention 3

Tetanus occurs almost exclusively among persons who are unvaccinated or inadequately vaccinated, or in those whose vaccination histories are unknown or uncertain, as reported by the Centers for Disease Control and Prevention 3
Tetanus does not confer natural immunity, so patients must complete a full primary immunization series after recovery, as recommended by the American Academy of Pediatrics, although the specific guideline is from Praxis Medical Insights, an alternative source is not provided 5