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Tetanus

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.

Symptoms Causes Risk factors Complications Prevention

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:

  • Fever
  • Sweating
  • 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
  • Burns
  • 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.

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

The booster

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.

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