Tetanus

What Is It?

Tetanus, also called lockjaw, is a life-threatening infection caused by Clostridium tetani bacteria. Although these bacteria are especially common in the soil and manure of farms, they can be found almost anywhere. They live in the dirt of suburban gardens and in the dirty waters of floods. They also contaminate dust in cities.  

Tetanus bacteria usually enter the body through a dirty puncture wound, cut, scrape or some other break in the skin. Once inside the skin, they multiply and produce a toxin, or poison, that affects the body's nerves. This toxin causes severe muscle spasms, cramps and seizures. Spasms in the jaw muscles produce lockjaw. Spasms also occur in muscles of the throat, chest, abdomen and extremities. If you don't receive proper treatment, the toxin's effect on respiratory muscles can interfere with breathing. If this happens, you may die of suffocation. 

A tetanus infection may develop after almost any type of skin injury, major or minor. This includes cuts, punctures, crush injuries, burns and animal bites. In rare cases, a tetanus infection also can occur after surgery, an ear infection, a dental infection or an abortion. Among drug users, tetanus infections have followed heroin injections, especially if the heroin was mixed with quinine. Tetanus also can develop after body piercing, tattooing, an insect sting or even a tiny splinter. 

In the United States, only 50 cases of tetanus occur each year, because so many Americans have been immunized against the infection. Almost everyone who develops tetanus in the United States has been inadequately immunized against tetanus. Some have immigrated from developing countries where vaccines are not available to everyone. Others were born in the United States but never received the primary series of injections. Still others simply failed to keep up with the normal schedule of tetanus shots. This is a common problem among adults, especially those older than 60. 

Symptoms

On average, symptoms of tetanus begin seven to eight days after tetanus bacteria enter the body. These symptoms may include: 

• Spasms in the jaw muscles (lockjaw)  
• Stiff muscles in the neck, shoulder and back  
• Difficulty swallowing  
• Prolonged contraction of the facial muscles, which may produce what looks like a sneer or grimace  
• An arched back resulting from contraction of the back muscles  
• Muscle spasms and muscle rigidity in the chest, abdomen and extremities  
• Fever and profuse sweating  
• High blood pressure  
• Rapid or irregular heartbeat  
• Seizures  
• Difficulty breathing  
• Fractured bones and ruptured muscles caused by severe muscle spasms

Diagnosis

There is no laboratory test for tetanus. A doctor will diagnose tetanus based on your symptoms, a history of a recent cut or puncture wound, and immunization history.

Expected Duration

People who have tetanus must be treated in a hospital. Severe muscle spasms may last for about three to four weeks and then slowly get better. Once these spasms subside, recovery takes several months.

Prevention

Immunization can prevent almost all cases of tetanus. 

In the United States, babies are immunized against tetanus through a series of four vaccinations. This primary series is given in the form of DTaP shots. In addition to the vaccine for tetanus, each DTaP shot contains vaccines against diphtheria, which is a severe respiratory infection, and pertussis, also called whooping cough. The usual schedule for DTaP shots is as follows: 

• First shot: age 2 months  
• Second shot: age 4 months  
• Third shot: age 6 months  
• Fourth shot: age 15 to 18 months  

Once the primary series of tetanus immunizations is complete, a child usually receives two tetanus booster shots. One is given between the ages of 4 and 6 years, just before the child starts school. The second is given between the ages of 11 and 12 years. Booster shots enhance (boost) a child's level of tetanus immunity. 

After age 12, a tetanus booster shot usually is recommended every 10 years. Under special circumstances, however, a doctor may give the booster dose sooner. For example, a tetanus booster is usually given if you get a severe cut or puncture wound and it has been more than 5 years since your last tetanus shot. This is because some people show a decrease in tetanus immunity within 5 to 10 years after the last tetanus booster. 

In adults and children older than 7 who have never been immunized against tetanus, doctors use a primary series of Td shots. Once the primary Td series is finished, booster shots are usually given every 10 years. Because of the recent increase in pertussis cases, at least one of the shots should be a DTaP during adulthood. 

All adults and children should receive routine tetanus immunizations. However, certain groups of people must be especially careful to keep their tetanus shots up to date. These people have jobs or hobbies that expose them to dirt, dust, manure or dirty water. Some examples include farm workers, landscapers, gardeners, firefighters and people who are exposed to sewage or flood water. Veterinary workers and people who deal with animal waste are also at high risk. 

Doctors review a patient's tetanus immunizations before surgery and before childbirth. All women of childbearing age should be immunized against tetanus. Newborns rely on their mother's tetanus immunity to protect them from tetanus until their own DTaP shots begin. An infant who is not properly protected against tetanus can develop a tetanus infection even from having his or her umbilical cord cut. 

Any wound should be cleaned well as soon as possible, especially if it is contaminated with dirt, to reduce the risk of infection with the bacteria that cause tetanus. 

Treatment

If you seek medical care for a wound, your doctor will ask you when you had your last tetanus shot. If your tetanus immunization is not up-to-date, the doctor will give you a tetanus booster. However, this booster shot will not produce immunity right away, so you may receive tetanus immune globulin as well. Tetanus immune globulin contains an antitoxin that neutralizes the tetanus toxin, temporarily protecting you until your immune system responds to the tetanus booster. 

If you have full-blown tetanus, you will be treated in a hospital. There you will receive tetanus immune globulin to neutralize the tetanus toxin. Your muscle spasms will be treated with muscle relaxants, and you also may be sedated. If necessary, you will be placed on a ventilator to help you breathe. If you have an obvious wound infection, you will probably receive antibiotics as well. Once your condition begins to improve, you will begin a schedule of shots to restore your tetanus immunity, because a tetanus infection does not make you immune to the disease.

When To Call a Professional

Call your doctor immediately if you develop symptoms of tetanus. Also, seek medical care immediately for any deep cut, serious puncture wound or any wound contaminated by dirt or manure. 

If you are an adult, check your immunization records for the date of your last tetanus shot. If it has been more than 10 years since your last tetanus booster, schedule an appointment with your doctor. Also contact your doctor if your health records show that you never received a full primary series of tetanus immunizations. 

If you are a parent, be sure your child's immunizations are all up-to-date. This is especially true for DTaP shots and other vaccines that are given in a series. 

Prognosis

Most patients with tetanus survive and return to previous function. Older people and those who have a rapid progression from time of infection to severe symptoms have a higher risk of death.

Additional Info

Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/