Tetanus

Tetanus, sometimes called “lockjaw,” is a serious infectious disease that causes muscle spasms and breathing problems, and can result in death. It is caused by the bacterium Clostridium tetani, which is commonly found in the environment. The bacteria enter the body through broken skin and produce toxins that affect the nervous system.

Tetanus is now uncommon in places where the tetanus vaccine is widely used. However, anyone who has not been immunised against tetanus is at risk.

Symptoms of tetanus#

One of the first signs of tetanus is spasm of the jaw muscles, or “lockjaw,” which can make it hard to open the mouth. Other symptoms can include:

• muscle spasms that begin in the jaw and neck
• stiffness or pain in the neck, shoulder and back muscles
• trouble swallowing
• breathing difficulties
• painful convulsions (fits)
• rapid heartbeat or abnormal heart rhythms

Symptoms usually appear between 3 days and 3 weeks after infection, with most cases occurring within 10 days. Generally, the infection is more severe if symptoms appear very quickly.

Complications of tetanus#

Tetanus is extremely serious and can result in death. Complications can include:

• pneumonia
• broken bones (from muscle spasms)
• pulmonary embolism (one or more arteries in the lungs become blocked by a blood clot)
• respiratory failure
• high or low blood pressure
• heart attack

How tetanus spreads#

Tetanus is not passed from person to person. The bacteria can live in soil and in animal faeces. Infection occurs when the bacteria enter the body through a break in the skin.

Who is at risk#

Anyone can get tetanus, but you are at increased risk if you:

• have never received a tetanus vaccine
• have missed doses of the vaccine
• are an older adult who has not had a booster dose within the past 10 years
• have tetanus-prone wounds
• work with soil, animals or in dusty environments
• inject drugs
• have diabetes
• have a condition that weakens the immune system

Wound care to prevent tetanus#

Some wounds are more likely to encourage the growth of tetanus bacteria. These are called “tetanus-prone” wounds and include:

• any penetrating wound, such as a cut from a rusty nail or rose thorns
• wounds contaminated with soil, manure or foreign objects such as wood fragments
• bite wounds, such as animal bites (including snakebites) or human bites
• open (compound) fractures
• burns
• frostbite

Immediate and good wound care can help prevent infection. You should:

• apply first aid even to minor, non-infected wounds
• wash your hands with soap and water, or use an alcohol-based hand rub
• seek medical attention immediately if you have a tetanus-prone wound and are not fully vaccinated, or have not had a tetanus booster in the last 5 years

If you sustain a wound, seek medical attention as soon as you can, as you may need a tetanus vaccine.

Immunisation against tetanus#

Immunisation is a safe and effective way to protect against serious diseases like tetanus. Tetanus vaccines provide good protection, but this can fade over time, which is why booster doses are recommended.

The tetanus vaccine is given as a combined vaccine, meaning it is given together with vaccines against other serious diseases. The type of combined vaccine used depends on your age. Vaccination schedules vary from country to country, but a tetanus-containing vaccine is generally offered during childhood, again in adolescence, and during pregnancy.

A course of tetanus-containing vaccine is recommended for anyone who has never been vaccinated. Because immunity decreases over time, you may need booster vaccines. If you have been vaccinated before, a booster dose is recommended if you have not had one in the past 10 years. A booster every 5 to 10 years is also recommended if you travel to countries where health care may be difficult to access. Speak with your doctor or immunisation provider for more information.

A single dose of the combination diphtheria-tetanus-pertussis (whooping cough) vaccine is recommended in each pregnancy. This is given ideally between 20 to 32 weeks, but may be given up until delivery. It also helps protect newborns against whooping cough. People who are breastfeeding can also receive this combination vaccine.

The immunisations you need are decided by your health, age, lifestyle and occupation. Talk to your immunisation provider if you think you or someone in your care may have factors that mean immunisation is needed.

Diagnosis and treatment#

People with symptoms of tetanus should seek prompt medical care at a hospital. Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) immediately if you are having difficulty breathing.

A doctor will diagnose tetanus by taking a medical history, including information about immunisation. It is difficult to confirm a diagnosis of tetanus through laboratory tests.

Tetanus is a life-threatening disease, and death can sometimes occur even with prompt medical attention. Treatment may include life support. Having tetanus does not make you immune, so you can be infected again. This is why tetanus vaccination (where indicated) is recommended as soon as possible.

Key points#

• tetanus is caused by Clostridium tetani, which is commonly found in the environment
• tetanus is now uncommon where the tetanus vaccine is widely used
• anyone who has not been immunised against tetanus is at risk
• symptoms can include muscle spasms, trouble swallowing, breathing difficulties and abnormal heart rhythms
• symptoms usually occur between 3 days and 3 weeks after infection