Tetanus, caused by Clostridium tetani, a toxin-producing bacteria, is an infectious disease of the nervous system. It is more commonly known as a lockjaw. Being highly resistant to the elements and many antiseptics, bacterial spores are found commonly in places like the soil, animal faeces, ash, rusty nails, wires, etc.

Tetanus is a non-communicable disease that enters the body by the infection of cuts or wounds. It is a major public health concern in many parts of the world, especially in developing countries with suboptimal vaccination programs. 

Research indicates that the highest number of tetanus cases is seen in babies who contract it from mothers who haven’t been adequately vaccinated against the infection.¹ The WHO’s Maternal and Neonatal Tetanus Elimination (NTE) program from 1999, aimed at increasing immunisation of pregnant women with at least 2 doses of tetanus vaccine, reported an 88% fall in neonatal tetanus cases worldwide and a decrease of 92% in the estimated deaths of infants between 2000 and 2020.² 

Established tetanus infection often results in fatality, even in cases where expert treatment is provided. Therefore, it is important to prevent the disease with timely immunization using the tetanus toxoid-containing vaccine (TTCV) and effective wound care.

Symptoms of tetanus

The initial signs of tetanus usually begin around the 7-10 day mark and gradually become more severe over the following fortnight.

Symptoms of tetanus include:

• Cramping and tightening of the jaw and neck—commonly referred to as lockjaw
• Muscle spasms in the back, abdomen, and extremities
• Difficulty swallowing
• Headache
• Changes in blood pressure
• Altered heart rate
• Excessive sweating accompanied by fever
• Seizures
• Paralysis

Tetanus, if not managed promptly, has the potential to cause severe spasms resulting in broken bones, breathing difficulty, pulmonary embolism, pneumonia, and eventual fatality. If any sign or symptom of tetanus is observed it is best to seek emergency care.

Treatment

Tetanus being a medical emergency needs immediate care in a hospital setting, especially if the last immunisation against tetanus was done over 10 years ago.

Treatment for tetanus involves:

• Cleaning and sterilisation of the wound
• Antitoxin injection with human tetanus immune globulin (TIG)
• Antibiotics
• Tetanus vaccination to support the immune system for targeted support
• Sedatives to ease the muscle spasms
• Other medications for heart rate and blood pressure management

Prevention

Despite the severe risk caused by a tetanus infection, it can easily be prevented by regular immunisation with a tetanus toxoid-containing vaccine (TTCV). Tetanus vaccination begins as early as a baby’s antenatal care and continues as part of routine childhood and adult vaccination programs worldwide.

How does the vaccine work?

The tetanus toxoid vaccine³ contains a killed or inactivated form of tetanus bacteria. When injected into the arm or thigh muscle, the vaccine stimulates the immune system to produce antibodies in response to the shot. This ensures the body recognizes, and is prepared to fight any future exposure to the tetanus bacteria, Clostridium tetani.

Importance of vaccination

Ensuring immunisation against tetanus bacteria can have the following benefits for individuals:

Disease prevention

By stimulating the immune responses, the vaccine can prepare the body to fight and prevent tetanus infections on exposure to the bacteria.

Long-term protection

Childhood vaccination protects against any future exposure to the infection, although timely boosters must be taken to maintain the protection.

Prophylaxis on exposure

In cases where recent boosters have not been taken in the past decade, immediate vaccination upon exposure can prevent tetanus infection from setting in.

Reduction in neonatal tetanus cases

Scaling up tetanus vaccination in pregnant women resulted in a 97% reduction in deaths from neonatal tetanus between 1988 and 2018, as per WHO estimates.

Global health impact

Countries, that have achieved greater immunisation coverage nationwide have witnessed a drastic decline in tetanus cases.

Types of tetanus shots

The tetanus vaccines are further categorised based on, what vaccine combinations (containing vaccines for other diseases) are administered for tetanus. The differential for this is primarily made based on age.

Vaccine administered in newborns and young children up to 7 years

1. DTaP

The most common combination seen is the DTaP vaccine, which contains a combination vaccine for Diphtheria, Tetanus, and Pertussis (commonly known as whopping cough.

According to the WHO, lifetime protection from tetanus can be achieved with 3 primary doses of the DTap. The primary series consists of 3 doses: the first around 6 weeks, the second at 10-14 weeks, and the third at 14-18 weeks. The first booster dose is given at 15-18 months. Further booster administration decisions are based on local disease data and are prescribed at ages 4-6 years.⁴

2. DT

A diphtheria and tetanus vaccine combination is commonly administered to children who can’t tolerate the Pertussis vaccine.

Vaccine administered between 7-18 years

1. Tdap - Adolescents are recommended a single dose of Tdap vaccine which contains the tetanus toxoid vaccine, reduced diphtheria toxoid vaccine, and acellular pertussis vaccine. The most commonly recommended age for this dose is 11-12 years

Vaccine administered to adults over 18 years

1. Tdap - Adults who have never received Tdap are recommended aTdap vaccine. For those who have prior Tdap immunization, a booster dose every 10 years is recommended. It is also advised when indicated for wound management
2. Td - The Td vaccine contains low-dose diphtheria toxoid and is administered every 10 years to protect against tetanus and diphtheria. It is also advised at times of serious wound injury. If prior vaccination for tetanus has not been received, then it is recommended to take either the DTap or Tdap vaccine instead of the Td vaccine

Vaccine administered during pregnancy

1. DTaP: This vaccine is also approved during the last three months of pregnancy as part of antenatal care
2. Tdap: Advised during the third trimester, preferably between 27 and 36 weeks of pregnancy, the Tdap vaccine should be administered to pregnant women for protection against maternal and neonatal tetanus⁵

Risks associated with tetanus vaccination 

Complications occur in rare cases, tetanus vaccination is largely considered safe. The complications may include:

1. Allergic reaction
2. Muscle pain and weakness 
3. Tinnitus or ringing in the ear
4. Dizziness
5. Vision changes

Among infants and young children, one or more of the following side effects of the tetanus vaccine can be observed in rare cases:

1. Persistent crying for several hours
2. High fever of 105 F or more
3. Seizures

Side effects

The tetanus vaccine is safe and effective and is known to cause only a few mild side effects that go away on their own. These include:

1. Muscle soreness, redness, and swelling at the injection site
2. Body ache
3. Chills and low-grade fever
4. Fatigue
5. Headache
6. Diarrhoea
7. Nausea and vomiting
8. Loss of appetite 

Among infants and young children, fussiness and crying are additional.

Who should avoid a tetanus vaccination?

While largely considered safe and used effectively in a widespread manner to prevent tetanus infection, there are a few scenarios where the tetanus shot might not be suitable. 

It is important to discuss with a healthcare provider before taking the vaccine if there is:

1. An allergy to a previous tetanus vaccine
2. Coma patient
3. Someone with a history of seizures
4. Guillain-Barré Syndrome (GBS)
5. Bleeding disorder
6. Recent transplant surgery

There are also a few drugs that might interfere with the tetanus vaccine and should be brought to the attention of the healthcare provider, like:

1. Immunosuppressant medications
2. Cancer treatment drugs
3. Corticosteroids

Summary

Regular tetanus vaccination is essential to prevent this dangerous disease, which affects the nervous system and causes severe muscle spasms. It can be life-saving, especially in cases of serious wounds and injuries.

Primary and booster doses in childhood, followed by the timely boosters of the right vaccine combinations after every ten years, provide long-term protection. Similarly, proper immunization during pregnancy reduces maternal and neonatal tetanus.

Keep your vaccination records updated and consult your healthcare provider to ensure protection. Prophylactic tetanus vaccinations have significantly improved outcomes for patients exposed to tetanus infection. Ongoing global immunization efforts help protect individuals and improve overall public health.