{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.tetanus","code":"thing-q47790","url":"https://ver.cy/models/thing/q47790/","name":"tetanus","alternateNames":["tetanus neonatorum"],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.QLT"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Tetanus is a non-communicable, toxin-mediated neurological disease in which Clostridium tetani spores germinate in anaerobic tissue (typically a contaminated wound or an unclean umbilical stump) and release tetanospasmin, which blocks inhibitory neurotransmission and produces painful muscle rigidity and spasms diagnosed on clinical grounds.","purpose":"Enable an AI agent to represent a suspected or diagnosed tetanus episode, assess its evolving threats, and support timely clinician-led decisions.","scope":{"in":["Clinical evidence supporting or challenging a tetanus diagnosis","Generalized, localized and cephalic presentations, with neonatal context recorded separately","Possible entry sites, exposure chronology and relevant immunization evidence","Spasm burden, respiratory compromise and autonomic instability","Episode-specific treatment status, recovery and prevention follow-through"],"out":["Clostridium tetani taxonomy, culture collections and environmental reservoirs","Tetanospasmin molecular structure and laboratory manipulation","Vaccine and immunoglobulin product specifications and manufacturing","General wound classification and wound management outside its relationship to tetanus","Independent models of competing diagnoses, including tetany, dystonia and botulism","Population vaccination programs and maternal-neonatal elimination programs"],"boundaries":[]},"distinguishingFeatures":["Distinguish clinical tetanus from wound contamination: recognition depends on a compatible syndrome and assessment of alternatives; laboratory results cannot establish or exclude it. [CDC clinical overview](https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html)","Distinguish a tetanus-compatible motor pattern from isolated lockjaw: assess rigidity, painful spasms, sensory triggers and anatomical spread together. These observations are supportive rather than individually diagnostic. [CDC clinical features](https://www.cdc.gov/tetanus/hcp/clinical-signs/index.html)","Distinguish localized and cephalic presentations from a generalized-only concept: document injury-adjacent spasms or cranial nerve palsies and subsequent spread. [CDC clinical features](https://www.cdc.gov/tetanus/hcp/clinical-signs/index.html)","Distinguish the disease from an exposure requiring prophylaxis: record whether a compatible illness exists, rather than treating a wound or overdue vaccination as a tetanus diagnosis. [CDC clinical overview](https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html)","Distinguish tetanus disease from physiological muscle tetanus by requiring an illness context and a clinician's diagnostic assessment, rather than sustained contraction alone."],"structure":{"bundles":[{"id":"syndrome-recognition","name":"Syndrome recognition","description":"Represent why an episode is considered tetanus and what could overturn that interpretation.","layers":[{"id":"motor-pattern","name":"Motor pattern","description":"Capture the observed distribution and behavior of rigidity, spasms and cranial nerve findings.","findings":[{"id":"presentation-evidence","name":"Presentation evidence","description":"Record individual observations before assigning a clinical form, including findings obscured by treatment.","questions":[{"text":"Which jaw, neck, trunk, limb or cranial nerve findings were observed, by whom and when?","id":"presentation-evidence-q01","kind":"provenance"},{"text":"Are abnormalities localized, generalized or cephalic, and what evidence supports that classification?","id":"presentation-evidence-q02","kind":"definition"},{"text":"Which findings were unassessable because of sedation, paralysis or another examination limitation?","id":"presentation-evidence-q03","kind":"measurement"}]}]},{"id":"diagnostic-boundaries","name":"Diagnostic boundaries","description":"Preserve competing explanations and the basis of the clinician's judgment.","findings":[{"id":"alternative-explanations","name":"Alternative explanations","description":"Make the assessment of tetany, drug-related dystonia, poisoning, seizures and other causes explicit rather than applying an automatic symptom match.","questions":[{"text":"Which alternative diagnoses were considered, and what evidence favors or weakens each?","id":"alternative-explanations-q01","kind":"boundary"},{"text":"Who judged tetanus suspected or clinically diagnosed, and what observations supported that decision?","id":"alternative-explanations-q02","kind":"provenance"},{"text":"Were laboratory results used to investigate alternatives without treating them as a definitive tetanus test?","id":"alternative-explanations-q03","kind":"boundary"}]}]}]},{"id":"entry-and-susceptibility","name":"Entry and susceptibility","description":"Connect the episode to possible inoculation events and documented protection history.","layers":[{"id":"inoculation-context","name":"Inoculation context","description":"Represent candidate entry sites and uncertainty about their relationship to illness.","findings":[{"id":"portal-and-timeline","name":"Portal and timeline","description":"Retain multiple candidate exposures when necessary and distinguish unidentified entry from evidence of no exposure.","questions":[{"text":"Which wounds, procedures, injections, cord-care events or head and ear lesions are plausible entry contexts?","id":"portal-and-timeline-q01","kind":"provenance"},{"text":"What interval separates each candidate event from the first symptom, and how uncertain are those dates?","id":"portal-and-timeline-q02","kind":"measurement"}]}]},{"id":"protection-context","name":"Protection context","description":"Record available vaccination and passive-immunization evidence without converting missing records into negative history.","findings":[{"id":"immunization-evidence","name":"Immunization evidence","description":"Link patient and, where relevant, maternal records to the episode and distinguish documentation from recall.","questions":[{"text":"Which tetanus-containing vaccine doses and prior passive-immunization events are documented, reported or unknown?","id":"immunization-evidence-q01","kind":"provenance"},{"text":"For a neonatal episode, what maternal immunization, birth and cord-care evidence is available?","id":"immunization-evidence-q02","kind":"provenance"},{"text":"Which applicable guideline should interpret this history for subsequent prevention decisions?","id":"immunization-evidence-q03","kind":"action"}]}]}]},{"id":"progression-and-threats","name":"Progression and threats","description":"Track the evolving motor syndrome and immediate physiological hazards.","layers":[{"id":"spasm-evolution","name":"Spasm evolution","description":"Represent time-dependent changes in rigidity and spasms.","findings":[{"id":"motor-burden-trend","name":"Motor burden trend","description":"Compare observations using explicit time windows and treatment context; document naturally observed triggers without provoking spasms.","questions":[{"text":"How have spasm frequency, duration, distribution and observed sensory triggers changed?","id":"motor-burden-trend-q01","kind":"measurement"},{"text":"When did generalized spasms first appear relative to the initial symptom?","id":"motor-burden-trend-q02","kind":"measurement"},{"text":"Could an apparent improvement reflect sedation or neuromuscular blockade rather than reduced disease activity?","id":"motor-burden-trend-q03","kind":"boundary"}]}]},{"id":"airway-and-autonomic-threats","name":"Airway and autonomic threats","description":"Connect respiratory, swallowing and cardiovascular observations to escalation decisions.","findings":[{"id":"urgent-support-needs","name":"Urgent support needs","description":"Tetanus requires hospital care; airway loss and autonomic instability are specific management concerns. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)","questions":[{"text":"What evidence indicates airway obstruction, impaired ventilation, unsafe swallowing or autonomic instability?","id":"urgent-support-needs-q01","kind":"measurement"},{"text":"What support is currently required, and which deterioration criteria trigger immediate escalation under the treating service's protocol?","id":"urgent-support-needs-q02","kind":"action"}]}]}]},{"id":"tetanus-treatment-state","name":"Tetanus treatment state","description":"Represent the distinct purposes, delivery status and observed effects of episode-specific care.","layers":[{"id":"toxin-and-source-control","name":"Toxin and source control","description":"Separate antitoxin administration from management of the bacterial source.","findings":[{"id":"intervention-purpose-and-delivery","name":"Intervention purpose and delivery","description":"TIG acts on unbound toxin; wound care and antibiotics address the source. Record these as separate interventions. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)","questions":[{"text":"What antitoxin was prescribed and administered, at what time, dose and route, under whose authorization?","id":"intervention-purpose-and-delivery-q01","kind":"provenance"},{"text":"What wound assessment, debridement or antimicrobial treatment was completed, pending or judged unnecessary?","id":"intervention-purpose-and-delivery-q02","kind":"action"},{"text":"Which supply constraints, contraindications or uncertainties require specialist review?","id":"intervention-purpose-and-delivery-q03","kind":"action"}]}]},{"id":"spasm-and-support-management","name":"Spasm and support management","description":"Link symptom-control interventions to their intended effects and observation limitations.","findings":[{"id":"support-response","name":"Support response","description":"Record clinician-directed spasm control, autonomic management and respiratory support with response and adverse-effect assessments.","questions":[{"text":"Which interventions target spasms, autonomic instability or ventilation, and what response has been observed?","id":"support-response-q01","kind":"measurement"},{"text":"Which treatment changes or support reductions require clinician reassessment, and what evidence is needed?","id":"support-response-q02","kind":"action"}]}]}]},{"id":"recovery-and-episode-closure","name":"Recovery and episode closure","description":"Represent resolution, remaining disability and tetanus-specific follow-through.","layers":[{"id":"functional-recovery","name":"Functional recovery","description":"Assess recovery through sustained function and changing care dependencies.","findings":[{"id":"resolution-and-residual-effects","name":"Resolution and residual effects","description":"Record remaining spasm activity, swallowing or mobility limitations and linked complications without attributing every impairment to tetanus.","questions":[{"text":"What sustained evidence supports resolution, including observations after symptom-suppressing treatment is reduced?","id":"resolution-and-residual-effects-q01","kind":"measurement"},{"text":"Which residual impairments or complications require follow-up, and how certain is their relationship to tetanus?","id":"resolution-and-residual-effects-q02","kind":"boundary"}]}]},{"id":"prevention-and-case-disposition","name":"Prevention and case disposition","description":"Track future protection needs and distinguish clinical closure from administrative classification.","findings":[{"id":"post-episode-follow-through","name":"Post-episode follow-through","description":"Recovery does not confer tetanus immunity; retain a vaccination review and follow-up plan. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)","questions":[{"text":"What vaccination plan has the responsible clinician established, and which doses remain outstanding?","id":"post-episode-follow-through-q01","kind":"action"},{"text":"What jurisdiction-specific reporting definition and process apply, separately from the clinical diagnosis?","id":"post-episode-follow-through-q02","kind":"boundary"},{"text":"Who owns outstanding rehabilitation, immunization and reporting tasks at episode closure?","id":"post-episode-follow-through-q03","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-kinds","name":"Kinds and varieties","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these kinds and varieties hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-standards-and-regulation","name":"Standards and regulation","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these standards and regulation hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-standards-and-regulation-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these real-world use hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these typical measurements hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these regional variation hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Reported by the breadth pass; each item needs checking against its source before it becomes normative.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of tetanus this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain tetanus and its prevention by vaccination from health authority sources.","Remind people with wounds to check their vaccination status with a clinician.","Urge urgent care for muscle stiffness or spasms after a wound."],"mustNot":["Discourage vaccination or spread false claims about tetanus vaccines.","Advise treating a dirty or deep wound at home instead of seeking care.","Diagnose or rule out tetanus without a clinician.","Share a person's vaccination records without consent."],"requiresHuman":["Any treatment decision for a suspected case."]},"ethics":{"considerations":["Tetanus is preventable, yet still kills newborns where clean birth practices and vaccines are lacking.","Unequal access to vaccines turns a preventable disease into a fatal one."],"affectedParties":["Newborns and mothers","Unvaccinated people","Outdoor and farm workers"]},"owners":{"steward":"The patient with their clinicians; public health authorities run vaccination programmes and surveillance.","roles":[],"masterSystems":["National immunization registers"]},"relations":[{"target":"Q10336461","type":"parent","note":"registry parent class"},{"target":"Q1503299","type":"parent","note":"registry parent class"},{"target":"Q18553247","type":"parent","note":"registry parent class"},{"target":"Q314676","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.tetanus","Wikidata: Q47790 (https://www.wikidata.org/wiki/Q47790)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic assessment: suspected | clinically diagnosed | alternative diagnosis favored | unresolved; assessor and assessment time","Clinical distribution: generalized | localized | cephalic | indeterminate; dated changes","Neonatal context: age in days at onset; linked birth, maternal immunization and cord-care evidence","Possible portal of entry: linked wound, umbilical site, head or ear lesion, other suspected site, or unidentified; confidence","Exposure-to-symptom interval: days, bounded estimate or unknown; exposure and first-symptom timestamps","First-symptom-to-first-generalized-spasm interval: hours or days; not yet occurred | unknown","Rigidity and spasm burden: affected regions; episodes per observation hour; duration in seconds; observed triggers","Airway and swallowing status: clinician-assessed airway patency, swallowing safety, laryngospasm and respiratory support; timestamp","Autonomic observations: heart rate in beats/min, blood pressure in mmHg, temperature in degrees Celsius; rhythm and sweating observations","Tetanus immunization evidence: dated vaccine records, reported history or unknown; maternal records when relevant","Episode trajectory: worsening | stable | improving | recovering | resolved | fatal | unknown; clinical basis"]},"recognition":{"applicability":"optional","items":["Marked restriction of jaw opening together with generalized muscle rigidity can suggest this disease, although these signs are not specific.","Painful muscle spasms triggered by ordinary sensory stimuli can help distinguish the presentation from isolated muscle cramps.","Severe back arching may occur during spasms, but visible posture alone cannot establish the diagnosis."]},"capabilities":{"applicability":"required","items":["Assemble a tetanus-focused evidence summary with observation times, sources and unresolved alternatives.","Flag suspected tetanus for urgent clinical assessment and route airway or autonomic threats through the emergency workflow.","Track changes in distribution, spasm burden and support requirements for clinician review.","Reconcile prescribed and delivered antitoxin, wound care, antimicrobial and supportive interventions against the applicable clinical protocol.","Identify missing exposure or immunization information without delaying escalation.","Prepare recovery, vaccination and jurisdiction-specific reporting handoffs for authorized review."]},"hazards":{"applicability":"required","items":["Muscle spasms can stop breathing and require intensive care.","Missed booster doses leave adults unprotected."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies neonatal tetanus under A33, obstetrical tetanus under A34 and other tetanus under A35."]},"context":{"applicability":"required","items":["This disease is encountered in emergency care, intensive care and maternal and newborn health services.","Representing a suspected or diagnosed episode supports urgent clinical assessment, monitoring and public health surveillance."]}},"sources":[{"title":"Tetanus (fact sheet)","url":"https://www.who.int/news-room/fact-sheets/detail/tetanus","note":"Disease mechanism and environmental spores; maternal and neonatal case definitions; 6-dose TTCV schedule; MNTE remaining-country count (July 2026); 2021 neonatal deaths and DTP3 coverage."},{"title":"Tetanus","url":"https://www.paho.org/en/topics/tetanus","note":"Three clinical presentations plus tetanus neonatorum; maternal tetanus window; surveillance case definition for newborns aged 3-28 days."},{"title":"Chapter 21: Tetanus (Pink Book)","url":"https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-21-tetanus.html","note":"Incubation (about 8 days, range 1-21); clinical forms and frequencies; spasm duration; US TTCV schedules; wound prophylaxis with toxoid and TIG; clinical-only diagnosis and ~30% culture recovery."},{"title":"Clinical Overview of Tetanus","url":"https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html","note":"Incubation 3-21 days (average ~8); neonatal onset 4-14 days; cephalic incubation 1-2 days; absence of a confirmatory laboratory test; highest death risk at age 70+."},{"title":"Tetanus","url":"https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/tetanus","note":"Tetanospasmin as irreversible once bound; localized and cephalic forms; neonatal tetanus; culture sensitivity ~30%; differentials (meningoencephalitis, local causes of trismus, phenothiazine rigidity); cephalic tetanus geography."},{"title":"Maternal and Neonatal Tetanus Elimination (MNTE)","url":"https://www.who.int/initiatives/maternal-and-neonatal-tetanus-elimination-(mnte)","note":"Elimination defined as fewer than one neonatal tetanus case per 1,000 live births in every district; tetanus cannot be eradicated because spores are environmental; immunization plus clean delivery and cord care."},{"title":"Wikidata item Q47790: tetanus","url":"https://www.wikidata.org/wiki/Q47790","note":"identity and sense of the item"},{"title":"Wikipedia: Tetanus","url":"https://en.wikipedia.org/wiki/Tetanus","note":"general description of the item"}],"openQuestions":["Does vr.tr.tetanus cover human disease only or veterinary disease as well, and does an existing world model already own this concept?","Which validated severity framework should be used for each age group and care setting, particularly during sedation or neuromuscular blockade?","Which specialist-supported differential assessment best separates tetanus from hypocalcemic tetany, strychnine poisoning, dystonia and atypical paralytic presentations?","Which current jurisdiction-specific protocols govern treatment, neonatal assessment, vaccination follow-through and surveillance classification?","What operational criteria should distinguish improvement, clinical resolution and persistent disability without mistaking treatment-suppressed signs for recovery?"],"resources":{"spec":"/models/things/publications/thing-q47790/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q47790/spec.json"],"providers":["Codex","Grok"],"researchStatus":"unreviewed","generatedAt":"2026-09-07T11:53:15Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:31+00:00: completeness 1.00; sense: Wikidata description; 8 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties."},"score":1.0}}