A single copy of this article may be reprinted for personal, noncommercial use only.
TetanusBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/tetanus/DS00227
Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw."
Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and the developed world. The incidence of tetanus is much higher in less developed countries. Around a million cases occur worldwide each year.
There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization.
Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days.
Common signs and symptoms of tetanus, in order of appearance, are:
- Spasms and stiffness in your jaw muscles
- Stiffness of your neck muscles
- Difficulty swallowing
- Stiffness of your abdominal muscles
- Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light
Other signs and symptoms may include:
- Elevated blood pressure
- Rapid heart rate
When to see a doctor
See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot within the past five years or aren't sure of when your last booster was. Or see your doctor about a tetanus booster for any wound — especially if it may have been contaminated with dirt, animal feces or manure — if you haven't had a booster shot within the past 10 years or aren't sure of when you were last vaccinated.
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your motor neurons can cause muscle stiffness and spasms — the major signs of tetanus.
In addition, certain factors are necessary for tetanus bacteria to proliferate in your body. These include:
- Lack of immunization or inadequate immunization — failure to receive timely booster shots — against tetanus
- A penetrating injury that results in tetanus spores being introduced to the wound site
- The presence of other infective bacteria
- Injured tissue
- A foreign body, such as a nail or splinter
- Swelling around the injury
Tetanus cases have developed from the following types of injuries:
- Puncture wounds — including from splinters, body piercings, tattoos, injection drugs
- Gunshot wounds
- Compound fractures
- Crush injuries
- Surgical wounds
- Injection drug use
- Ear infections
- Animal bites
- Infected foot ulcers
- Infected umbilical stumps in newborns born of inadequately immunized mothers
Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires the growth of new nerve endings and can take up to several months.
Complications of tetanus infection may include:
- Broken bones. The severity of spasms may cause the spine and other bones to break.
- Disability. Treatment for tetanus typically involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In infants, tetanus infections may cause lasting brain damage, ranging from minor mental deficits to cerebral palsy.
- Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing, causing periods in which you can't breathe at all. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death.
Preparing for your appointment
If your wound is small and clean but you're concerned about infection or whether you're immune from tetanus, start by seeing your family doctor. If your wound is severe or you're experiencing symptoms of tetanus infection (or your infant is), seek emergency care.
What you can do
If possible, let your doctor know the following information:
- When, where and how you received the injury (or any recent injury, if a wound isn't obvious)
- Your immunization status, including when you received your last tetanus booster shot (a record of vaccines you've received and when) would be helpful)
- How you've been caring for the wound
- Any chronic illness or pre-existing condition you may have, such as diabetes, heart disease or pregnancy
If seeking care for an infant other than your own, let the doctor know the mother's country of origin, her immune status and how long she's been in the United States
For tetanus, some basic questions to ask your doctor include:
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I manage them together?
- Do I need to see a specialist?
- Are there restrictions I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
What to expect from your doctor
If a wound is obvious, your doctor will inspect it. He or she will likely ask you a number of questions, including:
- Have you experienced any tentanus symptoms and, if so, when did they start?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve or worsen your symptoms?
- When were you last vaccinated for tetanus and what type of vaccine did you receive?
- Have you recently had a wound (if not obvious)?
Tests and diagnosis
Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.
Treatments and drugs
Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.
Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.
- Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
- Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
- Vaccine. Having tetanus once doesn't make you immune to the bacteria afterward. So you'll need to receive a tetanus vaccine in order to prevent future tetanus infection.
- Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
- Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation.
Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator.
Lifestyle and home remedies
Puncture wounds or other deep cuts, animal bites or particularly dirty wounds may put you at increased risk of tetanus infection. Get medical attention if the wound is deep and dirty, and particularly if you're unsure of your immune status. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage.
Your doctor may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you've previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus.
If you have a minor wound, these steps will help prevent you from getting tetanus:
- Control bleeding. If the wound is bleeding, apply direct pressure to control the bleeding.
- Keep the wound clean. After the bleeding has stopped, rinse the wound thoroughly with clean running water (or saline solution if available). Clean the area around the wound with soap and a washcloth. If debris is embedded in a wound, see your doctor.
- Use an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as the multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics won't make the wound heal faster, but they can discourage bacterial growth and infection and may allow the wound to heal more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
- Cover the wound. Exposure to the air may speed healing, but bandages can help keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms.
- Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.
You can easily prevent tetanus by being immunized against the toxin. Almost all cases of tetanus occur in people who've never been immunized or who haven't had a tetanus booster shot within the preceding 10 years.
The primary vaccine series
The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (diphtheria), whooping cough (pertussis) and tetanus.
The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh to children at ages:
- 2 months
- 4 months
- 6 months
- 15 to 18 months
- 4 to 6 years
A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine (Td). In 2005, a tetanus, diphtheria and pertussis (Tdap) vaccine was approved for use in teens and adults under age 65 to ensure continuing protection against pertussis, too.
It's recommended that adolescents get a dose of Tdap, preferably between the ages of 11 and 12, and that a Td booster be given every 10 years thereafter. If you've never received a dose of Tdap, substitute it for your next Td booster dose and then continue on with Td boosters.
If you're traveling internationally, it's a good idea to have up-to-date immunity because tetanus may be more common where you're visiting, especially if you're traveling to a developing country. If you receive a deep or dirty wound and it's been more than five years since your last booster shot, get another booster shot.
To stay up to date with all of your vaccinations, ask your doctor to review your vaccination status regularly.
If you were never vaccinated against tetanus as a child, see your doctor about getting the Tdap vaccine.
- Tetanus: Questions and answers. Immunization Action Coalition. http://www.immunize.org/catg.d/p4220.pdf. Accessed Jan. 31, 2013.
- Roush SW, et al. Manual for the Surveillance of Vaccine-Preventable Diseases. 4th ed. Atlanta, Ga.: Centers for Disease Control and Prevention; 2011. http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html. Accessed Jan. 31, 2013.
- Tetanus. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec14/ch178/ch178i.html. Accessed Jan. 13, 2013.
- Long SS, et al. Principles and Practice of Pediatric Infectious Diseases. 4th ed. St. Louis, Mo.: Elsevier Saunders; 2012. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-2702-9..00301-9&isbn=978-1-4377-2702-9&uniqId=399011628-4#4-u1.0-B978-1-4377-2702-9..00301-9. Accessed Jan. 24, 2013.
- Prevention and management of wound infection. World Health Organization. http://www.who.int/hac/techguidance/tools/Prevention%20and%20management%20of%20wound%20infection.pdf. Accessed Jan. 31, 2013.
- Diphtheria, tetanus & pertussis vaccines: What you need to know. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdf. Accessed Feb. 1, 2013.
- Tetanus, diphtheria (Td) or tetanus, diphtheria, pertussis (Tdap) vaccine: What you need to know. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-td-tdap.pdf. Accessed Feb. 1, 2013.