Tetanus, Diphtheria, and Pertussis

Tetanus is a bacterial infection caused by *Clostridium tetani*. The organism is found in soil, dust and animal feces. When C. tetani enter a deep wound, its spores produce tetanospasmin, a powerful toxin. Tetanospasmin actively impairs motor neurons. "Hallmark" manifestations of tetanus include muscle stiffness and spasms in jaw, neck, and abdominal muscles, and difficulty swallowing. Other signs and symptoms may include fever, sweating, elevated blood pressure, and rapid heart rate. ³¹

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. The organism is transmitted by airborne droplets and contaminated personal and household items. Signs and symptoms usually begin two to five days after a person becomes infected. The “hallmark” sign of diphtheria is a thick, gray membrane covering the throat and tonsils. Other clinical manifestations may include a sore throat, hoarseness, enlarged lymph nodes, difficulty breathing, nasal discharge, fever, and chills.³²

Pertussis is a highly contagious bacterial (Bordetella pertussis) infection. It is transmitted by direct contact with respiratory secretions or by airborne droplets. The incubation period is about 7 to 10 days. Early symptoms are indistinguishable from those of other respiratory infections. "Hallmark" signs of pertussis are paroxysms (fits) of rapid coughs, followed by a high-pitched "whoop" and vomiting. The period of communicability starts with the early symptoms and extends into the paroxysmal stage.³³

Active Immunization: Tetanus, Diphtheria and Pertussis Vaccines^4,6,34

Vaccine formulations (Table 5) contain either inactivated adsorbed (aluminum-salt-precipitated) tetanus and diphtheria toxoids (Td) or tetanus and diphtheria toxoids and protein components of acellular pertussis (Tdap). OHCP with an uncertain history of primary vaccination should receive an initial dose of Tdap. All OHCP should receive a Td or Tdap booster every 10 years. Tdap is also recommended as part of wound management.³⁴