Related topics: •  Infections & Infectious Diseases

Tetanus is a bacterial infection caused by the germ Clostridium tetani. The disease was first described by the Greek physician Hippocrates in the fifth century BC, and is very well understood today.

Tetanus germs have a reputation for hanging out on rusty nails, but the spores (dormant forms of the bacteria) can be found almost anywhere -- and they are extremely hardy. Tetanus is more common when it's warm and humid, but can be found in all climates. The spores are common in soils around the world, especially in areas with lots of people or animals, including farms, jungles, and your own backyard. The germ is found in the intestines of people as well as cats, dogs, and other domestic animals, and you can get it from an animal bite. And yes, you can catch tetanus from nails and splinters, too.

Once a spore finds a good environment (your finger, say, after you've just poked yourself while gardening) it becomes active and the bacteria start to multiply. The tetanus bacterium is anaerobic, meaning it can't grow in air. That's why it's mainly a problem in cases of puncture wounds like splinters and deep bites, where the germ is pushed deep inside and air can't reach it.

Once tetanus spores get inside a wound, the bacteria will start multiplying and releasing a poison called tetanospasmin that can attack nerves throughout your body. It's rare to have natural immunity to the tetanus toxin. This may be because the immune system doesn't have time to react and neutralize the potent toxin. If you haven't had a tetanus shot in 10 years, you may be at risk, because over time, vaccine protection wears off.

Symptoms can appear anywhere from three days to three weeks after the time you're infected. As the toxin starts damaging nerves, the muscles near the wound may start cramping or twitching, and there may be pain around the wound.

As the toxin spreads through your body, you may have trouble swallowing, and you may develop spasms or severe stiffness in other muscles, including your neck and jaw (hence the old common name “lockjaw”). The spasms can be strong enough to break bones. Other symptoms include fever, high blood pressure, and periods of fast heartbeat. Spasms can continue for several weeks, and complete recovery may take months.

Complications can include damage to the heart, lung, and kidneys. In the United States in recent years, about 10 percent of cases have been fatal. Among certain age groups, especially the elderly, death rates are even higher, so it's important to be treated quickly.

If you never completed a primary tetanus series as a child or adult, OR it's been more than 10 years since your last booster, (five years if the wound is serious or dirty), you'll need to get treatment for a puncture wound.

First, wash the wound with soap and water and gently pat it dry with a clean towel or napkin. Cover the wound lightly with a clean bandage or gauze pad (to allow some air to reach the wound) and get on your way.

If you don't have full immunity (full primary vaccine series and up-to-date booster), there are several ways to treat a tetanus infection. Your doctor may give you a tetanus shot to help your body fight the toxin. You might also get a shot of something called tetanus immune globulin to neutralize the toxin that hasn't yet bound to nerves. In some cases, you may be started on antibiotics to slow the infection.

Absolutely. Not long ago, puncture wounds and open sores were an invitation to tetanus. While around 1 million people around the world still get tetanus infections every year, there are only about 43 cases reported each year in the United States, mainly among adults who haven’t kept up on their vaccinations. About 75 percent of tetanus deaths occur among older adults over age 60. Among Americans ages 60 to 69, fewer than 50 percent still have immunity to tetanus; after age 70 it drops to 30 percent.

The tetanus vaccine contains an inactivated form of the tetanospasmin toxin. So, unlike most other vaccines, the tetanus vaccine primes your immune system to fight not the germ itself, but rather the toxin. The cost of the vaccine is often covered by health plans; contact your plan for details.

Protection against tetanus should start in infancy. Children receive the DTaP vaccination that combines protection against tetanus, diphtheria, and pertussis (whooping cough). According to the Centers for Disease Control and Prevention, children should get a total of five doses of the vaccine, at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age. After that, school-age children should get one booster shot sometime between the ages of 11 and 18.

Because the protection wears off over time, it’s important for adults to get regular booster shots every 10 years. For people under age 65, the CDC now recommends the Tdap vaccine (a combination tetanus, diphtheria, and pertussis shot that’s approved for people 11 to 64) instead of the Td vaccine, which doesn't protect against pertussis (whooping cough).

If you're over 18 and never had the tetanus-containing series as a child, you should get an adult series of three shots. After that, you'll still need a regular booster every 10 years.

Because the tetanus vaccine is made from an inactivated toxin instead of a live virus, it is generally recommended even for people who have lowered immunity. However, if you have cancer, lupus, AIDS, or any other condition that affects your immune system, you should talk to your doctor before getting any vaccine; some vaccines may not be safe for you, and most will not be as effective, so you may need to take different precautions.

If you are pregnant or nursing, talk to your doctor about the right time to schedule a vaccine. Newborns can get tetanus through the umbilical cord stump if their mothers don't have immunity; worldwide, this causes more than 200,000 deaths among newborns each year, but it's extremely rare in this country.

So if you've been putting off that booster, or aren't sure whether you were vaccinated as a child, now is an excellent time to schedule a visit with your doctor.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, Prevention, and other journals. He writes The Healthy Skeptic, a biweekly column in the Los Angeles Times. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

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First published March 20, 2008
Copyright © 2008 Consumer Health Interactive

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