Tetanus

What Is Tetanus?

Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body's muscles and nerves.

Starting at 2 months of age, all babies in the United States are vaccinated against tetanus. The disease is much more common in developing countries than it is in the United States.

What Causes Tetanus?

Tetanus is caused by a type of bacteria called Clostridium tetani that usually live in soil. The bacteria make a toxin (a chemical or poison that harms the body). This toxin attaches to nerves around a wound area and travels inside the nerves to the brain or spinal cord. There it interferes with the normal activity of nerves, especially the motor nerves that send direct messages to muscles.

In the United States, most cases of tetanus follow a contaminated cut or deep puncture injury, such as a wound caused by stepping on a nail. Sometimes the injury is so small the person never even sees a doctor.

Tetanus is most common in:

• injuries that involve dead skin, such as burns, frostbite, gangrene, or crush injuries
• wounds contaminated with soil, saliva (spit), or feces, especially if not cleaned well
• skin punctures from nonsterile needles, such as with drug use or self-performed tattooing or body piercing

What Is Neonatal Tetanus?

Another form of tetanus, neonatal tetanus, happens in newborns born in unsanitary conditions, especially if the umbilical cord stump becomes contaminated. Routine immunizations and sanitary cord care have made newborn tetanus very rare in developed countries.

What Are the Signs & Symptoms of Tetanus?

Tetanus often begins with muscle spasms in the jaw (called trismus). Someone also can have trouble swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. The spasms can spread to the muscles of the belly, upper arms, and thighs. The symptoms can happen days to months after exposure to the bacteria.

How Is Tetanus Treated?

Someone who has tetanus will be treated in a hospital, usually in the intensive care unit (ICU). There, they usually get antibiotics to kill bacteria and tetanus immune globulin (TIG) to neutralize the toxin already released. They'll also get medicines to control muscle spasms and may need treatment to support vital body functions.

Can Tetanus Be Prevented?

Yes. The two most important ways to prevent tetanus are:

1. getting vaccinated against tetanus
2. getting a shot (post-exposure tetanus prophylaxis) after an injury that could cause tetanus

Tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. Kids usually get:

• a series of four doses of DTaP vaccine before 2 years of age
• another dose at 4–6 years of age
• a booster (Tdap) at 11–12 years of age, or later if it was missed

Then, they should get a Tdap or a tetanus and diphtheria (Td) booster every 10 years through adulthood.

The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether they had the vaccine before, or when it was last given.

Neonatal tetanus can be prevented by making sure that all pregnant women have had their tetanus immunizations, by delivering babies in sanitary conditions, and by proper umbilical cord care.

Post-exposure tetanus prophylaxis involves getting tetanus shots after an injury. Shots given will depend on:

• when the patient last had a booster
• the total number of tetanus vaccinations the patient has had
• the nature of the wound

Any skin wound — especially a deep puncture or a wound that may be contaminated with feces, soil, or saliva — should be cleaned and dressed right away.

When Should I Call the Doctor?

If you're not sure whether your kids have gotten their tetanus vaccinations, or if you know they're not fully immunized, call your doctor. If it's been more than 10 years since someone in your family got a tetanus booster, see your doctor to bring immunizations up to date.

If a puncture or other deep wound happens, clean the wound and call the doctor to ask about post-exposure tetanus prophylaxis. If your child develops lockjaw or muscle spasms — particularly after a wound — get medical care right away.