Tetanus

Topic Overview

What is tetanus?

Tetanus is a disease caused by a bacterial infection. The bacteria make a toxin, or poison, that causes severe muscle spasms. Tetanus can be very dangerous, but you can get a shot to prevent it. Tetanus is also called "lockjaw" because muscle spasms in your jaw make it hard to open your mouth. Tetanus also causes seizures and makes it hard for you to swallow or breathe.

In the United States, most people have had shots to prevent tetanus, so the disease is relatively rare. People who have never been immunized or haven't had a booster in the last 10 years are more likely to get tetanus. This includes people who recently moved to the U.S. from countries where tetanus shots are rare. When these people work on farms and ranches where they come in contact with animal wastes, they have a higher chance of getting tetanus. People who inject illegal drugs and haven't been immunized also have a greater chance of getting tetanus.

How can you prevent tetanus?

You can prevent tetanus by getting all of your recommended immunizations. There are three different combination immunizations that include a vaccine for tetanus.

DTaP (diphtheria, tetanus, and pertussis)(What is a PDF document?) DTaP is given in a series of 5 shots beginning at age 2 months and ending between ages 4 and 6 years.

Tdap (tetanus, diphtheria, and pertussis)(What is a PDF document?) Tdap is the first booster shot for tetanus and is recommended for children between ages 11 and 12 years who have completed the DTaP immunization series. Teens or adults who have never had the Tdap vaccine should talk to their doctors about getting it for their next tetanus booster.

Td (tetanus and diphtheria)(What is a PDF document?) Td is given as a booster shot every 10 years.

If you have a dirty cut or wound, get a tetanus shot as soon as possible if 5 or more years have passed since your last tetanus shot. Some people may need tetanus immune globulin (TIG) for a wound that is at high risk for developing tetanus. The immune globulin is usually only needed if you have not (or do not know whether you have) completed the tetanus immunization series.

What causes tetanus?

The bacteria that cause tetanus are usually found in dirt and soil, most often in areas with animal waste such as farms and ranches. Tetanus bacteria typically enter the body through a wound or cut. The bacteria that cause tetanus grow best only when they are not around oxygen. The deeper and narrower the wound, the less oxygen there is around it, and so tetanus is more likely. For example, the bacteria can thrive in a puncture wound from a dirty nail. The dirtier the wound, the higher the risk of getting tetanus. But tetanus can also grow in a clean wound.

What are the symptoms?

Tetanus symptoms appear slowly and get worse over time. The time it takes for symptoms to appear after a cut or injury ranges from days to months. In most cases, symptoms of tetanus appear within 14 days.

Tetanus symptoms often begin with a headache and trouble opening your mouth (lockjaw). You also may have trouble swallowing and/or a stiff neck, back, or shoulders.

As the toxin spreads, it can be deadly. It can cause problems with your blood pressure and heart rate. It can cause severe and painful muscle spasms in your neck, arms, legs, and belly. If spasms continue and get worse, they can break bones, including the spine.

How is tetanus diagnosed?

There is no lab test for tetanus. A doctor can usually diagnose tetanus after asking questions about your symptoms and past health and doing a physical exam. Because other problems can cause muscle spasms like tetanus, you doctor will do tests to make sure your symptoms are not caused by something else.

Your doctor will do tests to decide how to treat the symptoms of tetanus. For example, your doctor may order a blood test (arterial blood gases) to see how well you are breathing.

How is it treated?

If you are infected with tetanus, you will need to stay in a hospital so you can get medicines and fluids to control muscle spasms and pain. You also may need treatment to help you breathe. Your doctor will fully clean any wound or cut to remove bacteria. Cleaning the affected area stops bacteria from making toxin. Treatment also includes:

• Antibiotics. These medicines kill bacteria.
• Tetanus immune globulin (TIG). This is a protein that helps your body's immune system find and destroy bacteria. TIG boosts your immunity while your body fights the infection.
• Medicines to decrease muscle spasms. You also may be treated in an intensive care unit (ICU) with medicines that paralyze your muscles for a while until your body begins to recover. In this case, you will need treatment to help with breathing and other body functions.
• Tetanus immunization.

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Author:	Debby Golonka, MPH	Last Updated: February 23, 2007
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics
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