What is tetanus?

Tetanus is an acute bacterial infection that affects the nervous system. The bacteria enters the body through an open wound and releases a toxin that causes painful muscle contractions. Tetanus is also called lockjaw because it causes neck and jaw muscles to contract or ‘lock up’. A vaccine can prevent tetanus. There is a risk of tetanus if soil or manure-containing bacteria come in contact with the wound, burn or scratch.¹ Tetanus occurs more often in warmer climates or during the warmer months.²

Risk factors

Following are the risk factors that can lead to developing tetanus infection.

• If the person is not fully vaccinated (Consult with your GP if you’re not sure whether you’ve been fully vaccinated against tetanus)
• If you had a large or deep wound or
• If the wound is not clean^3,6

Causes

Tetanus is caused by the bacteria Clostridium tetani. The bacterial spores which are typically found in soil and manure enter the body through cuts and breaks in the skin. Once inside, the spores become active, growing into live bacteria. These bacteria produce a toxin called tetanus toxin, that results in blockage of nerve signals from the spinal cord to the muscles, leading to severe muscle spasms. These spasms can be so intense that they can tear muscles or cause spinal fractures. 

The bacteria can enter the body through various means, including:

• Burns
• Exposed broken bones(compound fractures)
• Crush injuries
• Insect and dog bites
• Using infected syringes
• Surgical procedures
• Dental infections

Tetanus is non-communicable and does not spread from person to person

Signs and symptoms

The duration from the exposure to the bacteria till the onset of symptoms is called the incubation period. It usually 3-21 days in tetanus cause bacteria. However, the range varies widely based on the severity and the type of wound. Sometimes it could develop within a day or may take up to a few months.

Other symptoms may include:

• Difficulty swallowing or breathing
• Drooling
• High blood pressure
• Neck muscle stiffness
• Seizures
• Fever
• Sweating
• Increased heart rate (tachycardia)
• Muscle spasms in the back, arms and legs
• Uncontrolled peeing (urination) and pooping (defecation)^1,5

Complications

It's important to note that tetanus infections occur in individuals with no immunity or low levels of anti-tetanus antibodies. Life-threatening complications from tetanus can arise such as pneumonia due to aspiration, laryngospasm (sudden closure of the throat muscles), rhabdomyolysis (rapid muscle breakdown), bleeding from the gut, cardiovascular instability (such as transient cardiac arrest, increased or decreased heart rate, or abnormal heartbeats), hypertension, acute kidney failure and secondary wound infections. Mortality from tetanus typically results from respiratory failure and cardiovascular collapse, associated with autonomic dysfunction.⁴

Diagnosis

Tetanus is diagnosed based on the presence of symptoms. Medical history and physical examination also play an essential role in diagnosing this condition. There are no laboratory tests to confirm tetanus.¹

Providers may find a positive wound culture and the isolation of the organism; however, this occurs in only 30% of cases. An assay for antitoxin levels, though not readily available, may help in excluding the possibility of tetanus. A serum antitoxin level of 0.01 IU/mL or higher is generally accepted as protective, making the possibility of tetanus less likely.

The spatula test shows high specificity and sensitivity for the clinical diagnosis of tetanus. This involves using a soft-tipped instrument to touch the posterior pharyngeal wall. If this elicits an involuntary jaw contraction instead of the normal gag reflex, this suggests a positive test.⁴

Treatment

The treatment for tetanus depends on its severity. Immediate medical care is needed once the diagnosis is confirmed. Tetanus is treated by

Providing wound care

This includes the application of antiseptic and washing the wound thoroughly. Sometimes healthcare providers may need to perform surgery to clean the wound and remove the source of the toxin.

Bed rest

A calm environment with dim lights and low noise is recommended. Bright lights and loud noises can worsen muscle spasms.

Breathing support

Breathing support is provided by oxygen through a breathing tube or breathing machine (ventilator).

Medications include

• Tetanus immune globulin (TIG)

TIG is also called tetanus antitoxin. This helps reduce the severity of illness. But it cannot remove the toxin that has already affected the central nervous system 

• Antibiotics 

Antibiotics are used when there is a chance of getting an infection through the wound.

• Muscle relaxants

These medications help to control your muscle spasms.

• Vaccine booster

Includes tetanus vaccination or booster shot. Having tetanus once does not provide future protection (immunity) from getting the condition again. Hence, the vaccine is essential for protection.¹

Prevention

Proper wound care is crucial in preventing tetanus infection. Seek immediate first aid for cuts, injuries, and other wounds, including minor ones like scrapes, blisters, and splinters. To prevent bacteria from entering the wounds, wash your hands adequately with soap and water.

Vaccination is the most effective way to prevent tetanus. The tetanus vaccine, known as Tetanus toxoid, typically has mild side effects such as redness and swelling at the site of injection, and fever. In many countries, the tetanus vaccine is included in the childhood immunisation schedule.

Adults should ensure that they receive their tetanus booster shots on time. It is recommended to receive a Tdap (tetanus-diphtheria-acellular pertussis) or Td (tetanus-diphtheria) booster every 10 years. For additional prevention techniques, contact your healthcare provider.

Vaccination schedule

The NHS(National Health Service) recommends that children receive five shots, as combination vaccines provide protection. The first three doses are administered at 2,3 and 4 months of age as DTaP(diphtheria, tetanus, and pertussis). The fourth dose is given as a preschool booster between 3 years and 4 months(DTaP) , and the fifth dose is administered as a teenage booster(Td- tetanus and diphtheria) at 14 years of age. Adults should then receive a Td booster every 10 years. If an adult did not receive a DTaP previously, they should get a DTaP dose instead of the Td booster, though it can be given sooner if necessary. Always consult your doctor for personalised medical advice.³

Summary

Tetanus is a serious bacterial infection caused by Clostridium tetani, affecting the nervous system and leading to painful muscle contractions, commonly known as lockjaw. The bacteria enter the body through wounds contaminated with soil, dust, or manure. Tetanus is more common in warmer climates. The risk of contracting tetanus increases with deep or dirty wounds, especially if not fully vaccinated. Symptoms typically appear within 3-21 days of exposure and include jaw muscle stiffness, difficulty swallowing, muscle spasms, fever and high blood pressure.The diagnosis is based on clinical evaluation, as no specific lab tests exist. The treatment involves wound care, medications like tetanus immune globulin, antibiotics and supportive care. Prevention is primarily through vaccination, with children receiving DTaP shots and adults needing Tdap or Td boosters every 10 years. 

Frequently asked questions(FAQs)

1. What is tetanus and how does it affect children? 

Tetanus is a bacterial infection caused by Clostridium tetani that affects the nervous system, leading to painful muscle contractions. In children, it can cause severe muscle stiffness and spasms, particularly in the jaw and neck, making it difficult to open the mouth or swallow.

2. What are the signs of tetanus in children?

Early signs of tetanus in children include headaches, jaw cramping (lockjaw), difficulty opening the mouth, muscle stiffness, and spasms. Other symptoms can include difficulty swallowing, drooling, fever and sweating.

3. How is tetanus diagnosed?  

Tetanus is diagnosed based on clinical evaluation, including a physical examination and medical history review. There are no specific laboratory tests to confirm tetanus.

4. What treatments are available for children with tetanus?

Treatment for tetanus involves wound care to remove the source of the toxin, administration of tetanus immune globulin (TIG), antibiotics, muscle relaxants, and supportive care such as bed rest and breathing support if needed. Vaccination or booster shots are also given as a part of the treatment.

5. How can tetanus be prevented in children?

The best way to prevent tetanus in children is through vaccination. The DTaP vaccine, which protects against diphtheria, tetanus, and pertussis, is given in a series of five shots during early childhood. Practising good wound care and hygiene also helps prevent tetanus.

6. What is the vaccination schedule for tetanus in children? 

Children should receive the DTaP vaccine at 2,3 and 4 months of age, 3 years and 4 months, and Td vaccine at 14 years of age. A booster dose (Td) is given every 10 years afterwards.