Tetanus, commonly known as lockjaw, is a nervous system disorder characterized by muscle spasms, particularly of the jaw and neck. This infection is caused by the bacteria Clostridium tetani, which are found in the soil. Tetanus symptoms usually emerge about 7 to 10 days after the initial infection. However, this can vary from 4 days to about 3 weeks and may take months, in some cases.
Open wounds that are soiled, sharing contaminated needles, and deliveries in unhygienic conditions are the main risk factors for getting tetanus. Most cases occur in people who did not complete their primary tetanus vaccination schedule or did not receive any booster shot within the previous decade.
Tetanus is a deadly and highly debilitating condition that, fortunately, can be prevented by timely vaccinations. The tetanus vaccines should be given to children. The primary vaccination schedule consists of 5 tetanus shots given as part of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccination in children between 2 months to 6 years.
Tetanus is treated with wound care, antibiotics, and tetanus immunoglobulin to neutralize the toxin, along with supportive care for symptoms.
Overview
Key Facts
Causes
Symptoms
Types
Risk factors
Diagnosis
Prevention
Specialist to visit
Treatment
Complications
Alternatives therapies
Living with
FAQs
References
Frequently Asked Questions
There is no cure for tetanus, and there is no definitive proof that childhood vaccinations will provide you with lifelong immunity. As a result, for the time being, the CDC recommends booster vaccines every 10 years to help your immune system protect against these infections.
After completing the initial tetanus series, you must receive booster shots every ten years. However, if you have a puncture wound, you should get a booster shot regardless of your previous tetanus shot.
If you do not get a tetanus shot after being cut by rusty metal, the toxin's effect on the respiratory muscles can cause breathing problems. This will eventually result in suffocation and death.
A booster dose, booster vaccine, or booster shot is an additional dose of a vaccine that may need to be administered on a regular basis (usually once every few years) after the initial or primary vaccination against certain diseases is completed. This helps to 'boost' your immunity to such diseases, ensuring that you are adequately protected.
Once a person develops symptoms of tetanus, there is no cure; only supportive care and management of complications can be provided in a hospital setting. Tetanus is best treated through vaccination or immunization.
If a scheduled vaccination or a booster dose of tetanus toxoid is missed, talk to your doctor and arrange another visit as soon as possible.
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Tetanus is caused by a toxin produced by Clostridium tetani bacteria spores found in dust, animal feces, and soil. When these spores enter a deep flesh wound, they transform into bacteria that release a lethal toxin known as tetanospasmin.
The toxin damages the muscles, specifically the motor neurons that control muscle function. This causes muscle spasms and stiffness, which is a major symptom of tetanus.
Tetanus cases are frequently seen in people who have never been immunized or in adults who have not received their 10-year booster shot. Tetanus is not a contagious disease and thus cannot be passed from person to person.
Other ways:
Tetanus bacteria can also infect someone’s body through breaks in the skin caused by:
Clean superficial wounds (when only the topmost layer of skin is scraped off)
Surgical procedures
Insect bites
Dental infections
Compound fractures (an exposed broken bone)
Chronic sores and infections
Intravenous (IV) drug use
Intramuscular injections (shots given in a muscle).
Tetanus cases are frequently seen in people who have never been immunized or in adults who have not received their 10-year booster shot. Tata 1mg offers adult vaccinations with convenient home visits, making it easier than ever to prioritize your health.
Symptoms Of Tetanus
The most common sign of this infection is tightening of the jaw muscles. Tetanus infection can lead to serious health problems, including being unable to open the mouth and having trouble swallowing and breathing. Other symptoms can include:
Jaw cramping
Sudden, involuntary muscle spasms often in the stomach
There are four forms of tetanus, based on clinical findings. They include:
1. Generalized tetanus
It is the most prevalent kind. Typically, the head and neck muscles are the first to become tight and spastic, with the rest of the body eventually being affected. The full recovery from these spasms may take several months, and they can persist for up to 4 weeks.
2. Localized tetanus
It is an uncommon form of the disease in which patients have persistent contraction of muscles in the same body part as the injury. These contractions could last for several weeks before fading down gradually.
3. Neonatal tetanus
It is a type of tetanus that manifests within a week of birth in newborn babies. In case the mother is not immune, neonatal tetanus affects newborns who are not protected by their immune system or antibodies from the mother.
Note: The newborn should receive human tetanus immunoglobulin (TIG) without delay. Also, it can be prevented by immunizing the mother before or during pregnancy or by ensuring a clean delivery in a sterile environment.
4. Cerebral tetanus
It is also called cephalic tetanus, which involves muscles of the face and larynx. It only affects the head's nerves and muscles. The most frequent cause of cephalic tetanus is head trauma. It is extremely uncommon, making up around 1% to 3% of tetanus cases.
Risk Factors For Tetanus
Tetanus usually occurs in persons who are not immunized, partially immunized, or fully immunized but lack adequate booster doses. Other risk factors can include the following:
1. Contaminated cuts or wounds
Tetanus bacteria can enter the body through skin breaks, especially from contaminated objects like nails or needles, or through contact with feces or saliva.
2. Unvaccinated mother
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3. Delivery in contaminated areas
Obstetric tetanus occurs during pregnancy or within 6 weeks of the end of pregnancy. It happens following the contamination of wounds with Clostridium tetani spores during pregnancy or the use of contaminated tools during deliveries or abortions.
4. Septic cutting of the umbilical cord
Neonatal tetanus occurs when non-sterile instruments are used to cut the umbilical cord or when contaminated material is used to cover the umbilical stump.
5. Family history
A history of neonatal tetanus in a previous child increases the risk for neonatal tetanus in subsequent children.
Patients who have diabetes and chronic wounds are more prone to tetanus than other populations.
Note: Overall, diabetics are more likely to contract tetanus than non-diabetics. Do not let diabetes impact your quality of life.
7. History of immunosuppression
Individuals who are on medications for autoimmune conditions or post-organ transplant have low immunity, which can increase their chances of tetanus infections.
8. Sharing contaminated needles
Skin punctures by contaminated needles (such as those used to inject illegal drugs or to tattoo or do body piercing) can also lead to tetanus.
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Diagnosis Of Tetanus
No confirmatory laboratory testing is available; the diagnosis is made clinically. Other things to help confirm the diagnosis include:
1. History
When there is a history of a prior tetanus-prone injury and insufficient tetanus immunization, tetanus should be suspected in particular. Tetanus can be identified by a person's recent history of trauma, wounds, scrapes, and punctures, as well as by a doctor looking for specific symptoms and indicators.
2. Spatula test
The spatula test is a simple diagnostic test. Touching the throat with a spatula in normal individuals elicits a gag reflex and efforts to expel the spatula; a negative result. If tetanus is present, a reflex spasm occurs, and the patient bites the spatula; a positive result.
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Prevention Of Tetanus
Vaccination and good wound care are the cornerstones in the prevention of a tetanus infection. They are discussed as follows:
1. Vaccination
The only way to prevent a tetanus infection is by getting vaccinated on time. The tetanus vaccine is given as part of the following vaccines:
Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine: Contains full doses of diphtheria, tetanus, and pertussis (whooping cough) vaccines.
Diphtheria and tetanus (DT) vaccine
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine: Contains a full dose of the tetanus vaccine and a lower dose of diphtheria and whooping cough vaccines.
Note: DTaP/DT are only given to babies and children younger than 7 years, whereas Tdap/Td/TT are given to adolescents and adults.
Who should take the tetanus vaccination and when?
Children
Children between 2 months to 6 years should get 5 DTaP shots. Three doses at 6, 10 & 14 weeks and two booster doses at 16-24 months and 5-6 years of age, respectively.
Children who had a very bad reaction to DTaP can receive the DT vaccine. However, they will not receive any protection against whooping cough.
Children 11-12 years old should get 1 booster shot of Tdap.
Adults
Adults over 18 years who did not receive primary immunization, three doses of the Td vaccine are indicated. Two doses are administered at least 4 weeks apart, and the third dose is given 6-12 months after the second dose. The Tdap vaccine can substitute for any one of the Td doses.
Adults who have completed their primary vaccination schedule should get TT or Td shot every 10 years till the age of 65. One dose of Tdap vaccine may be administered in place of Tt/Td vaccine.
Pregnant women
The national immunization schedule in India recommends the 2 doses of TT/Td regardless of the immunization status of pregnant women. There should be a minimum gap of 4 weeks between the two doses. Tdap vaccination can also be considered instead of the second dose of the TT/Td injection.
If a mother received 2 TT/Td doses in the last pregnancy and gets pregnant within 3 years, then only one booster dose is recommended.
Stay protected—book your vaccination at home with a certified TATA 1MG nurse today.
Contraindications of Tetanus vaccination
History of a severe adverse reaction to any vaccination ingredient.
If, within seven days after vaccination, an individual experiences unexplained encephalopathy, manifesting as coma, decreased consciousness, or prolonged seizures.
History of Guillain-Barré syndrome (GBS)
Immunization is one of the most effective tools to prevent severe infections in kids as well as adults. Know more about the 7 vaccinations to protect against deadly diseases.
2. Appropriate wound care
Control bleeding: Use a clean tissue, piece of gauze, or clean cloth to apply direct pressure to the cut or wound until bleeding stops. To aid in reducing bleeding, try to elevate the arm or leg above the heart if possible.
Maintain hygiene: First of all, wash your hands before cleaning and dressing the wound. Once the bleeding has stopped, a saline solution, bottled water, or clear running water should be used to rinse the wound.
Cover the wound: Use a sterile bandage after using an antibiotic cream to lower the chance of infection.
Change the dressing: Replace the bandage at least once every day, or whenever the dressing is soiled or wet. You can use an antibiotic ointment to control the infection.
Manage adverse reactions: If you observe any rash or wound getting worse due to antibiotic use or if you are allergic to the adhesive used in bandages, switch to adhesive-free dressings or sterile gauze and paper tape.
Watch this informative video to learn more about how to manage wounds efficiently.
Research suggests that vitamin C might play an important role in preventing tetanus and reducing mortality. It also acts as an antioxidant, helps wound healing, and enhances immunity.
Check out our broad range of vitamin C supplements to fill any gaps in your diet.
Specialists To Visit
The following specialists help to reduce morbidity and mortality associated with tetanus:
General physician
Toxicologist
Neurologist
Pulmonary medicine specialist
Anesthesiologist
A toxicologist helps to rule out any poisoning and to determine if any substance is toxic or harmful.
A neurologist is a doctor who treats diseases of nerves and in the case of tetanus, they treat seizures.
A pulmonary medicine specialist can help when there is respiratory compromise and can help with providing ventilation.
An anesthesiologist is to administer drugs, such as baclofen.
When to see a doctor?
You are not sure about completing your tetanus vaccination schedule.
You haven't received a tetanus injection in the last ten years.
Not sure when the last tetanus vaccination was taken.
You are injured outdoors.
The wound has been in direct contact with the soil.
The wound has dirt or debris that won’t come out.
A deep puncture wound, an object in the wound, an animal bite, or a severe cut.
Do not wait until things get out of hand. Seek advice from our trusted team of world-class doctors.
Treatment Of Tetanus
Tetanus is a medical emergency, and its management comprises the following:
1. Early and aggressive wound debridement
This involves thoroughly cleaning the wound with sterile or clean water and an antiseptic solution to remove dirt, debris, or foreign objects that could harbor bacteria.
In cases where there is dead or contaminated tissue, surgical debridement may be necessary to eliminate environments conducive to bacterial growth.
Always keep your first aid kit handy in case of an emergency.
2. Antimicrobial therapy
Although they are always advised, antibiotics probably only have a little part to play in the treatment of tetanus. It is crucial to note that without proper wound debridement, appropriate antibiotic therapy may fall short of eliminating C. tetani. Drugs used are:
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5. Hospitalization and supportive care
People with severe tetanus need to stay in an intensive care environment. As sedatives inhibit breathing, they may need to stay under ventilation temporarily.
Nutritional support should also be initiated early. As the energy demands in tetanus can be extremely high due to repeated spasms, excessive sweating, muscular contractions, etc.
Heparin or any other anticoagulant should be administered early to prevent blood clotting in the veins.
Physical therapy is also suggested as soon as spasms have stopped.
6. Vaccination during recovery
Tetanus disease does not provide immunity against tetanus. Active immunization should be initiated or continued with a tetanus toxoid-containing vaccine as soon as the person’s condition has stabilized.
Complications Of Tetanus
Serious health problems that can happen because of tetanus include:
Laryngospasm: It is an uncontrolled/involuntary tightening of the vocal cords that may lead to interference with breathing.
Fractures: Fractures of the spine or long bones may result from involuntary muscle movements.
Hypertension and/or abnormal heart rhythm: Hyperactivity seen in tetanus may lead to hypertension. It can also cause abnormal heart rhythm.
Nosocomial infections: These are infections that are acquired while getting medical care, but were absent at the time of admission.
Pulmonary embolism:It refers to a blood clot that has passed through the bloodstream from another part of the body and blocked the major artery of the lung or one of its branches.
Aspiration pneumonia: It is a lung infection that develops when things like saliva or vomit accidentally go into the lungs.
Death: Tetanus can be fatal in some cases. These mostly include people 60 years of age or older and those who have never received a vaccination.
Alternative Therapies For Tetanus
A few alternative therapies that have shown some promise in the management of tetanus include:
Botulinum toxin
Botulinum toxin, also called “miracle poison,” is a neurotoxin produced by the bacterium Clostridium botulinum. Studies show that, other than immunization, the administration of this toxin is a treatment approach that has been used in recent years to reduce rigidity and spasms in tetanus patients.
Living With Tetanus
Tetanus can have various adverse effects on a person’s lifestyle, depending on the severity of the symptoms. The challenge or ease of living with tetanus varies for each survivor, subject to the availability of medical care and rehabilitation opportunities, and their family and social support. Various forms of rehabilitation and support include:
Get physical therapy
It is used to help with muscle rigidity and spasms, increase mobility and movement, and maximize function and quality of life.
Try Cardiopulmonary physical therapy
It is a specialized treatment that helps improve breathing and heart function. In tetanus patients, it aids in preventing respiratory complications and assists in managing muscle rigidity and spasms.
Tips For Caregivers
Provide emotional support and maintain open communication
Ensure proper wound care and monitor for any signs of infection
Administer prescribed medications and assist them with physical therapy
Monitor vital signs and seek medical attention if conditions worsen
Maintain a calm environment to reduce stress and anxiety
Encourage adequate nutrition and hydration
Assist with mobility and positioning to prevent complications.
Educate yourself about tetanus management and recovery
Keep a record of symptoms and treatments for medical reference.
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Did you know?
Spasm progressively extends to the facial muscles causing the typical facial expression of fixed sarcastic grimace and anxious expression called “ risus sardonicus”.
Did you know?
A history of diphtheria or tetanus vaccinations is believed to be associated with less severe manifestations of COVID-19.
Read more about the importance of vaccination in preventing many diseases.
Did you know?
Researchers are developing special lab-made antibodies (monoclonal antibodies) that can block the tetanus toxin from affecting the body. In animal studies, these antibodies have shown promise in both preventing and treating tetanus. However, this treatment is still under research and not yet available for general use.
Did You Know?
There has been a 96% reduction in tetanus cases since 1988, largely due to scaled-up immunization programmes.
Get vaccinated if you haven't got one yet.
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