What Is It?

Tetanus, also called lockjaw, is a life-threatening infection caused by Clostridium tetani bacteria. Although these bacteria are especially common in the soil and manure of farms, they can be found almost anywhere. They live in the dirt of suburban gardens and in the dirty waters of floods. They also contaminate dust in cities, and are carried on the skin of people who have never visited rural areas.

Tetanus bacteria usually enter the body through a dirty puncture wound, cut, scrape or some other break in the skin. Once inside the skin, they multiply and produce a toxin, or poison, that affects the body’s nerves. This toxin causes severe muscle spasms, cramps and seizures. Spasms in the jaw muscles produce lockjaw. There are also spasms in muscles of the throat, chest, abdomen and extremities. If the person doesn’t receive proper treatment, the toxin’s affect on respiratory muscles can interfere with breathing. If this happens, the infected person may die of suffocation.

A tetanus infection may develop after almost any type of skin injury, major or minor. This includes cuts, punctures, crush injuries, burns and animal bites. In rare cases, a tetanus infection also can occur after surgery, an ear infection, a dental infection or an abortion. Among drug users, tetanus infections have followed heroin injections, especially if the heroin has been mixed with quinine. Tetanus also can develop after body piercing, tattooing, an insect sting or even a tiny splinter.

In the United States, only 50 to 100 cases of tetanus occur each year, because so many Americans have been immunized against the infection. Almost everyone who develops tetanus in the United States these days has been inadequately immunized against tetanus. Some have immigrated from developing countries where vaccines are not available to everyone. Others were born in the United States, but their families did not believe in immunization. Still others simply failed to keep up with their normal schedules of tetanus shots. This is a common problem among adults, especially those over age 60.

On average, symptoms of tetanus begin seven to eight days after tetanus bacteria enter the body. These symptoms may include:

• Spasms in the jaw muscles (lockjaw)
• Stiffness of muscles in the neck, shoulder and back
• Difficulty swallowing
• Prolonged contraction of the facial muscles, which may produce what looks like a sneer or grimace
• An arched back resulting from contractions of the back muscles
• Muscle spasms and muscle rigidity in the chest, abdomen and extremities
• Fever and profuse sweating
• High blood pressure
• Rapid or irregular heartbeat
• Seizures
• Difficulty breathing
• Fractured bones and ruptured muscles caused by severe muscle spasms

There is no laboratory test for tetanus. Doctors make the diagnosis based on a person’s symptoms and immunization history. It is helpful if the person can recall a recent cut or puncture wound.

People who have tetanus must be treated in a hospital. Even with good hospital care, however, about 30 percent of patients die. Those who do survive usually suffer from muscle spasms for about three to four weeks. Once these spasms subside, recovery takes several months.

Immunization can prevent almost all cases of tetanus.

In the United States, babies are immunized against tetanus through a series of four vaccinations. This “primary series” is given in the form of DTaP shots. In addition to the vaccine for tetanus, each DTaP shot contains vaccines against diphtheria, which is a severe respiratory infection, and pertussis, also called whooping cough. The usual schedule for DTaP shots is as follows:

• First shot: age 2 months
• Second shot: age 4 months
• Third shot: age 6 months
• Fourth shot: age 15 to 18 months

Once the primary series of tetanus immunizations is complete, a child usually receives two tetanus booster shots. One is given between the ages of 4 and 6 years, just before the child starts school. The second is given between the ages of 11 and 12. Booster shots enhance (boost) a child’s level of tetanus immunity.

After age 12, a tetanus booster shot usually is recommended every 10 years. Under special circumstances, however, a doctor may give the booster dose sooner. For example, a tetanus booster is usually given when a person suffers a severe cut or puncture wound and it has been more than five years since the last tetanus shot. This is because some people show a decrease in tetanus immunity within five to 10 years after the last tetanus booster.

In adults and older children (over age 7) who have never been immunized against tetanus, doctors use a primary series of three Td shots. Td shots contain vaccines against tetanus and diphtheria, but not against pertussis. This is because pertussis rarely causes severe illness after early childhood. Once the primary Td series is finished, booster shots are usually given every 10 years.

All adults and children should receive routine tetanus immunizations. However, certain groups of people must be especially careful to keep their tetanus shots up-to-date. These people have jobs or hobbies that expose them to dirt, dust, manure or dirty water. Some examples include farm workers, landscapers, gardeners, firefighters and people who are exposed to sewage or floodwaters. Veterinary workers and people who deal with animal waste are also at high risk.

In the health-care setting, doctors review a patient’s tetanus immunizations before surgery and before childbirth. All women of childbearing age should be immunized against tetanus to prevent the infection from striking their newborn infants. Newborns rely on their mother’s tetanus immunity to protect them from tetanus until their own DTaP shots begin. An infant who is not properly protected against tetanus can develop a tetanus infection even from having his or her umbilical cord cut. The risk of infection is especially high if the child is born outside a health-care facility.

Finally, a wound should be cleaned well as soon as possible, especially if it is contaminated with dirt, to reduce the risk of infection with the bacteria that cause tetanus.

If you seek medical care for a wound, your doctor will ask you about when you had your last tetanus shot. If your tetanus immunization is not up-to-date, the doctor will give you a tetanus booster. However, this booster shot will not produce immunity right away. So you may receive tetanus immune globulin as well. Tetanus immune globulin contains an antitoxin that neutralizes the tetanus toxin, temporarily protecting you until your immune system responds to the tetanus booster.

If you have full-blown tetanus, you will be treated in a hospital. There you will receive tetanus immune globulin to neutralize the tetanus toxin. Your muscle spasms will be treated with muscle relaxants, and you also may be sedated. If necessary, you will be placed on a ventilator to help you breathe. If you have an obvious wound infection, you will probably receive antibiotics as well. Once your condition begins to improve, you will begin a schedule of shots to restore your tetanus immunity. This is because someone who has had a tetanus infection does not become immune to the disease.

Call your doctor immediately if you develop symptoms of tetanus. Also, seek medical care immediately for any deep cut, serious puncture wound or any wound contaminated by dirt or manure.

If you are an adult, check your immunization records for the date of your last tetanus shot. If it has been more than 10 years since your last tetanus booster, schedule an appointment with your doctor. Also contact your doctor if your health records show that you never received a full primary series of tetanus immunizations.

If you are a parent, be sure to keep all doctors’ appointments for your child’s immunizations. This is especially true for DTaP shots and other vaccines that are given in a series.

About 30 percent of people with tetanus die from the infection. The risk of death is greatest in those over age 50.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.