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At a Glance
Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Several vaccines are used to prevent tetanus among children, adolescents, and adults including DTaP, Tdap, DT, and Td.
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Tetanus is different from other vaccine-preventable diseases because it does not spread from person to person. The bacteria are usually found in soil, dust and manure and enter the body through breaks in the skin – usually cuts or puncture wounds caused by contaminated objects.
Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil contains a lot of organic matter. In 2013 it caused about 59,000 deaths – down from 356,000 in 1990. Description of the disease by Hippocrates exist from at least as far back as the 5th century BCE. The cause of the disease was determined in 1884 with a vaccine being developed in 1924
Today, tetanus is uncommon in the United States, with an average of 29 reported cases per year from 1996 through 2009. Nearly all cases of tetanus are among people who have never received a tetanus vaccine, or adults who don’t stay up to date on their 10-year booster shots.
Tetanus is an international health problem, as C. tetani spores are ubiquitous. The disease occurs almost exclusively in persons unvaccinated or inadequately immunized. It is more common in hot, damp climates with soil rich in organic matter. This is particularly true with manure-treated soils, as the spores are widely distributed in the intestines and feces of many animals such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Spores can be introduced into the body through puncture wounds. In agricultural areas, a significant number of human adults may harbor the organism.
Causes and Transmission
Tetanus is an infection caused by bacteria called Clostridium tetani. Tetanus bacteria are everywhere in the environment, including soil, dust and manure.
Common Ways Tetanus Gets Into Your Body
The bacteria can get into the body through broken skin, usually through injuries from contaminated objects. Certain breaks in the skin that are more likely to get infected with tetanus bacteria. These include:
- Wounds contaminated with dirt, poop (feces), or spit (saliva)
- Wounds caused by an object puncturing the skin, like a nail or needle (puncture wounds)
- Crush injuries
- Injuries with dead tissue
Rare Ways Tetanus Gets Into Your Body
Tetanus has also been linked to clean superficial wounds (when only the topmost layer of skin is scraped off), surgical procedures, insect bites, dental infections, compound fractures (a break in the bone where it is exposed), chronic sores and infections, and intravenous (IV) drug use.
The incubation period – time from exposure to illness – is usually 3–21 days (average 10 days), although it may range from 1 day to several months, depending on the kind of wound. Most cases occur within 14 days. In general, shorter incubation periods are seen with more heavily contaminated wounds, more severe disease, and a worse outcome of the disease (prognosis).
Symptoms and Complications
Tetanus is often called “lockjaw” because the jaw muscles tighten, and the person cannot open his mouth.
The most common initial sign is spasms of the muscles of the jaw, or “lockjaw”.
Tetanus symptoms include:
- Jaw cramping
- Sudden, involuntary muscle tightening – often in the stomach (muscle spasms)
- Painful muscle stiffness all over the body
- Trouble swallowing
- Jerking or staring (seizures)
- Fever and sweating
- High blood pressure and fast heart rate
Tetanus complications include:
- Uncontrolled/involuntary muscular contraction of the vocal cords (laryngospasm)
- Break in the bone (fracture)
- Hospital-acquired infections
- Blockage of the main artery of the lung or one of its branches by a blood clot that has travelled from elsewhere in the body through the bloodstream (pulmonary embolism)
- Pneumonia, a lung infection, that develops by breathing in foreign materials (aspiration pneumonia)
- Breathing difficulty, possibly leading to death (10-20% of cases are fatal)
Diagnosis and Treatment
Doctors can diagnose tetanus by examining the patient and looking for certain signs and symptoms. There are no hospital lab tests that can confirm tetanus.
Tetanus is a medical emergency requiring:
- Immediate treatment with human tetanus immune globulin (TIG) (or equine antitoxin)
- Tetanus vaccine
- Drugs to control muscle spasms
- Aggressive wound care
Depending on how severe the infection is, a machine to help you breathe may be required. A tetanus vaccine should be given along with treatment.
Being fully immunized is the best tool to prevent tetanus. Tetanus vaccines are recommended for people of all ages, with booster shots throughout life. Learn who needs to be vaccinated and when.
Immediate and proper wound care can also help prevent infection. If you get a tetanus infection, you can still get it again someday if you’re not protected by timely vaccination.
Tetanus Prevention After A Natural Disaster
In most settings, a disaster does not increase the risk for tetanus. However, the risk of tetanus among disaster survivors and emergency responders can best be minimized by following standard immunization recommendations and providing proper wound care. Learn more about tetanus prevention after a disaster
Tetanus vaccines are recommended throughout your life. There are four combination vaccines used to prevent tetanus: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines contain DTaP along with other childhood vaccines.
Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism. For more information, see tetanus vaccination.
For Those Getting Vaccinated
- Tetanus Vaccine Basics
Offers comprehensive offers information about pertussis vaccines and other educational tools.
- Td or Tdap Vaccine “What You Need To Know”
This one-page CDC vaccine information statement explains who should get Td or Tdap vaccine and when.
- DTaP Vaccine “What You Need To Know”
This one-page CDC vaccine information statement explains who should get DTaP vaccine and when.
- Vaccine Safety
- Who Should Not Be Vaccinated with DTaP, Td, or Tdap?
What can travelers do to prevent tetanus?
Get a tetanus vaccine:
- CDC recommends a tetanus vaccine before you travel, especially if you are going to an area where it may be difficult to access health care services.
- In the United States, tetanus vaccine is only available in combination with other vaccines that protect you against diseases such as diphtheria and pertussis. The tetanus vaccine comes in three forms: Td, Tdap (both for adults), andDTaP (for children).
- Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also contains protection against pertussis (whooping cough). Adolescents 11 through 18 years of age (preferably at age 11–12 years) and adults 19 or older should receive a single lifetime dose of Tdap.
- DTaP vaccine is given to children younger than 7 years of age.
- Children should get 5 doses of DTaP, one dose at each of the following ages: 15–18 months 2, 4, 6, and 4–6 years.
- See Vaccine Information Statements (VIS) for more information.