Kris Gaublomme, MD
September 1996

THE DISEASE

Tetanus as a clinical entity is linked to a bacteria, Clostridium tetani. Obviously, the germ is not as malicious as one may think because it lives as a harmless commensal in the animal and human intestinal tract (1). It is not the very presence of the bacteria which causes the trouble, but the toxins that are produced by the bacteria under anaerobic conditions, that is, where the bacteria operates in an environment free of oxygen. These toxins can be spread through the blood vessels and finally affect the nervous system causing tetanic muscle contraction and pain. The condition is extremely painful and potentially lethal.

Tetanus morbidity is very low in industrial countries. In the USA, for example, there are only about 50 cases a year (2); in Germany, 17 (3).

Mortality figures range between 33% (4) and 20% (2). The incidence is higher in tropical countries and under poor hygienic conditions. Mortality is 135 times higher in developing countries compared to developed countries. In those countries, tetanus in newborns plays a very important rote. Most of those cases are caused by using dirty, rusty scissors when cutting the umbilical string of the newborn.

David Brownstein, MD

August 9, 2010

I frequently get asked by my patients, “Should I take the shingles vaccine?” Shingles is a consequence of the chicken pox virus which becomes reactivated and causes a rash. Associated with the rash can be a painful condition called postherpetic neuralgia. A vaccine that avoids the onset of postherpetic neuralgia would be a worthy item.

Zostovex is a vaccine that contains live, attenuated chicken pox virus (varicella-zoster). It is the same vaccine given to children to prevent chicken pox, only it is approximately 14 times stronger in the adult version. It has been approved by the FDA for the prevention of shingles in adults 60 years of age or older. The [U.S. CDC's] Advisory Council on Immunization Practices has recommended Zostovex as a prevention of postherpetic neuralgia.