Tetanus is a toxin produced by an anaerobe called Clostridium Tetani which causes tetanus. The spores are distributed widely in the environment and infection generally results from these spores entering wounds at the time of injury. Polio is predominantly contracted through contaminated food and water, although acute infections may be passed on through the nasopharyngeal droplets. Diphtheria is usually contracted by respiratory droplet infection but can also be contracted by articles soiled by infected persons. Skin infection is common on the limbs of children in the tropics who go around barefoot. Distribution and Transmission Tetanus distribution is worldwide. Polio has impacted significantly on developing countries resulting in many people being crippled. Effective vaccinations have virtually eradicated the disease, with the exception of Asian and African developing countries. Diphtheria is in most of sub-Saharan Africa, parts of South East Asia and South America. These countries present a high risk of contracting diphtheria. Signs and Symptoms: Tetanus has an incubation period of 3 – 21 days. During this time muscle rigidity begins to increase, finally resulting in Trismus the inability to open the mouth widely, and rigidity of spinal and abdominal muscles. Further deterioration follows resulting is facial grimacing and back arching, and finally tetanus can prove to be fatal. Polio has an incubation period of 7-14 days. With 90% of cases there are no symptoms. Sometimes resulting in lifetime immunity. A mild flu like illness with a fever presents in 8% of cases, and the remaining 2% of cases, symptoms include paralysis, bladder dysfunction, impaired swallowing, breathing and speech (bulbar poliomyelitis) which may be fatal. Diphtheria incubation period is usually 2-5 days. Toxicity is most severe in pharyngeal diphtheria. Can cause death. Recommendations for Travellers: It is strongly recommended that travelers vaccinate against Tetanus, Polio and Diphtheria.