The tetanus vaccine is often believed to be only required after a puncture wound caused by rusted nails or an open injury that is contaminated. However, the bacteria that cause tetanus are also present in soil and manure.
Typically, the tetanus vaccine is given during childhood and comes combined with the diphtheria vaccine, with or without the pertussis vaccine. The full course of the vaccine consists of five doses, which are completed before seven years of age. Though, it is recommended for all adults to get a tetanus booster at least every 10 years, even if there is no puncture wound or injury.
Not enough research exists to prove or disprove the booster timeline. However, it is recommended by doctors based on clinical experience. If vaccination status is not known, the tetanus booster will most likely be given during an open injury.
Tetanus is an incurable, rare disease that can cause severe complications, including death. Treatment typically involves long-term supportive care to ease symptoms while the disease runs its course. Recovery time is long, and the prognosis is quite poor. Hence, it’s best to prevent the disease by getting the vaccine every 10 years and seeking medical attention immediately after an open injury to receive proper wound care.
What is tetanus?
Tetanus, also called lockjaw, is a serious disease of the nervous system caused by a toxin-producing bacteria called Clostridium tetani, which are often found in a dormant state in soil and animal feces. The disease causes involuntary muscle contractions, particularly of the jaw and neck muscles or the entire body. Signs and symptoms usually appear after the initial infection (incubation period) in about 3 to 21 days, with the average being 10 days.
Risk factors of tetanus include:
- Being unvaccinated or incompletely vaccinated for tetanus (this includes not taking the booster every 10 years)
- Scratches, cuts, puncture wounds or other open injuries exposed to soil or manure
- Animal bites
- Foreign body in a wound, such as soil, nail or splinter
- Diseases or medication suppressing the immune system
- Infected umbilical cord when the mother isn't fully vaccinated
- Sharing and unsanitary needles for illegal drug use
What are the signs and symptoms of tetanus?
Signs and symptoms usually begin at the jaw and neck, and then progress downward, affecting the entire body, which is called generalized tetanus, the most common type of the disease. From there, symptoms grow progressively worse.
Signs and symptoms of generalized tetanus include:
- Stiffness (rigidity) and spasms of muscles, which are very painful
- Tension in muscles around the lips (appearance of a persistent grin)
- Difficulty swallowing
- Difficulty breathing
- Rigid abdominal muscles
- Low or high blood pressure
- Rapid heart rate
- Muscle spasms, which may be triggered by sound, light, touch, wind or light
- Typically, the neck and back arch, the legs become rigid, the arms are drawn up to the body and the fists are clenched
What are the complications of tetanus?
Complications of tetanus can be fatal and may include the following.
- Difficulty breathing: This can occur due to the tightening of the vocal cords, rigidity in the neck and abdominal muscles and generalized spasms.
- Pulmonary embolism: Blockage of a lung artery due to a blood clot that has traveled from elsewhere in the body.
- Pneumonia: Lung infection due to accidental inhalation of a foreign body, such as food or vomit into the lungs (aspiration pneumonia).
- Fractures: Generalized spasms can cause fractures of the spine or other bones.
- Death: This can occur due to blockage of the airway during spasms or damage to the nerves, which control breathing, heart rate and other organs, resulting in multiple organ failures.
Centers for Disease Control and Prevention. Diphtheria, Tetanus, and Whooping Cough Vaccination: What Everyone Should Know. https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/public/index.html
Dong SW, Stead W. Do Adults Really Need Tetanus Booster Shots? Harvard Health Publishing. https://www.health.harvard.edu/blog/do-adults-really-need-tetanus-booster-shots-2020051219786
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