Q&A

Tetanus

What causes tetanus?

  • Tetanus is caused by a toxin produced by a bacterium, clostridium tetani. The C. tetani bacteria cannot grow in the presence of oxygen. They produce spores that are very difficult to kill as they are resistant to heat and many chemical agents.

How does tetanus spread?

  • C. tetani spores can be found in the soil and in the intestines and faeces of many household and farm animals and humans. The bacteria usually enter the human body through a puncture (in the presence of anaerobic [low oxygen] conditions, the spores will germinate). Tetanus is not spread from person to person.

How long does it take to show signs of tetanus after being exposed?

  • The incubation period varies from 3-21 days, with an average of eight days. The further the injury site is from the central nervous system, the longer the incubation period. The shorter the incubation period, the higher the risk of death.

What are the symptoms of tetanus?

  • The symptoms of tetanus are caused by the tetanus toxin acting on the central nervous system. In the most common form of tetanus, the first sign is spasm of the jaw muscles, followed by stiffness of the neck, difficulty in swallowing, and stiffness of the abdominal muscles.
  • Other signs include fever, sweating, elevated blood pressure, and rapid heart rate. Spasms often occur, which may last for several minutes and continue for 3-4 weeks. Complete recovery, if it occurs, may take months.

How is tetanus diagnosed?

  • Diagnosis is based on the clinical signs and symptoms only.

What kind of injuries might allow tetanus to enter the body?

  • Tetanus bacilli live in the soil, so the most dangerous kind of injury involves possible contamination with dirt, animal faeces, and manure.
  • Although we have traditionally worried about deep puncture wounds, in reality many types of injuries can allow tetanus bacilli to enter the body. In recent years, a higher proportion of cases had minor wounds than major ones, probably because severe wounds are more likely to be properly managed.
  • People have become infected with tetanus following surgery, burns, lacerations, abrasions, crush wounds, ear infections, dental infections, animal bites, abortion, pregnancy, body piercing and tattooing, and injection drug use.

I stepped on a nail in our yard. What should I do?

  • Any wound that may involve contamination with tetanus bacilli should be attended to as soon as possible.
  • Treatment depends on vaccination status and the nature of the wound. In all cases, the wound should be cleaned. Seek treatment immediately. With wounds that involve the possibility of tetanus contamination, a patient with an unknown or incomplete history of tetanus vaccination needs a tetanus and diphtheria-containing shot (Td or Tdap) and a dose of tetanus immune globulin (TIG) as soon as possible.
  • A person with a documented series of three tetanus and diphtheria-containing shots (Td or Tdap) who has received a booster dose within the last 10 years should be protected. However, to ensure adequate protection, a booster dose of vaccine may still be given if it has been more than five years since the last dose, and the wound is other than clean and minor.

Is there a treatment for tetanus?

  • There is no “cure” for tetanus once a person develops symptoms, just supportive treatment and management of complications. The best “treatment” is prevention through immunization.

What is neonatal tetanus?

  • Neonatal tetanus is a form of tetanus that occurs in newborn infants, most often through the use of an unsterile cutting instrument on the unhealed umbilical stump. These babies usually have no temporary immunity passed on from their mother because their mother hasn’t been vaccinated.

Tetanus toxoid vaccines

What kind of vaccine is the tetanus toxoid?

  • The tetanus vaccine is an inactivated toxin (poison) called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. Because it is not a live vaccine, a person’s immunity tends to decline with time, which is why booster doses are recommended.

What’s the difference between all the vaccines containing tetanus toxoid?

  • Tetanus toxoid is available as a single shot (TT) but is rarely given that way as it is best to also provide needed protection against other diseases at the same time. Tetanus toxoid can be combined with diphtheria toxoid as DT (for children younger than 7 years). It can also be combined with diphtheria and pertussis as DTaP (for children younger than 7 years).

Who should get this vaccine?

  • The China immunization programme requires that all infants and children should receive tetanus toxoid as part of their DTaP vaccine series.

How safe is this vaccine?

  • Most children have no serious reactions from the combined DTaP vaccine. The most common reactions are at the injection site, such as soreness, redness, and swelling, especially after the fifth dose. Other possible reactions may include fussiness, fever, loss of appetite, tiredness, and vomiting. The use of the more purified DTaP instead of DTP has decreased these reactions substantially.
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