- Things to Know
- Incubation Period
- Signs & Symptoms
- Diagnosis & Prognosis
- Tetanus Shots
- Vaccine Side Effects
Things to know about tetanus
- Tetanus is frequently fatal infectious disease.
- Tetanus is caused by a type of bacteria (Clostridium tetani).
- The tetanus bacteria often enter the body through a puncture wound, which can be caused by nails, splinters, insect bites, burns, any skin break, and injection-drug sites.
- All children and adults should be immunized against tetanus by receiving vaccinations.
- A tetanus booster is needed every 10 years after primary immunization or after a puncture or other skin wound that could provide an entry point for the tetanus bacteria to enter the body.
What is tetanus?
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium Clostridium tetani. This bacterium is found throughout the world in the soil and animal and human intestines. The bacterium can also lay dormant in its spore form for years before becoming activated and developing into a regularly reproducing bacterium.
Where do tetanus bacteria grow in the body?
Contaminated wounds are sites where tetanus bacteria multiply. Deep wounds or those with dead tissue are particularly prone to tetanus infection.
Puncture wounds, such as those caused by nails, splinters, or insect bites, are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (using the uterus after delivery and through the umbilical cord stump).
The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm from tetanus.
How does the tetanus toxin cause damage to the body?
The tetanus toxin affects the interaction between the nerve and the muscle that it stimulates, specifically at the neuromuscular junction. The toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms.
Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate.
Of note, because of tetanus vaccination programs, first introduced in the late 1940s, tetanus infection rates have dropped substantially. In fact, according to the World Health Organization, there have only been three cases of neonatal tetanus reported in the U.S. since 2000. In each of these cases, the mothers were incompletely immunized.
Unfortunately, throughout the world, tetanus is still common. In 2014, there were over 2,000 cases of neonatal tetanus and over 9,000 cases of non-neonatal tetanus. In comparison, there were 114,000 overall cases reported in 1980.
What is the incubation period for tetanus?
The incubation period between exposure to the bacteria in a contaminated wound and the development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.
What is the course of tetanus? What are tetanus symptoms and signs?
During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the entire body in a set of continuous muscle contractions. Restlessness, headache, and irritability are common.
The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures (mechanical ventilation). Even with breathing support, infections of the airways within the lungs can lead to death.
Is tetanus contagious?
Tetanus is not contagious. You cannot "catch" tetanus from another infected individual. That means one person cannot be infected by another individual by coming in contact with secretions or other exposures. The bacterial spores must enter a wound to develop into an infection.
What is the treatment for tetanus?
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 spasms, 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.
How is tetanus diagnosed, and what is the prognosis of tetanus?
The diagnosis of tetanus is made clinically, based on a patient's history of exposure such as stepping on a rusty nail in the backyard, and by the symptoms present, such as "lockjaw," difficulty swallowing, fever, and generalized muscle spasms.
Once diagnosed and treated, the prognosis is generally good if the patient receives appropriate care early in the illness. The toxin does no permanent damage, and patients who receive appropriate supportive care generally recover. Sometimes symptoms develop rapidly, and some people live in remote areas where they are not able to receive appropriate care and are at a higher risk of death from tetanus.
Is it possible to prevent tetanus?
Active immunization ("tetanus vaccine") plays an essential role in preventing tetanus. Preventative measures to protect the skin from being penetrated by tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).
What is the schedule for active immunization (tetanus shots)?
All children should be immunized against tetanus by receiving a series of five DTaP vaccinations, which generally are started at 2 months of age and completed at approximately 5 years of age. A booster vaccination is recommended at 11 years of age with Tdap.
Follow-up booster vaccination is recommended every 10 years thereafter. While a 10-year period of protection exists after the basic childhood series is completed, should a potentially contaminated wound occur, an "early" booster may be given in selected cases and the 10-year "clock" resets.
What are the side effects of tetanus immunization?
Side effects of tetanus immunization occur in approximately 25% of vaccine recipients. The most frequent side effects are usually quite mild (and familiar) and include soreness, swelling, and/or redness at the site of the injection. More significant reactions are extraordinarily rare. The incidence of this particular reaction increases with decreasing intervals between boosters.
What is passive immunization (by way of specialized immunoglobulin)?
In individuals who exhibit the early symptoms of tetanus or in those whose immunization status is unknown or significantly out of date, the tetanus immunoglobulin (TIG) is given into the muscle surrounding the wound with the remainder of the dose given into the buttocks.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
Switzerland. World Health Organization. "Diphtheria Reported Cases." July 15, 2015. <http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencediphtheria.html>.
Top Tetanus Related Articles
Childhood Vaccination ScheduleChildhood immunizations can protect children from potentially deadly diseases. Vaccinations included on the childhood immunization schedule include Hib, polio, DTaP, MMR, HPV, flu, chickenpox, meningitis, rotavirus, pneumonia, hepatitis A, and hepatitis B.
Cuts, Scrapes, and Puncture WoundsLearn about first aid for cuts, scrapes (abrasions), and puncture wounds, when to see a doctor, if tetanus shots are necessary, and how to spot signs of infection.
Do I Need a Tetanus Shot for a Small Scratch?You need a tetanus shot for a small scratch if your tetanus immunization is not up to date and the injury caused a break in your skin.
Do You Need a Tetanus Shot?A bacteria called Clostridium tetani causes tetanus (lockjaw). Tetanus causes symptoms and signs that include severe muscle spasms and an inability to open the mouth. The tetanus vaccine is a toxoid that is 100% effective against tetanus. The DTaP vaccine is part of a child's routine immunization schedule. Doctors recommend the Tdap for children at their 11-year checkup. People should get a tetanus booster vaccination every 10 years.
Dog BiteA dog bites about 4.5 million people each year, and about 27,000 will need surgery. Dog bites often become infected and will need medical treatment and management. Make sure that the dog's rabies vaccination is current; if not, rabies treatment may be necessary. A dog bite may cause symptoms and signs like puncture wounds, lacerations, pain, swelling, and redness. Treatment and management of a dog bite in and infant, child, teen, or adult depends upon the severity of the wound.
HeadacheHeadaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Vaccination Schedule for Adults and AdolescentsImmunizations can prevent many diseases nowadays. It's important to follow the vaccination guidelines recommended on the CDC's vaccination schedule for adults and adolescents in order to stay informed about new vaccines and to learn how often and when the vaccines should be administered.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Spider Bites (Black Widow and Brown Recluse)
Most spiders in the United States are harmless; however, black widow and brown recluse spider bites may need medical treatment. Symptoms of a harmless spider bite generally include pain, redness, and irritation.
Signs and symptoms of a black widow spider bite include pain immediately, redness, burning, and swelling at the site of the bite. Sometimes the person will feel a pinprick or double fang marks.
Brown recluse spider bite symptoms and signs are a mild sting, followed by severe pain and local redness. These symptoms usually develop within eight hours or more after the bite. Black widow and brown recluse spider bites have similar symptoms, for example, nausea, vomiting, fever, headache, and abdominal or joint pain.
Generally, brown recluse and black widow spider bites need immediate medical treatment. If you think that you or someone you know has been bitten by a brown recluse or black widow spider, go to your nearest Urgent Care or Emergency Department for medical treatment.
Travel Health SlideshowExplore travel health tips and vaccines to prevent disease while abroad. Learn to protect yourself against malaria, hepatitis, tetanus and more by learning which vaccines or health precautions are advised for your destination.
Vaccination FAQVaccinations increase our ability to fight diseases that may be contagious or even fatal. Immunity occurs by getting the disease or through the use of a vaccine. There are two types of vaccine: inactivated vaccines and vaccines made from live, weakened viruses.