Introduction
   Tetanus is a dangerous infectious disease. However since the infection is not transmitted from person to person, it has been so far left neglected and ignored in the Japanese immunization program. People in general are also indifferent to this disease. A famous physician providing consultation and treatment in Nepal for travelers from foreign countries mentioned in an article published in the Review of the Japanese Society for International Travel Medicine that less than 5% of the Japanese have been immunized against tetanus and hepatitis A, whereas less than 5% of the tourists from Europe and the US have not been vaccinated against these diseases, and that more Japanese should be protected against tetanus and hepatitis A through vaccination. Japanese traveling abroad may not immediately receive proper consultation and treatment as in Japan if they fall or sustain injuries during their trips abroad. In that event, the most worrying disease is tetanus. General information on tetanus will be described in this article.
What kind of disease is tetanus?
   Tetanus means "stretching", "straining". This ailment elicits generalized muscular convulsions by bending the body as an arch and results in death by suffocation. Since the convulsions are repeated, fractures of the vertebra due to compression may occur.
   The tetanus toxin is the second most violent toxin after botulinus toxin. One gram of this toxin is equivalent to the lethal dose for six million adults with a body weight of 60 kg.
   In recent years the number of tetanus patients has been reported to be around 50 cases per year, which is a low incidence of about one per 2.4 million population. Many doctors have recently never seen tetanus patients. In order to understand what this sickness is, the general public is advised to read the literary works called "The Earth" written by Takashi Nagatsuka (Iwanami Bunko), and ? "The Trembling Tongue" written by Taku Miki (Shincho Bunko). The latter has been made into a film.
Distribution of Clostridium tetani and importance of vaccination
   Clostridium tetani is present everywhere. It is found in particular in gardens of private houses, fields and roads. It is also isolated from 0.1 mg of soil from fields. Tetanus whose primary focus is a tiny wound such as puncture wounds and contusions take up over one-fourth of all the cases.
   Tetanus is a disease targeted considered for vaccination and not for treatment. This argument is constantly advocated by tetanus specialists. If a series of four doses of diphtheria-tetanus-pertussis (DTP) trivalent combined vaccine is given during the early infancy followed by a booster of DT vaccine when graduating from elementary school, immunity should persist for approximately ten years thereafter. It has also been reported in Japan that less than 80% have completed the whole series of this immunization. In the United States, children who have not been vaccinated with the DTP trivalent combined vaccine are refused admission to kindergartens and elementary schools. They are admitted only after submitting evidence that their family doctors have given them the required shots.
Approach to people who have not been vaccinated against tetanus
   Being asked whether he/she was immunized against tetanus, an American research student replied that in the United States people living an ordinary community life who have not been vaccinated against tetanus were either persons affiliated with special religious organizations refusing blood perfusions, even if they had a massive hemorrhage or were on the verge of dieing or refugees from South East Asia.
Efficacy of vaccination against tetanus
   Tetanus is inseparable from war. During World War II the French army sent all its officers and soldiers to the front after immunizing them against tetanus. As a result non of them acquired tetanus. The US army also took the same approach, and there was only one tetanus patient amid those who were wounded in combat. By contrast there were twelve tetanus victims amid 266 soldiers of the Japanese army, which had not given vaccination to its troops who fought in the Marshall Islands. The number of tetanus patients in other areas and details are unknown, since Japan lost the war and did not conduct further investigation.
   If vaccination against tetanus is given during adulthood, that is two doses of adsorbed tetanus toxoid at a one-month interval followed by a booster dose 6-12 months later, immunity should persist for approximately five years.