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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.
Tetanus Signs and Symptoms
The symptoms of tetanus usually develop within 4 to 21 days after infection. On average, they start after around 10 days.
The main symptoms include:
- stiffness in your jaw muscles (lockjaw) – this can make it difficult to open your mouth
- painful muscle spasms – these can make swallowing and breathing difficult
- a high temperature (fever) of 38C (100.4F) or above
- a rapid heartbeat (tachycardia)
Left untreated, the symptoms can continue to get worse over the following hours and days. In some cases, life-threatening problems such as suffocation or a cardiac arrest (where the heart stops beating) can occur.
Clostridium tetani is a gram-positive rod-shaped bacterium that is found worldwide in soil; it is usually in its dormant form, spores, and becomes the rod-shaped bacterium when it multiplies. The vegetative rods produce the spore usually at one end of the rod (Figure 1). The organisms are considered anaerobic, meaning they do not require oxygen to survive.
- Clostridium tetani is the bacterium responsible for the disease. The bacteria are found in two forms: as a spore (dormant) or as a vegetative cell (active) that can multiply.
- The spores are in soil, dust, and animal waste and can survive there for many years. These spores are resistant to extremes of temperature.
- Contamination of a wound with tetanus spores is rather common. Tetanus, however, can only occur when the spores germinate and become active bacterial cells that release exotoxins.
- The active bacterial cells release two exotoxins, tetanolysin and tetanospasmin. The function of tetanolysin is unclear, but tetanospasmin is responsible for the disease.
- The disease typically follows an acute injury or trauma that results in a break in the skin. Most cases result from a puncture wound, laceration (cut), or an abrasion (scrape).
- Other tetanus-prone injuries include the following:
- Crush wound
- IV drug users (site of needle injection)
- Wounds with devitalized (dead) tissue (for example, burns or crush injuries) or foreign bodies (debris in them) are most at risk of developing tetanus.
- Tetanus may develop in people who are not immunized against it or in people who have failed to maintain adequate immunity with active booster doses of vaccine.
What is the incubation period for tetanus?
The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it’s commonly within 14 days of injury.
- 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
A tetanus vaccination is given as part of the NHS childhood vaccination programme.
The full course of the vaccination requires five injections, usually given on the following schedule:
- the first three doses are given as part of the 5-in-1 vaccine for babies at two, three and four months of age
- a booster dose is given as part of the 4-in-1 pre-school booster at around four years of age
- a final booster is given as part of the 3-in-1 teenager boosterbetween 13 and 18 years of age
After the course of five injections, you should have long-lasting protection against tetanus. But if you or your child has a deep or dirty wound, it’s best to get medical advice.
If you’re not sure whether you’ve had the full vaccination course, contact your GP surgery for advice. It is possible to fully vaccinate older children and adults who weren’t vaccinated when they were younger.
How you get tetanus
Tetanus is caused by bacteria called Clostridium tetani. These bacteria can survive for a long time outside the body, and are commonly found in soil and the manure of animals such as horses and cows.
If they enter the body through a wound, the bacteria can quickly multiply and release a toxin that affects the nerves, causing symptoms such as muscle stiffness and spasms.
The bacteria can cause tetanus if they get into the body through:
- cuts and scrapes
- tears or splits in the skin
- animal bites
- body piercings, tattoos and injections
- eye injuries
- injection of contaminated drugs
Deep wounds containing dirt or foreign objects are most likely to lead to tetanus, but the condition can occur after a minor injury you didn’t notice at the time.
Tetanus cannot be spread from person to person.
General measures to treat the sources of the bacterial infection with antibiotics and drainage are carried out in the hospital while the patient is monitored for any signs of compromised breathing muscles. Treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to life-threatening breathing difficulty.
In more severe cases, breathing assistance with an artificial respirator machine may be needed.
The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers.
After recovery, patients still require active immunization because having the tetanus disease does not provide natural immunization against a repeat episode