What is Tetanus?

Tetanus, often called “lockjaw,” is caused by a specific bacterium (called Clostridium tetani) usually found as spores in soil, dust, and manure. These spores can enter the body through a break in the skin, most commonly through a cut or puncture wound by a contaminated object (such as from a rusty nail). Tetanus cannot be transmitted person-to-person and is now relatively uncommon in the United States. Between 1996 and 2009, 29 cases were reported.

The time from exposure to Clostridium tetani spores and the onset of illness is usually 3-21 days with most cases occurring within 8-10 days. The most common initial symptom is spasms of the jaw muscles and difficulty opening the mouth, thus the term “lockjaw.” Other symptoms may include headache, stiffness in the neck and abdominal muscles, swallowing difficulty, generalized body spasms, and fever. Without treatment, tetanus can lead to difficulty breathing and even fractures of bones. At least one in 10 who contract tetanus will die, even with the best medical care.

Tetanus is diagnosed by physical examination and a supportive history (usually with known exposure to a contaminated object). Currently, there are no blood tests to confirm tetanus. Admission to a hospital is usually warranted. A person with suspected tetanus will receive tetanus immune globulin (TIG), which induces specific antitoxins. Antibiotics will be given to decrease the number of spores. Administration of muscle relaxants is often helpful in relieving painful spasms. In severe cases, assisted respiratory support with a special breathing machine, called a mechanical ventilator, may be required.

The best way to prevent tetanus is to be vaccinated against the disease. Tetanus vaccines are recommended for all age groups, beginning at 2 months of age. A tetanus vaccine is recommended at the following ages: 2 months, 4 months, 6 months, 15 –18 months, and 4–6 years. One dose of the tetanus vaccine is administered at age 11 or 12. A booster of tetanus vaccine (either Td or TDaP) is then given every 10 years. Unvaccinated pregnant women should also receive TDaP to pass along antibodies against tetanus to the unborn fetus. Besides vaccination, immediate and proper wound care can help prevent infection. Even if fully vaccinated, a booster dose of the tetanus vaccine may be recommended if a person sustained a severe cut or burn.

Sources:

• Centers for Disease Control and Prevention
• About Tetanus.
  Centers for Disease Control and Prevention
• Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2015..
  American Academy of Pediatrics
• Tetanus
• In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds
• Red Book®: 2012 REPORT OF THE COMMITTEE ON INFECTIOUS DISEASES
• American Academy of Pediatrics; 2012; 707-712.
  Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds
• Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book)
• 12th ed
• Washington, DC: Public Health Foundation; 2011.

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