Timeline of tetanus

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This is a timeline of tetanus, atempting to describe major events such as scientific and medical developments concerning the disease.

Big picture

Year/period Key developments
Ancient times < Tetanus is first described in Egypt around 3000 years ago, and is considered to be prevalent throughout the ancient world.[1]. Tetanus would be a major menace and a master killer in all the wars during most of history.[2]
1880s–1920s Most crucial developments on the understanding and treatment of tetanus happen in this period, starting from the discovery of tetanus bacterium in 1884 until the first effective vaccine around 1923.[3][4]
1930s < Routine vaccination starts to be implemented in several countries.[5][6][7] The adoption of tetanus toxoid prophylaxis during World War II presents an opportunity to note the incidence of tetanus with and without active immunization and to some extent to compare success attained by different programs of immunization.[2]
1980 < The World Health Organization starts collecting data on diphtheria–pertussis–tetanus (DPT3) vaccination coverage. All regions apart from Americas and Europe are found to have a coverage under 20%. Since then, global coverage of DTP3 vaccination would increase steeply. By 2013 the lowest regional coverage stands at 75% in the WHO African Region and the global average at 86%.[8]
Recent years Tetanus remains a public health problem in many parts of the world and is often fatal, even within modern intensive care facilities.[8] The disease remains a major health problem in the developing world and is still encountered in the developed world. Between 800000 and 1 million deaths due to tetanus are reported each year, of which approximately 400,000 are due to neonatal tetanus. Africa and South East Asia account for 80% of these deaths. Tetanus remains endemic in 90 countries world-wide.[1]

Visual data

Total neonatal tetanus cases given by 194 countries. Period 1980–2015.
Reported cases and deaths from tetanus in the United States. Period 1950–2013.
Tetanus total reported cases for the period 1980–2015, with Bangladesh, Angola and Afghanistan showing non–negligible figures. Table 1.
Tetanus total reported cases for the period 1980–2015. Table 2.
Tetanus total reported cases for the period 1980–2015. Table 3.
Tetanus total reported cases for the period 1980–2015, showing Egypt and DR Congo as the most affected countries. Table 4.


Year/period Type of event Event Location
3000 BP Early record Tetanus is described in Egypt. The disease is thought to be prevalent throughout the ancient world.[9][1] Egypt
5th century BC Early record Records from these time contain descriptions of tetanus.[10][4]
1884 Scientific development Tetanus bacterium clostridium tetani is discovered when Italian scientists Giorgio Rattone and Antonio Carle first produce tetanus in animals by injecting them with pus from a human case.[10][11][12][4] Italy
1884 Scientific development Shortly after the advent of the germ theory of infectious diseases, German internist Arthur Nicolaier finds through experimentation with animals that tetanus is associated with bacilli of the soil. Nicolaier would produce tetanus in animals by injecting them with soil samples.[3][4] Germany
1889 Scientific development Japanese bacteriologist Shibasaburo Kitasato manages to isolate tetanus bacteria from an infected person, showing that they cause disease when injected into animals, and reports that the toxin could be neutralised by specific antibodies. This would be considered the first vaccine for passive immunology.[10][11][12][4] Germany (Berlin)
1890 Scientific development Danish researcher Knud Faber demonstrates the existence of a toxin by producing tetanus in animals injected with culture filtrates.[3] Denmark
1893 Scientific development French microbiologist and veterinarian Edmond Nocard demonstrates passive tetanus immunization by successfully treating with serum therapy and curing horses suffering from tetanus.[1] [11] France
1893 Scientific development French bacteriologist Pierre Paul Émile Roux and colleague L. Ann Vaillard, working at Pasteur Institute, attenuate the tetanus toxin by treatment with an iodine–potassium iodide solution.[3][13] France
1897 Scientific development Edmond Nocard demonstrates the protective effect of passively transferred antitoxin. Passive immunization in humans would be used for treatment and prophylaxis during World War I.[4] Passive tetanus profilaxis with equine antiserum is recognized as being able to prevent tetanus.[14][4][10]
1902 Scientific development Marie and Morax postulate the nervous pathway of transport of tetanus toxin. This would be demonstrated later by various investigators.[3]
1914 Medical development Anti-tetanus serum is introduced. This would be followed by an abrupt fall in tetanus incidence, even during World War I.[10][15]
1917 Medical development Vallé and Bazy carry out the vaccination of wounded during World War I with toxin detoxified by iodine treatment.[3]
1923 Scientific discovery French veterinarian and biologist Gaston Ramon reports the preparation of an antigenic toxoid by formaldehyde and heat treatment of the tetanus toxin. It would be considered the first inactive tetanus toxoid discovered and produced. The diphtheria and tetanus toxoid (TT), for which Ramon is considered their discoverer, are then referred to as anatoxins.[3][4]"[10][16][12][4] France
1924 Medical development Gaston Ramon student P. Descombey produces the tetanus toxoid that would be used in the United States military during World War II."[11][4]
1926 Medical development Gaston Ramon and Christian Zoeller successfully immunize human subjects with tetanus toxoid.[3][5]
1933 Medical development Fluid form of tetanus toxoid is licensed in the United States. Absorbed forms would follow later.[5] United States
1937 Medical development Tetanus toxoid is first licensed as a vaccine.[8]
1947 Medical development Combination diphtheria and tetanus toxoids for pediatric use is first licensed in the United States.[17][14] United States
1948 Scientific development Researchers first isolate the tetanus toxin in crystalline form.[3]
1953 Medical development Tetanus and diphtheria toxoids (adult formulation) are first licensed in the United States, after the concentration of diphtheria toxoid is reduced.[17] United States
1961 Policy Routine vaccination is implemented in the United Kingdom.[6] United Kingdom
1968 Scientific development Researchers first report the structure of the tetanus toxin.[3]
1968 Policy Italy introdouces routine vaccination against tetanus for all new-borns.[7] Italy
1974 Program launch Diphtheria toxoid combined with tetanus and pertussis vaccines (DTP) is included in the newly incepted World Health Organization Expanded Programme on Immunization.[18]
1975 Scientific development Soviet scientist Georgy N. Kryzhanovsky defines tetanus as a polysystemic disease due to the implication of many other organic systems in the effect of tetanus toxin, in addition to its prominent effect on the central nervous system.[3]
1980 Program launch The World Health Organization starts collecting data on diphtheria-tetanus-pertussis (DTP3) vaccination coverage. All regions apart from the Americas and Europe are found to have coverage under 20%.[8]
1989 Program launch The 42nd World Health Assembly calls for global neonatal tetanus elimination by 1995. Elimination is defined as less than one cases per 1,000 live births in every district of every country. The WHA goal would not be met.[10][19][1][6][20]
1990 Program launch The World Summit for Children lists neonatal tetanus elimination as one of its goals, and this goal is again endorsed by the 44th World Health Assembly.[20]
1996 Medical development Lederle Laboratories licenses diphtheria and tetanus toxoids, and acellular pertussis vaccine Acel-Imune, for use as the first through fifth doses in the series.[17]
1997 Medical development British pharmaceutical company SmithKline Beecham licenses Infanrix (diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed), for the first four doses of the series.[17]
1998 Medical development North American Vaccine Inc licenses Certiva (diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed), for boosting immunization of infants and children.[17]
1999 Medical development Connaught Laboratories licenses diphtheria and tetanus toxoids and acellular pertussis vaccine Tripedia.[17]
1999 Program launch Progress towards the attainment of the global tetanus elimination goal is reviewed by UNICEF, WHO and UNFPA. This Initiative is re-constituted and elimination of maternal tetanus is added to the goal with a 2005 target date (later shifted to 2015).[20]
2000–2007 An average of 31 cases in the United States is given in this period, with an all time low of 21 cases in the year 2003.[12] United States
2002 Medical development British pharmaceutical GlaxoSmithKline licenses Pediarix, a vaccine combining diphtheria, tetanus, acellular pertussis, inactivated polio, and hepatitis B antigens.[17]
2002 Medical development Aventis Pasteur licenses diphtheria and tetanus toxoids and acellular pertussis vaccine Daptacel.[17]
2004 Medical development Aventis Pasteur licenses vaccine Decavac, indicated for active immunization against tetanus and diphtheria.[17][21]
2011 Medical development United States Food and Drug Administration approves Boostrix (developed by GlaxoSmithKline) to prevent tetanus, diphtheria, and pertussis in older people.[17] United States
2013 The WHO African Region reports the highest number of non-neonatal tetanus cases at 4.0 per million population (3732 cases), followed by the South-East Asia Region at 1.9 per million population (3432 cases). Of the 12 African countries reporting any cases of non-neonatal tetanus, Uganda – the only country among them implementing voluntary medical male circumcision for HIV prevention – would report the highest number of non-neonatal tetanus cases at 67.1 per million population (2522 cases).[8]
2015 Report Neonatal tetanus remains a major public health problem in 23 countries: Afghanistan, Angola, Cambodia, Central African Republic, Chad, Congo DR, Equatorial Guinea, Ethiopia, Haiti, India, Indonesia, Iraq, Kenya, Mali, Niger, Nigeria, Pakistan, Papua New Guinea, Philippines, Somalia, Sudan, South Sudan, and Yemen.[22] Afghanistan, Angola, Cambodia, Central African Republic, Chad, Congo DR, Equatorial Guinea, Ethiopia, Haiti, India, Indonesia, Iraq, Kenya, Mali, Niger, Nigeria, Pakistan, Papua New Guinea, Philippines, Somalia, Sudan, South Sudan, Yemen.
2015 Report The World Health Organization estimates that 34,019 newborns died from neonatal tetanus, a 96% reduction from the situation in the late 1980s.<ref name="Maternal and Neonatal Tetanus Elimination (MNTE)">

See also


  1. 1.0 1.1 1.2 1.3 1.4 "Clostridium tetani (Tetanus)". antimicrobe.org. Retrieved 23 May 2017. 
  2. 2.0 2.1 "THE U. S. NAVY'S WAR RECORD WITH TETANUS TOXOID(THE U. S. NAVY'S WAR RECORD WITH TETANUS TOXOID*)". annals.org. Retrieved 26 May 2017. 
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Germanier, Rene. "Bacterial Vaccines". Retrieved 24 May 2017. 
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 "Tetanus" (PDF). cdc.gov. Retrieved 24 May 2017. 
  5. 5.0 5.1 5.2 Artenstein, Andrew W. Vaccines: A Biography. Retrieved 26 May 2017. 
  6. 6.0 6.1 6.2 Cook, T. M.; Protheroe, R. T.; Handel, J. M. "Tetanus: a review of the literature". oup.com. Retrieved 23 May 2017. 
  7. 7.0 7.1 "Epidemiology of tetanus in Italy in years 1971-2000". eurosurveillance.org. Retrieved 24 May 2017. 
  8. 8.0 8.1 8.2 8.3 8.4 "Tetanus disease and deaths in men reveal need for vaccination". US National Library of Medicine. doi:10.2471/BLT.15.166777. 
  9. "Tetanus". BMJ Journals. Retrieved 26 May 2017. 
  10. 10.0 10.1 10.2 10.3 10.4 10.5 10.6 "Tetanus, diphtheria and pertussis: ancient diseases in modern times". pntonline.co.za. Retrieved 23 May 2017. 
  11. 11.0 11.1 11.2 11.3 "Diphtheria, Tetanus (Lockjaw), and Pertussis (Whooping Cough) Cases and Deaths, and DTaP Vaccination Rates". procon.org. Retrieved 23 May 2017. 
  12. 12.0 12.1 12.2 12.3 Sanchez, Alexandra. "Tetanus". austincc.edu. Retrieved 24 May 2017. 
  13. The Anærobic Bacteria and Their Activities in Nature and Disease: Subject index. Retrieved 26 May 2017. 
  14. 14.0 14.1 Milligan, Gregg N.; Barrett, Alan D. T. Vaccinology: An Essential Guide. Retrieved 24 May 2017. 
  15. "Prevention of tetanus during the First World War.". US National Library of Medicine. Retrieved 23 May 2017. 
  16. Medical Sciences - Volume I (B.P. Mansourian, S.M. Mahfouz, A. Wojtezak ed.). Retrieved 9 May 2017. 
  17. 17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 "Vaccine Timeline". immunize.org. Retrieved 8 May 2017. 
  18. "Diphtheria". who.int. Retrieved 10 May 2017. 
  19. "Maternal immunization against tetanus" (PDF). who.int. Retrieved 23 May 2017. 
  20. 20.0 20.1 20.2 "Maternal and Neonatal Tetanus Elimination (MNTE)". who.int. Retrieved 26 May 2017. 
  21. "HIGHLIGHTS OF PRESCRIBING INFORMATION" (PDF). vaccineshoppe.com. Retrieved 8 May 2017. 
  22. "Vaccines for women for preventing neonatal tetanus". wiley.com. Retrieved 23 May 2017.