Table 1A.

Prognostic Scoring Systems in Tetanus Dakar Score

Prognostic Factor
Incubation period
Period of onset
Entry site
Spasms
Fever
Tachycardia

Score 1

Score 0

< 7 days
< 2 days
Umbilicus, burn, uterine,
open fracture, surgical
wound, IM injection
Present
> 38.4oC
Adult > 120 beats/min
Neonate > 150 beats/min

7 days or unknown
2 days
All others plus unknown
Absent
< 38.4oC
Adult < 120 beats/min
Neonate < 150 beats/min

Total Score

Table 1B. Prognostic Scoring Systems in Tetanus Phillips Score

Factor
Incubation Time
< 48 hours
2-5 days
5-10 days
10-14 days
> 14 days
Site of infection
Internal and umbilical
Head, neck, and body wall
Peripheral proximal
Peripheral distal
Unknown
State of protection
None
Possibly some or maternal immunisation in neonatal patients
Protected > 10 years ago
Protected < 10 years ago
Complete protection
Complicating factors
Injury or life threatening illness
Severe injury or illness not immediately life threatening
Injury or non life threatening illness
Minor injury or illness
ASA Grade 1
Total Score

Score
5
4
3
2
1
5
4
3
2
1
10
8
4
2
0
10
8
4
2
0

Table 1C. Prognostic Scoring Systems in Tetanus, Grading of Severity [Urwadia

1994]
Grade 1 (Mild):
Grade 2 (Moderate):

Grade Three (Severe):

Grade Four (Very

Severe):

Mild to moderate trismus, general increased tone, no respiratory

distress, no spasms, and no dysphagia
Moderate trismus, marked rigidity, short lasting spasms,
tachypnoea 35minute-1, mild dysphagia.
Severe trismus, generalised increased tone, reflex spontaneous or
prolonged spasms, respiratory distress with
tachypnoea 40minute-1, apnoeic spells, severe dysphagia,
tachycardia 120 minute-1,moderate increase in autonomic nervous
system dysfunction.
Features of Grade III, plus severe autonomic dysfunction,
persistent labile blood pressure and pulse rate.

Table 2. Vaccination Schedules [Peter 1995].

Vaccine

Children under 7 years

1-DPT

6-8 weeks

2-DPT

4-8 weeks after previous dose

3-DPT

4-8 weeks after previous dose

4-DPT

1 year after previous dose

Booster-DPT

4-6 years of age

Adults and children not previously vaccinated

1-Td

At presentation

2-Td

4-8 weeks after previous dose

3-Td

6 months - 1 year after previous dose

Booster- Td

Every 10 years after previous dose

Pregnant women previously vaccinated

Booster- TT

During first six months of pregnancy

Pregnant women not previously vaccinated

1-TT

First encounter during pregnancy

2-TT
4 weeks after previous dose
Abbreviations: DPT, diphtheria and tetanus toxoid and pertussis absorbed; Td tetanus and reduced-dose
diphtheria toxoids absorbed; TT, tetanus toxoid