Key facts

Tetanus is acquired through infection of a cut or wound with the spores of the bacterium Clostridium
tetani, and most cases occur within 14 days of infection. Tetanus cannot be transmitted from person to
person.

Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV).

However, people who recover from tetanus do not have natural immunity and can be infected again.

The majority of reported tetanus cases are birth-associated among newborn babies and mothers who
have not been sufficiently vaccinated with TTCV.

In 2018, about 25 000 newborns died from neonatal tetanus, a 97% reduction since 1988, largely due to
scaled-up immunization with TTCV.

In 2022, 84% of infants worldwide were vaccinated with 3 doses of diphtheria-tetanus-pertussis (DTP)
containing vaccine.

Overview

Tetanus is an acute infectious disease caused by spores of the bacterium Clostridium tetani. The spores
are found everywhere in the environment, particularly in soil, ash, intestinal tracts/feces of animals and
humans, and on the surfaces of skin and rusty tools like nails, needles, barbed wire, etc. Being very
resistant to heat and most antiseptics, the spores can survive for years.

Anyone can get tetanus, but the disease is particularly common and serious in newborn babies and
pregnant women who have not been sufficiently immunized with tetanus-toxoid-containing vaccines.
Tetanus during pregnancy or within 6 weeks of the end of pregnancy is called maternal tetanus, and
tetanus within the first 28 days of life is called neonatal tetanus.

The disease remains an important public health problem in many parts of the world, but especially in
low-income countries or districts, where immunization coverage is low, and unclean birth practices are
common. Neonatal tetanus occurs when nonsterile instruments are used to cut the umbilical cord or
when contaminated material is used to cover the umbilical stump. Deliveries carried out by people with
unclean hands or on a contaminated surface are also risk factors.

In 2018, approximately 25 000 newborns died from neonatal tetanus, a 97% reduction from 1988 when
an estimated 787 000 newborn babies died of tetanus within their first month of life. However, there is
increased risk of tetanus in adolescent and adult males who undergo circumcision due to waning
immunity and limited opportunity for receiving booster doses in males in many countries.
Symptoms and diagnosis

The incubation period of tetanus varies between 3 and 21 days after infection. Most cases occur within
14 days.

Symptoms can include:

jaw cramping or the inability to open the mouth

muscle spasms often in the back, abdomen and extremities

sudden painful muscle spasms often triggered by sudden noises

trouble swallowing

seizures

headache

fever and sweating

changes in blood pressure or fast heart rate.

In neonatal tetanus, symptoms include muscle spasms, which are often preceded by the newborn’s
inability to suck or breastfeed, and excessive crying.

Tetanus is diagnosed on the basis of clinical features and does not require laboratory confirmation. The
WHO definition of a confirmed neonatal tetanus case is an illness occurring in an infant who has the
normal ability to suck and cry in the first 2 days of life, but who loses this ability between days 3 and 28
of life and becomes rigid or has spasms.

The WHO definition of non-neonatal tetanus requires at least one of the following signs: a sustained
spasm of the facial muscles in which the person appears to be grinning, or painful muscular
contractions. Although this definition requires a history of injury or wound, tetanus may also occur in
patients who are unable to recall a specific wound or injury.

Treatment
Tetanus is a medical emergency requiring:

care in the hospital

immediate treatment with medicine called human tetanus immune globulin (TIG)

aggressive wound care

drugs to control muscle spasms

antibiotics

tetanus vaccination.

People who recover from tetanus do not have natural immunity and can be infected again, and
therefore need to be immunized.

Prevention

Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV), which
are included in routine immunization programmes globally and administered during antenatal care
contacts.

To be protected throughout life, WHO recommends that an individual receives 6 doses (3 primary plus 3
booster doses) of TTCV. The 3-dose primary series should begin as early as 6 weeks of age, with
subsequent doses given with a minimum interval of 4 weeks between doses. The 3 booster doses should
preferably be given during the second year of life (12–23 months), at 4–7 years of age, and at 9–15 years
of age. Ideally, there should be at least 4 years between booster doses.

There are many kinds of vaccines used to protect against tetanus, all of which are combined with
vaccines for other diseases:

diphtheria and tetanus (DT) vaccines

diphtheria, tetanus, and pertussis (whooping cough) (DTaP) vaccines

tetanus and diphtheria (Td) vaccines

tetanus, diphtheria, and pertussis (Tdap) vaccines.

Neonatal tetanus can be prevented by immunizing women of reproductive age with TTCV, either during
pregnancy or outside of pregnancy. Additionally, robust medical practices can also prevent tetanus
disease including clean delivery and cord care during childbirth, and proper wound care for surgical and
dental procedures.

In countries where national programmes have maintained high immunization coverage for several
decades, tetanus incidence rates are very low.

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Chickenpox (Varicella)

Chickenpox (Varicella) Home

About Chickenpox

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Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an
itchy, blister-like rash among other symptoms. The rash first appears on the chest, back, and face, and
then spreads over the entire body.

Chickenpox can be serious, especially during pregnancy, in babies, adolescents, adults, and people with
weakened immune systems (lowered ability to fight germs and sickness).

The best way to prevent chickenpox is to get the chickenpox vaccineAnyone who has not had
chickenpox or gotten the chickenpox vaccine can get the disease. Chickenpox illness usually lasts about 4
to 7 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn
into scabs. The rash may first show up on the chest, back, and face, and then spread over the entire
body, including inside the mouth, eyelids, or genital area. It usually takes about one week for all of the
blisters to become scabs.

Other typical symptoms that may begin to appear one to two days before rash include:
fever

tiredness

loss of appetite

headache

Children usually miss 5 to 6 days of school or childcare due to chickenpox.

Chickenpox in Vaccinated People (Breakthrough Chickenpox)

Some people who have been vaccinated against chickenpox can still get the disease. However, they
usually have milder symptoms with fewer or no blisters (or just red spots), a mild or no fever, and are
sick for a shorter period of time than people who are not vaccinated. But some vaccinated people who
get chickenpox may have disease similar to unvaccinated people.

People at Risk for Severe Chickenpox

Some people who get chickenpox may have more severe symptoms and may be at higher risk for
complications. For more information, see complicationsTransmission

Español (Spanish)

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). The virus spreads
easily from people with chickenpox to others who have never had the disease or never been vaccinated.
If one person has it, up to 90% of the people close to that person who are not immune will also become
infected. The virus spreads mainly through close contact with someone who has chickenpox.

A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the
chickenpox lesions have crusted (scabbed). Vaccinated people who get chickenpox may develop lesions
that do not crust. These people are considered contagious until no new lesions have appeared for 24
hours.

The varicella-zoster virus also causes shingles. After chickenpox, the virus remains in the body
(dormant). People get shingles when VZV reactivates in their bodies after they have already had
chickenpox. People with shingles can spread VZV to people who have never had chickenpox or never
received the chickenpox vaccine. This can happen through direct contact with fluid from shingles rash
blisters or through breathing in virus particles that come from the blisters. If they get infected, they will
develop chickenpox, not shingles.

It takes about 2 weeks (from 10 to 21 days) after exposure to a person with chickenpox or shingles for
someone to develop chickenpox. If a vaccinated person gets the disease, they can still spread it to
others. For most people, getting chickenpox once provides immunity for life. It is possible to get
chickenpox more than once, but this is not common.