| If you have ever had an injury that involved a puncture wound, you were probably asked this question. “Do you remember when you had your last tetanus shot?” Tetanus is a serious illness caused by tetanus bacteria found in the soil and in the intestines and feces of many household and farm animals and humans. The bacteria usually enter the body through a cut, like those you might get from cutting yourself with a knife or stepping on a nail. The infection causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw, which makes it impossible to open your mouth or swallow. If this happens, you could die of suffocation. In the U.S., where 50 or fewer cases of tetanus occur each year, deaths are more likely to occur in persons 60 years of age and older and in persons who are diabetic. Almost all reported tetanus cases are in people who were never vaccinated or who have not had their booster every 10 years.
| Commonly known as “lockjaw,” tetanus is a serious bacterial disease that can appear anywhere from a few days to several weeks after the bacteria enter the body through a wound. The average incubation period is seven to eight days. 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 nerves can cause muscle stiffness and spasms, the major signs of tetanus. The painful body spasms can last for several minutes. Someone with tetanus may have difficulty swallowing and a fever as well as elevated blood pressure and a rapid heart rate. Tetanus cases can develop as a result of a puncture wound, a gunshot wound, a compound fracture and an animal bite. Infected ulcers on the feet of people with diabetes and the umbilical stumps of newborns whose mothers were not immunized can also develop tetanus.
| The DTaP vaccine, which covers diphtheria, tetanus, and pertussis, is highly effective in preventing tetanus in young children. DTaP shots are recommended for babies at ages 2, 4, and 6 months, and again at 15 through 18 months of age. A DTaP booster is recommended for children ages 4 through 6 years. Because immunity to tetanus decreases over time, older children need to get the Tdap vaccine, which contains a full dose of tetanus and lower doses of diphtheria and pertussis. The Tdap vaccine is recommended for all 11 through 18 year olds. Adults need to get a booster shot every 10 years since immunity to tetanus decreases over time. For adults who haven’t gotten Tdap yet, the easiest thing to do is to get Tdap instead of their next regular tetanus booster. The dose of Tdap can be given earlier than the 10-year mark, so it’s a good idea for adults to talk to their medical provider about what’s best for their specific situation.
| Once tetanus toxin has bonded to a patient’s 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. Since there is no cure for tetanus, treatment for the bacterial disease involves caring for the wound along with medications to ease the symptoms. Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt and dead tissue from the wound. The patient may be given an antitoxin, such as tetanus immune globulin, but it can only neutralize toxin that hasn’t yet bonded to nerve tissue. An antibiotic may be prescribed to fight tetanus bacteria while a sedative may be administered to control muscle spasms. Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, the patient may need to be supported temporarily by a ventilator.
| You’ve just suffered a severe cut on your arm. What should you do to avoid the risk of tetanus? First and foremost, seek medical attention, particularly if the wound is deep or dirty and you are unsure of your immunization status. Leave an unclean wound open to avoid trapping bacteria in the wound with a bandage. A physician may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you’ve previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus. 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. If you receive wound and it’s been more than five years since your last booster shot, it’s a good idea to get another booster shot. In order to stay up to date with all of your vaccinations, request that your doctor review your vaccination status on a regular basis.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 25 years.
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