Tetanus in horses: an overview of 70 cases

Tetanus prophylaxis in horses: guidelines for New Zealand and Australia based on a critical appraisal of the evidence

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.

Clostridial Diseases (Botulism and Tetanus)

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.

Clostridial Diseases of Horses: A Review

The clostridial diseases of horses can be divided into three major groups: enteric/enterotoxic, histotoxic, and neurotoxic. The main enteric/enterotoxic diseases include those produced by Clostridium perfringens type C and Clostridioides difficile, both of which are characterized by enterocolitis. The main histotoxic diseases are gas gangrene, Tyzzer disease, and infectious necrotic hepatitis. Gas gangrene is produced by one or more of the following microorganisms: C. perfringens type A, Clostridium septicum, Paeniclostridium sordellii, and Clostridium novyi type A, and it is characterized by necrotizing cellulitis and/or myositis. Tyzzer disease is produced by Clostridium piliforme and is mainly characterized by multifocal necrotizing hepatitis. Infectious necrotic hepatitis is produced by Clostridium novyi type B and is characterized by focal necrotizing hepatitis. The main neurotoxic clostridial diseases are tetanus and botulism, which are produced by Clostridium tetani and Clostridium botulinum, respectively. Tetanus is characterized by spastic paralysis and botulism by flaccid paralysis. Neither disease present with specific gross or microscopic lesions. The pathogenesis of clostridial diseases involves the production of toxins. Confirming a diagnosis of some of the clostridial diseases of horses is sometimes difficult, mainly because some agents can be present in tissues of normal animals. This paper reviews the main clostridial diseases of horses.

A survey of veterinarians' practices, recommendations and perceptions associated with the prevention of tetanus in horses in Australia

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.

Clinical findings and response to treatment of 17 cases of tetanus in horses (2012-2021)

Tetanus is a distressing and often fatal disease caused by exotoxins released by the bacterium Clostridium tetani. Clostridium tetani is a commensal of the gastrointestinal tract of humans and domestic animals, and its spores are highly resistant to environmental changes, acid, and alkali and may persist in the soil for many years. The disease is characterized by generalized muscular rigidity and spasms, hyperesthesia, convulsions, respiratory arrest, and death. Horses are the most susceptible domestic animals. Treatment is typically directed towards elimination of the source of the toxin, neutralization of any unbound toxin, establishment of antitoxin immunity, control of neuromuscular derangements, and relief of pain. This study described the clinical findings and therapeutic protocols of 17 horses with tetanus, treated between March 2012 and December 2021. The diagnosis of tetanus was based on the history and clinical examination findings of the animals. All horses received a treatment pattern composed of the administration of tetanus serum (50,000 UI, intravenously, followed by three injections of the same dose at 48-h intervals), procaine penicillin (25,000 UI kg, intramuscularly, BID, for 10 days), and muscle relaxant (acepromazine 0.02-0.05 mg/kg, intramuscularly, BID, for 8 days). Support therapy based on hydroelectrolytic replacements, feeding via a nasogastric tube, and assistance in the maintenance of the quadrupedal position were performed when needed. The mortality rate observed in this report was 23.52%. Early diagnosis associated with the instituted treatment contributed the most to the animal recovery.

Retrospective anti-tetanus antibody responses of zoo-based Asian elephants (Elephas maximus) and rhinoceros (Rhinocerotidae)

Tetanus toxoids (TT) commercially available for use in horses and livestock are commonly used to vaccinate elephants and rhinoceros that are in human care. Although recommendations for booster intervals have changed in human and horse protocols to reduce the risks associated with hyper-immunity (i.e. B-cell anergy and hypersensitivity reactions) these have generally not been adopted in zoo protocols. Additionally, there is no evidence to demonstrate commercial TT immunogenicity in rhinoceros. In this study, a preliminary analysis of rhinoceros antibody responses to TT was conducted, in addition to an exploration of the impact of various booster frequencies on antibody responses in elephant. Retrospective analysis of archived serum samples was conducted for 9 Asian elephants (Elephas maximus), 7 southern black (Diceros bicornis minor), one southern white (Ceratotherium simum simum), and two greater one-horned (Rhinoceros unicornis) rhinoceros. Pre-vaccination (baseline) samples and those following priming vaccination (rhinoceros only), annual and non-annual boosters were targeted. A commercially available competitive ELISA kit was used to quantify serum anti-TT antibodies. Average baseline and post-vaccination anti-tetanus antibody concentrations were greater in elephant (92 mg/L ± 42, n = 3, N = 3; 125 ± 76, n = 82, N = 9) than in rhinoceros (47 mg/L ± 39, n = 8, N = 8; 44 mg/L ± 37, n = 16, N = 7). Rhinoceros antibody concentrations did not differ markedly following vaccinations from their naturally acquired high pre-vaccination concentrations. Eight elephants demonstrated antibody maintenance for 3-5 years without a tetanus booster. Additionally, although five out of nine elephants developed local reactions consistent with delayed type IV hypersensitivity following some boosters, there was no association between high antibody concentrations and increased incidence of adverse reactions. In addition, no decrease in antibody concentrations was detected as a result of annual vaccination in elephants, though this does not entirely rule out potential for B-cell anergy.

Horses as a Crucial Part of One Health

One Health (OH) is a crucial concept, where the interference between humans, animals and the environment matters. This review article focusses on the role of horses in maintaining the health of humans and the environment. Horses' impact on environmental health includes their influence on soil and the biodiversity of animal and plant species. Nevertheless, the effect of horses is not usually linear and several factors like plant-animal coevolutionary history, climate and animal density play significant roles. The long history of the relationship between horses and humans is shaped by the service of horses in wars or even in mines. Moreover, horses were essential in developing the first antidote to cure diphtheria. Nowadays, horses do have an influential role in animal assisted therapy, in supporting livelihoods in low income countries and as a leisure partner. Horses are of relevance in the spillover of zoonotic and emerging diseases from wildlife to human (e.g., Hendra Virus), and in non-communicable diseases (e.g., post-traumatic osteoarthritis in horses and back pain in horse riders). Furthermore, many risk factors-such as climate change and antimicrobial resistance-threaten the health of both horses and humans. Finally, the horse is a valuable factor in sustaining the health of humans and the environment, and must be incorporated in any roadmap to achieve OH.

Vaccine Production to Protect Animals Against Pathogenic Clostridia

Clostridium is a broad genus of anaerobic, spore-forming, rod-shaped, Gram-positive bacteria that can be found in different environments all around the world. The genus includes human and animal pathogens that produce potent exotoxins that cause rapid and potentially fatal diseases responsible for countless human casualties and billion-dollar annual loss to the agricultural sector. Diseases include botulism, tetanus, enterotoxemia, gas gangrene, necrotic enteritis, pseudomembranous colitis, blackleg, and black disease, which are caused by pathogenic Clostridium. Due to their ability to sporulate, they cannot be eradicated from the environment. As such, immunization with toxoid or bacterin-toxoid vaccines is the only protective method against infection. Toxins recovered from Clostridium cultures are inactivated to form toxoids, which are then formulated into multivalent vaccines. This review discusses the toxins, diseases, and toxoid production processes of the most common pathogenic Clostridium species, including Clostridiumbotulinum, Clostridiumtetani, Clostridiumperfringens, Clostridiumchauvoei, Clostridiumsepticum, Clostridiumnovyi and Clostridiumhemolyticum.

Evaluation of a capture antigen ELISA for the characterisation of tetanus vaccines for veterinary use

We previously developed an ELISA assay for detection of tetanus toxoid antigen in tetanus vaccines for human use. Tetanus vaccines for veterinary use are qualitatively different to those used in humans, often containing a larger number and variety of non-tetanus antigens in the multi-valent products, and adjuvants that are not found in human vaccines. We assessed performance of the capture ELISA with a range of veterinary tetanus vaccines as a first step towards development of an immunoassay as a potential in vivo potency substitute. Nine tetanus vaccines were tested and all produced a good dose response in the ELISA. The shape of the dose response curve for the whole vaccine compared to a matched non-adjuvanted tetanus toxoid antigen was more comparable for vaccines containing a non-aluminium adjuvant than products containing aluminium adjuvants. Elution of the antigen from aluminium adjuvant did not improve the comparability of the dose response curve but did increase the total amount of tetanus antigen available for detection. The ELISA was highly specific for tetanus with no signal obtained for a large number of non-tetanus antigens. These results suggest that a capture ELISA assay can be applied to a control strategy for veterinary tetanus vaccines.