How To Prevent Tetanus

Overview

Tetanus is commonly called “lockjaw”. The World Health Organization (WHO) describes it  as a serious disease that is caused by spores of the bacterium Clostridium tetani.¹ These spores are found everywhere in the environment, particularly in soil, ash, animal and human feaces, and on the surfaces of skin and rusted tools such as nails, needles, and barbed wire. 

The bacteria can enter the body through deep cuts, wounds, or burns, and they mostly attack the nervous system.¹ When a person is infected with tetanus, the person could  experience painful muscle contractions, especially in the jaw and neck muscles. These contractions in the neck and jaw earned tetanus the name “lockjaw”.³ Tetanus is  a diseases of public health importance which is vaccine preventable. It is however not transmissible from one person to another.

According to estimates by the Centre for Disease Control (CDC), tetanus kills over 200,000 people each year (mostly newborns and young children), but because the disease is so rarely reported, all figures are only estimates.²

Between 2009 and 2017, 264 cases of tetanus were reported in the United States, with 19 deaths. The age distribution for cases was 23% in people 65 years old, 64% in people 20 to 64 years old, and 13% in people 20 years old, including 3 cases of tetanus neonatorum; all tetanus-related deaths occurred in people over the age of 55.^1,3 

Understanding tetanus

According to research, there are four common forms of tetanus: 

• Generalized tetanus is the most common type of tetanus and it occurs in approximately 80% of cases. Patients have a descending pattern of muscle spasms, beginning with lockjaw and risus sardonicus (rigid smile because of sustained contraction of facial muscles). This can lead to a stiff neck, difficulty swallowing, and pectoral and calf muscle rigidity. These spasms can last up to four weeks, and full recovery can take months. In these patients, instability of the nerves can manifest as fever, dysrhythmia, labile blood pressure and heart rate, respiratory difficulties, and even death⁸
• Neonatal tetanus is a type of tetanus that occurs in newborns born to unimmunized mothers or as a result of infection from a contaminated instrument used to cut the umbilical cord. Tetanus is rarely transmitted to infants born to immunized mothers due to passive immunity from the mother.⁸ Infected children are often irritable, do not feed well, experience spasms and contractions that are triggered by touch. Long-term consequences like neurodevelopmental impairments, behavioral problems, and poor language development have been reported in children born to mothers who are not vaccinated against tetanus⁸
• The most uncommon types of tetanus are localized tetanus and cephalic tetanus. Localized tetanus is characterized by persistent muscle contractions at the site of injury that can last for weeks.⁸ This type is rarely fatal; however, it can progress to the more dangerous generalized form of tetanus. Cephalic tetanus affects only the muscles and nerves of the head. Cephalic tetanus is most commonly caused by a skull fracture, laceration, eye injury, dental procedures, ear infections, or another injury site. The facial nerves are usually affected in this type of tetanus

Common causes of tetanus

Tetanus infection can occur when spores enter your body through an injury or wound. The spores develop into active bacteria that spread throughout the body and produce a poison known as tetanus toxin (also known as tetanospasmin). This poison prevents nerve signals from traveling from your spinal cord to your muscles, resulting in severe muscle spasms. Spasms can be so severe that they tear muscles or cause spine fractures.^1,3,8

Symptoms

Once a person is infected with the tetanus bacteria, it takes between 3 and 21 days for the person to begin exhibiting symptoms. However, the average time is 10 days. The symptoms would usually begin gradually and become worse over time, usually two weeks. 

The following are common symptoms of tetanus:

• Painful spasms or difficulty moving your jaw
• Difficulty swallowing
• Stiffness or tension of the muscles in or around your lips
• Painful spasms or difficulty moving your neck
• Rigidity or stiffness of the muscles in the stomach or abdominal area

As the tetanus toxin spreads through  the body, it causes painful, seizure-like spasms that last for several minutes (generalized spasms). When these spasms occur, the neck and back usually arch, the legs stiffen, the arms are drawn up to the body, and the fists are clenched. 

This posture, which is involuntary can last for several moments, causes breathing difficulties that may result from muscle rigidity in the neck and abdomen.^1,5Minor events that stimulate the senses, such as  loud sounds, physical touch, a draft, or light, can also trigger these severe spasms.⁵

As the disease progresses, other symptoms may develop, which include changes in blood pressure (high or low blood pressure), increased heart rate, fever, and excessive sweating.  

Diagnosis

Your doctor will examine you and inquire about your medical history. There is no specific laboratory test for tetanus. Meningitis, rabies, strychnine poisoning, and other diseases with similar symptoms may be ruled out with tests.

How to prevent tetanus

Tetanus can be prevented by immunization with tetanus-toxoid-containing vaccines (TTCV), which are included in global routine immunization programs and are given to pregnant women during antenatal care contacts.¹

A DTaP vaccination protects against three diseases: diphtheria, tetanus, and pertussis. The CDC recommends that children receive five DTaP vaccinations. The first three shots are administered at the ages of two, four, and six months. The fourth shot is administered between the ages of 15 and 18 months, with a fifth administered between the ages of 4 and 6 years.⁴

Tdap should be administered to 11 or 12-year-olds at regular checkups. Tetanus, diphtheria, and pertussis vaccine are included in the Tdap booster. If an adult did not receive Tdap as a preteen or adolescent, he or she should receive Tdap instead of the Td booster. Tdap doses are also recommended for pregnant women, to protect their children from the disease.⁴

Adults should get a Td booster every ten years, but it can be given earlier. Always seek advice from your healthcare provider.⁴

Treatments for tetanus

If your healthcare provider believes you might have tetanus from a wound but you do not have any symptoms yet, they will make sure your wound is thoroughly cleaned. They may also administer a tetanus immunoglobulin injection to you.⁶

If you have not been fully immunized against tetanus, or if you are unsure, you may be given a dose of the tetanus vaccine. Antibiotics may also be administered.⁶ Tetanus immunoglobulin is a medication that contains antibodies that inhibit the action of the tetanus toxin, thereby halting its effects on the nerves. It provides immediate, but brief, protection against the disease.⁶

Complications

Tetanus can cause the following complications:⁷

• Obstruction of the airways
• Difficulty breathing 
• Heart attack
• Pneumonia
• Fractures because of the spasms 
• Damage to the brain caused by a lack of oxygen during spasms

When to seek medical attention

Tetanus is a potentially fatal disease. Seek emergency medical attention if you have tetanus symptoms.If you have a simple, clean wound and have had a tetanus shot within the last 10 years, you can treat it at home.

You should seek medical attention if you have any of the symptoms of tetanus and any of these:⁵

• You have not had a tetanus shot in ten years
• You are not sure when your last tetanus shot was
• You have a puncture wound, a foreign object in your wound, an animal bite, or a deep cut
• Your wound is contaminated with dirt, soil, feces, rust, or saliva — or you are unsure whether you cleaned a wound thoroughly after such exposure. If it has been five years or more since your last tetanus shot, you will need a tetanus vaccination booster for any contaminated wounds

A tetanus infection requires immediate medical attention because it can be life-threatening. 

Summary

Tetanus, also called "lockjaw," is a serious disease caused by Clostridium tetani bacteria found in soil, feces, and rusty tools. It enters the body through cuts and affects the nervous system, causing painful muscle contractions, particularly in the jaw and neck. Tetanus kills over 200,000 people annually, mostly newborns and young children. In the US from 2009 to 2017, there were 264 cases and 19 deaths, primarily in people aged 20 to 64 and over 55. Vaccination is crucial for prevention.