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Lovett AL, Riley CB, Chapman V, Bell B, Bishop B, Grierson A, Johnstone LJ, Sykes BW. Tetanus prophylaxis in horses: guidelines for New Zealand and Australia based on a critical appraisal of the evidence. N Z Vet J 2024; 72:241-255. [PMID: 38910032 DOI: 10.1080/00480169.2024.2365283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 05/19/2024] [Indexed: 06/25/2024]
Abstract
Horses are exquisitely sensitive to tetanus neurotoxin and are exposed to the risk of infection with Clostridium tetani throughout life. The vaccine against tetanus is highly effective at preventing disease, whereas tetanus in unvaccinated populations is associated with high mortality rates. Current guidelines in New Zealand and Australia for the available vaccine contain contradictions and limitations surrounding the optimal tetanus immunisation protocols for both adult horses and foals. This review critically evaluates the scientific literature on tetanus prophylaxis in horses within the context of equine practice and available products in New Zealand and Australia. The review was conducted by a panel of industry and specialist veterinarians to obtain agreement on nine equine tetanus prophylaxis guidelines for practising veterinarians. The primary protocol for tetanus toxoid (TT) immunisation consists of a three-dose series IM for all horses ≥ 6 months of age, and a four-dose series IM is proposed if commencing vaccination in foals between 3 and 6 months of age. Tetanus prophylaxis in foals < 3 months of age relies on passive immunity strategies. Following the completion of the primary protocol, a TT booster dose IM should be administered within 5 years, and every 5 years thereafter. When followed, these protocols should provide adequate protection against tetanus in horses. Additional tetanus prophylaxis guidelines are provided for veterinarians attending a horse experiencing a known "risk event" (e.g. wound, hoof abscess, surgery, umbilical infection). When a correctly vaccinated horse experiences a risk event, pre-existing immunity provides protection against tetanus. When an unvaccinated horse or one with unknown vaccination status, or a foal born to an unvaccinated dam, experiences a risk event, TT IM and tetanus antitoxin (TAT) 1,500 IU SC should be administered simultaneously at separate sites, and the TT primary immunisation protocol should subsequently be completed for the horse's respective age. In previously immunised pregnant broodmares, a TT booster dose administered 4-8 weeks prior to parturition optimises the transfer of passive immunity against tetanus to the newborn foal via colostrum; provided that post-natal IgG concentration in serum is > 800 mg/dL (8 g/L), such foals should be passively protected against tetanus up to 6 months of age. Survivors of clinical tetanus must still receive the primary protocol for vaccination against tetanus. In summary, all horses in New Zealand and Australia should be vaccinated against tetanus with protection maintained throughout life via TT booster doses, facilitated by accurate medical record keeping and client education.
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Affiliation(s)
- A L Lovett
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - C B Riley
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - V Chapman
- Zoetis New Zealand Ltd., Auckland, New Zealand
| | - B Bell
- VetSouth Equine, Invercargill, New Zealand
| | - B Bishop
- Canterbury Equine Surgical Consultancy Ltd., Prebbleton, New Zealand
| | - A Grierson
- Auckland Veterinary Centre, Takanini, New Zealand
| | - L J Johnstone
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - B W Sykes
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Mayousse V, Soete C, Jeandel A. Suspected Generalized Neonatal Tetanus in a Litter of Puppies. J Am Anim Hosp Assoc 2023; 59:51-55. [PMID: 36584314 DOI: 10.5326/jaaha-ms-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 01/01/2023]
Abstract
Tetanus, caused by Clostridium tetani neurotoxin, is extensively described in adult dogs and is frequently associated with a recent history of wounds. Although this condition is reported in 2-3 mo old puppies, tetanus has not been described in neonates. Herein, we report the clinical signs of 3-5 day old American Bully puppies from the same litter, presenting with an acute onset of marked generalized stiffness of the extensor muscles, trismus, and an inability to suckle. Three puppies died because of tetanus: one died during consultation, one was euthanized owing to respiratory distress, and the third died 1 mo after initial presentation following deterioration. All three of these puppies were clinically affected by omphalitis. Complete bloodwork, toxicological screening (including strychnine assay), serology, and polymerase chain reaction tests for selected infectious diseases were unremarkable. Necropsy of the euthanized puppy confirmed suppurative omphalitis, which may have contributed to C. tetani infection. These are the first cases of suspected neonatal tetanus in puppies, which is a frequent condition in newborn humans and is associated with omphalitis as the route of infection.
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Affiliation(s)
- Vincent Mayousse
- From Neurology Unit (V.M.), Centre Hospitalier Vétérinaire des Cordeliers, Meaux, Il de France, France
| | - Caroline Soete
- From Internal Medicine Unit (C.S.), Centre Hospitalier Vétérinaire des Cordeliers, Meaux, Il de France, France
| | - Aurélien Jeandel
- From Neurology Unit, Centre Hospitalier Vétérinaire Pommery, Reims, France (A.J.)
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Clostridial Diseases (Botulism and Tetanus). Vet Clin North Am Equine Pract 2022; 38:269-282. [PMID: 35953145 DOI: 10.1016/j.cveq.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Botulism and tetanus are the 2 primary manifestations of neurologic disease caused by clostridial toxins. Only a small dose of clostridial toxin is required to induce severe, and often fatal, disease. Consequently, definitive diagnosis of either disease is nearly impossible to achieve antemortem or postmortem; presumptive diagnosis is usually made based on physical and neurologic examination findings. Because the severity of clinical signs can worsen rapidly, prognosis worsens when therapeutic intervention is delayed. Highly effective vaccines are available against both botulism and tetanus and are critical in preventative approaches to control.
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Desanti-Consoli H, Bouillon J, Chapuis RJJ. Equids' Core Vaccines Guidelines in North America: Considerations and Prospective. Vaccines (Basel) 2022; 10:398. [PMID: 35335029 PMCID: PMC8955191 DOI: 10.3390/vaccines10030398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination against infectious diseases is a cornerstone of veterinary medicine in the prevention of disease transmission, illness severity, and often death in animals. In North American equine medicine, equine vaccines protecting against tetanus, rabies, Eastern and Western equine encephalomyelitis, and West Nile are core vaccines as these have been classified as having a heightened risk of mortality, infectiousness, and endemic status. Some guidelines differ from the label of vaccines, to improve the protection of patients or to decrease the unnecessary administration to reduce potential side effects. In North America, resources for the equine practitioners are available on the American Association of Equine Practitioners (AAEP) website. Conversely, in small companion animals, peer review materials are regularly published in open access journals to guide the vaccination of dogs and cats. The aims of this review are to present how the vaccine guidelines have been established for small companion animals and horses in North America, to review the equine literature to solidify or contrast the current AAEP guidelines of core vaccines, and to suggest future research directions in the equine vaccine field considering small companion animal strategies and the current available resources in equine literature.
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Affiliation(s)
| | - Juliette Bouillon
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, Saint Kitts and Nevis;
| | - Ronan J. J. Chapuis
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, Saint Kitts and Nevis;
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Dennis ST, El Hage CM, Brookes VJ. A survey of veterinarians' practices, recommendations and perceptions associated with the prevention of tetanus in horses in Australia. Aust Vet J 2022; 100:181-186. [PMID: 35122431 DOI: 10.1111/avj.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Identify veterinarians' practices, recommendations and perceptions when preventing tetanus in horses in Australia. METHODS Graduated members of Equine Veterinarians Australia participated in an online survey about the prevention of tetanus in horses in Australia. RESULTS Of 77 respondents (response rate ~ 8%), 50 (65%) reported that they had attended collectively 145-152 cases of tetanus in horses in Australia (1.1 cases of tetanus observed/10 veterinarian-years since qualification). The estimated case fatality rate (CFR) was at least 79%. Puncture wounds were most frequently suspected as the entry point (32%; n = 47). Five respondents (7%) reported cases of localised tetanus. Three respondents reported generalised tetanus within 2 weeks of tetanus antitoxin (TAT) administration. Respondents did not report any cases of tetanus in horses which had been vaccinated according to manufacturer's recommendations. All respondents recommended vaccination, but over 50% (N = 45) stated 'lack of veterinary recommendation' as often or sometimes a reason why clients did not vaccinate horses. Opinions varied on the use of TAT for peri-exposure prophylaxis; 67% of respondents dosed TAT independent of body weight, with the rest dosing according to body weight. Cases of Theiler's disease related to the use of TAT were not reported in Australia by respondents. DISCUSSION The caseload of equine tetanus appears relatively low among equine veterinarians in Australia. Consistent with the literature, estimated CFR was high. Respondents' recommendations and perceptions about tetanus vaccination were generally consistent but varied regarding TAT usage. Evidence for TAT usage is limited and we recommend studies of TAT efficacy in horses.
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Affiliation(s)
- S T Dennis
- Centre for Equine Infectious Diseases, Melbourne Veterinary School, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - C M El Hage
- Centre for Equine Infectious Diseases, Melbourne Veterinary School, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - V J Brookes
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, New South Wales, 2008, Australia
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Affiliation(s)
- G. Galen
- School of Veterinary Medicine University of Sydney Sydney Australia
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Affiliation(s)
- G. Kay
- American Fondouk Fez Morocco
| | | | - M. Mazan
- Department of Clinical Sciences Cummings School of Veterinary Medicine Tufts University Grafton Massachusetts USA
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Blatter M, Thunig M, Kretschmar F, Rijkenhuizen ABM. Removal of a metallic foreign body from the tongue of three horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Blatter
- Pferdeklinik Leichlingen Leichlingen Germany
| | - M. Thunig
- Pferdeklinik Leichlingen Leichlingen Germany
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Anderson K, Keller J, Ramachandran A, Brandão J. Naturally occurring tetanus in a rabbit (Oryctolagus cuniculus) associated with Psoroptes cuniculi otitis. J Exot Pet Med 2020. [DOI: 10.1053/j.jepm.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Tetanus is a vaccine-preventable disease that still commonly occurs in many low-income and middle-income countries, although it is rare in high-income countries. The disease is caused by the toxin of the bacterium Clostridium tetani and is characterised by muscle spasms and autonomic nervous system dysfunction. Global vaccination initiatives have had considerable success but they continue to face many challenges. Treatment for tetanus aims to control spasms and reduce cardiovascular instability, and consists of wound debridement, antitoxin, antibiotics, and supportive care. Recent research has focused on intravenous magnesium sulphate and intrathecal antitoxin administration as methods of spasm control that can avoid the need for ventilatory support. Nevertheless, without access to mechanical ventilation, mortality from tetanus remains high. Even with such care, patients require several weeks of hospitalisation and are vulnerable to secondary problems, such as hospital-acquired infections.
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Affiliation(s)
- Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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