Disease: Tetanus

What Is Tetanus?

The bacteria that cause tetanus are found worldwide and cause about 1 million cases of the disease each year.

Often referred to as “lockjaw” because it can cause painful spasms and stiffness in your jaw muscles, tetanus is a serious disease that attacks the nervous system with the potentially deadly bacteria called Clostridium tetani.

In addition to the jaw, C. tetani bacteria can lead to painful muscle contractions in the neck, as well as cause breathing difficulties.

Due to the tetanus vaccine, the disease is rare in the United States and other developed countries, though about one million cases are reported around the world each year.

Most U.S. cases occur in people who have not received the tetanus vaccination. When tetanus does occur, it can take months to fully recover, and 1 out of 5 people who get tetanus die. Children who get tetanus may need several weeks of hospital care.

Causes of Tetanus

Tetanus does not spread between people. Spores of the C. tetani bacteria are found in soil, animal feces, and dust. While the spores are inactive in the soil, they can remain infectious for more than 40 years.

If the spores get into your body through an injury, burn, or wound, they release bacteria that make a poison called tetanospasmin (also known as tetanus toxin). This poison blocks nerve signals from your spinal cord to your muscles, causing severe muscle spasms, which in some cases can tear muscles or cause fractures of the spine.

Symptoms of Tetanus

The first symptoms can occur about 7 to 21 days after being infected with the bacteria C. tetani. However, the average incubation period is 7 to 8 days. Mild spasms and stiffness in the jaw muscles are usually the first signs of tetanus; with the below symptoms following shortly thereafter:

  • Stiffness in neck muscles
  • Difficulty swallowing
  • Stiffness in abdominal muscles
  • Spasms in the back, which often cause arching called opisthotonos, and spasms in other body parts (called tetany) that can cause contractions of muscle groups and even fractures and muscle tears
  • Spasms that affect muscles that help with breathing, leading to breathing problems

Other signs and symptoms may include:

  • Drooling
  • Fever
  • Excessive sweating
  • Elevated blood pressure
  • Rapid heart rate
  • Hand or foot spasms
  • Irritability
  • Uncontrolled urination or defecation

Tetanus in Infants and Children

Newborn babies whose mothers weren’t immunized can catch neonatal tetanus, a form of generalized tetanus, that usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. This form of tetanus causes the death of around 200,000 newborns annually around the world.

Treatment for Tetanus

There is no cure for tetanus, so treatment involves caring for the wound and taking medications to ease symptoms. With proper treatment, less than 15 percent of people with tetanus die. Treatment may include the following:

  • Surgery to clean the wound and remove the source of the poison
  • Antibiotics
  • Medicine to reverse the poison (tetanus immune globulin)
  • Muscle relaxers, such as diazepam
  • Sedatives
  • Other medications, such as magnesium sulfate, beta blockers, or morphine may help regulate involuntary muscle activity, such as your heartbeat and breathing
  • Breathing support with oxygen, a breathing tube, and a mechanical ventilator (breathing device)
  • Bed rest with a calm environment (dim light, reduced noise, and stable temperature)

Since catching tetanus doesn’t make you immune to getting the disease again, you will also need to receive a tetanus vaccine to prevent future infection.

Sources:

  • Tetanus; Mayo Clinic
  • Tetanus; National Institutes of Health
  • Tetanus-Fact Sheet for Parents; Centers for Disease Control and Prevention

Causes of Tetanus

A bacterium known as Clostridium tetani, the cause of tetanus, can be spread through open wounds or animal bites.

Tetanus develops when the potentially deadly bacteria called Clostridium tetani enters the body. Spores of C. tetani are found in soil, animal feces, and dust.

Although the spores can remain inactive in the soil, they may be infectious for more than 40 years.

If the spores get into your body through an injury, burn, or wound, they release bacteria that make a poison called tetanospasmin (also called tetanus toxin).

This poison blocks nerve signals from your spinal cord to your muscles, causing severe muscle stiffness and spasms, which in some cases can injure muscle tissue or cause fractures of the spine.

While people cannot pass on tetanus to each other, they may be infected after an animal bite. Additional ways that tetanus can develop include the following:

  • Puncture wounds, such as splinters, body piercings, and tattoos
  • Gunshot wounds
  • Compound fractures
  • Crush injuries
  • Surgical wounds
  • Injection drug use
  • Ear infections
  • Infected foot ulcers
  • Infected umbilical stumps in infants born from mothers who weren’t immunized

The following factors are necessary for tetanus bacteria to proliferate in your body:

  • Not getting immunized or not receiving booster shots
  • The existence of a penetrating injury that results in tetanus spores getting into the wound
  • The presence of other infective bacteria
  • Injured tissue
  • A foreign object, such as a nail or splinter
  • Swelling around the injury

Prevention of Tetanus

Tetanus is easily preventable by being immunized with the DTaP vaccine, which also provides immunity against the bacteria that cause diphtheria and pertussis (whooping cough). Immunization usually protects against tetanus infection for 10 years, and then a booster shot is needed for continued protection.

If you get a deep wound or other injury listed above that could cause tetanus, as long as you’ve been immunized prior to the incident, your body should quickly make the needed antibodies to protect you against the disease.

However, if you haven’t been immunized, seek medical attention if your wound is deep and dirty so the healthcare provider can properly clean the wound, prescribe an antibiotic, and provide other necessary treatment.

If you have a minor wound, these steps can help prevent you from getting tetanus:

  • Stop the bleeding: Apply direct pressure to a bleeding wound.
  • Clean the wound: If there is no objects embedded in the wound, once there is no more bleeding, use clean running water or saline solution to rinse the wound. You can use soap and a washcloth to clean the area around the wound.
  • Apply a topical antibiotic: While antibiotics won’t quicken the healing process, they can ward off bacterial growth and infection, so after you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as Neosporin and Polysporin.
  • Protect the wound: It’s true that air can speed healing, but bandages can protect the wound against harmful bacteria. Keep blisters that are draining covered until a scab forms.
  • Apply clean dressings: Whenever a dressing is wet or dirty, change it, and at the very least, change your dressing once a day.

Sources:

  • Tetanus; Mayo Clinic
  • Tetanus; National Institutes of Health
  • Tetanus-Fact Sheet for Parents; Centers for Disease Control and Prevention

Complications of Tetanus

Left untreated, tetanus can cause severe complications, including death.

Tetanus develops when the potentially deadly bacteria called Clostridium tetani enters the body. C. tetani spores are found in soil, animal feces, and dust.

The first symptoms of tetanus include mild spasms and stiffness in the jaw muscles (called lockjaw). Other symptoms follow:

  • Stiffness in neck muscles
  • Difficulty swallowing
  • Stiffness in abdominal muscles
  • Spasms in the back, which often cause arching called opisthotonos, and spasms in other body parts (called tetany) that can cause contractions of muscle groups and even fractures and muscle tears
  • Spasms that affect muscles that help with breathing, leading to breathing problems
  • Drooling
  • Fever
  • Excessive sweating
  • Elevated blood pressure
  • Rapid heart rate
  • Hand or foot spasms
  • Irritability
  • Uncontrolled urination or defecation

While there is no cure for tetanus, treatment involves caring for the wound and taking medications to ease the symptoms listed above.

However, once tetanus toxin has bonded to your nerve endings, it is impossible to remove, and the growth of new nerve endings, which can take months, is the only way to completely recover.

Wounds on the head or face that become infected with tetanus tend to be more dangerous than other parts of the body that become infected. Complications from tetanus may include the following:

  • Fractures and broken bones: Intense muscle spasms can cause the spine and other bones to break.
  • Disability: Because strong sedatives are used to control muscle spasms, the prolonged use of these drugs can lead to permanent disability.
  • Brain damage: Since spasms can restrict oxygen, tetanus may cause lasting brain damage in infants, from minor mental deficits to more serious conditions like cerebral palsy.
  • Death: Severe muscle spasms from tetanus can cause airway obstruction and the inability to breath. When this happens, respiratory failure can occur and lead to death. In fact, respiratory failure is the most common cause of death in people with tetanus. Cardiac arrest may also occur from lack of oxygen, as well as pneumonia, and both can lead to death.
  • Neonatal tetanus: Newborn babies whose mothers weren’t immunized can catch a form of generalized tetanus that usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. This form of tetanus causes the death of around 200,000 newborns annually.
  • If left untreated, 1 out of 5 people with tetanus will die, and the death rate is higher for infants who are left untreated. However, with proper treatment, less than 15 percent of people with tetanus die.

Call the Doctor if…

  • You have a deep open wound and haven’t been immunized for tetanus or you have not received a booster shot within 5 years.
  • You got injured outdoors, and the wound has been in contact with soil.

Sources:

  • Tetanus; Mayo Clinic.
  • Tetanus; National Institutes of Health.
  • Tetanus-Fact Sheet for Parents; Centers for Disease Control and Prevention.
  • Tetanus and neonatal tetanus (NT); World Health Organization.

Treatment for Tetanus

Though there's no cure for tetanus, treatment is critical to preventing complications.

Most cases of tetanus in the United States occur in people who have not received the tetanus DTaP vaccination. This combination vaccine offers protection from diphtheria, tetanus, and pertussis (whooping cough).

When tetanus does occur, it is a medical emergency that can take months to fully recover, and 1 out of 5 people who get tetanus will die. The death rate is higher for infants who are left untreated, and children who get tetanus may need weeks of hospital care.

However, with proper treatment, less than 15 percent of people with tetanus die.

How is Tetanus Diagnosed?

While there isn’t a specific laboratory test to diagnose tetanus, there are tests that can help exclude diseases with symptoms similar to tetanus, such as meningitis, rabies, and strychnine poisoning.

Once those are ruled out, medical professionals base tetanus diagnosis on the following:

  • A physical exam
  • Medical and immunization history
  • Signs and symptoms of muscle spasms, stiffness, and pain

Treating Options for Tetanus

There is no cure for tetanus, and wounds on the head or face that become infected with tetanus tend to be more dangerous than other parts of the body that become infected.

Treatment involves caring for the wound and taking medications to ease symptoms. Treatment may include the following:

  • Surgery to clean the wound and remove the source of the poison
  • Antibiotics given orally or with an injection
  • Medicine (tetanus immune globulin) to reverse the poison that hasn’t yet bonded to nerve tissue
  • Muscle relaxers, such as diazepam (Valium)
  • Strong sedatives to control muscle spasms
  • Other medications, such as magnesium sulfate, beta-blockers or morphine may help regulate involuntary muscle activity, such as your heartbeat and breathing
  • Breathing support with oxygen, a breathing tube, and a breathing machine
  • Bed rest with a calm environment (dim light, reduced noise, and stable temperature)

Since catching tetanus doesn’t make you immune to getting the disease again, you will also need to receive a tetanus vaccine to prevent future infection.

In addition to treatment, feeding through nasoduodenal tubes, gastrostomy tube feedings, or parenteral hyperalimentation (nutrients provided through a catheter) may be required to avoid choking and to maintain healthy nutrition throughout recovery.

Sources:

  • Tetanus; Mayo Clinic.
  • Tetanus; National Institutes of Health.
  • Tetanus-Fact Sheet for Parents; Centers for Disease Control and Prevention

What Is a Tetanus Shot?

The tetanus vaccine has been proven safe and effective.

Due to the tetanus vaccine, tetanus is rare in the United States and other developed countries, with around one million cases reported across the world each year.

Most cases in the United States occur in people who haven’t received the tetanus vaccination or who haven’t stayed up-to-date on their 10-year booster shots. Before the vaccine, there were more than 500 cases of tetanus reported annually in the United States.

DTaP Vaccine for Children

DTaP vaccination is a shot that combines the vaccines for tetanus, diphtheria, and pertussis (whooping cough).

The DTaP vaccine creates antibiodies against the tetanus toxin for at least 10 years. The vaccine shot is administered to children in the following way:

  • One dose each at 2 months, 4 months, and 6 months of age
  • A fourth dose at 15 through 18 months of age
  • A fifth dose at 4 through 6 years of age

Tetanus Booster Shots

To maintain protection from tetanus throughout life, people need to receive booster vaccines. When children are 11 or 12 years old, they should get a booster vaccine called Tdap (which protects against tetanus, diphtheria, and pertussis).

Starting at 19 years old, adults need a booster called the Td vaccine (for tetanus and diphtheria) every 10 years. For people who never received Tdap, the vaccine should be given once, before age 65, as a substitute for Td.

It’s important to stay up-to-date with your booster shots, especially if you plan to travel to developing countries because tetanus may be more common where you’re visiting. Before traveling, check with your doctor about when you received your last booster shot.

Tetanus Shot in Pregnant Women

Newborn babies whose mothers weren’t immunized can catch a form of generalized tetanus that usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. This form of tetanus causes the death of around 200,000 newborns annually.

However, if a mother has been immunized no more than 10 years before becoming pregnant or if she receives the vaccination during her pregnancy, she can protect her baby from tetanus because she passes antibodies to the baby across the placenta.

The Centers for Disease Control and Prevention (CDC) recommends that pregnant women who received the last dose of a tetanus vaccine more than 10 years prior to becoming pregnant should be immunized with Td during the second and third trimester instead of Tdap.

If their last tetanus toxoid-containing vaccine was less than 10 years ago, the CDC says she should wait until after delivery to receive Tdap.

Side Effects of the DTaP Vaccine

A serious reaction to the DTaP vaccine occurs in fewer than 1 in a million children. The most common side effects usually occur in about 1 out of 4 children. These include:

  • Redness, swelling, and pain where the shot was given
  • Fever
  • Vomiting

Other side effects include the following:

  • A fever over 105 degrees in 1 out of 16,000 children
  • Nonstop crying for 3 hours or more occurs in about 1 out of 1,000 children
  • Seizures occur in about 1 out of 14,000 children, but do not cause long-term harm

Prevention of Tetanus

Tetanus is easily preventable by being immunized with the DTaP vaccine.

If you get a deep wound or other injury listed below that could cause tetanus, as long as you’ve been immunized prior to the incident, your body should quickly make the needed antibodies to protect you against the disease.

However, if you haven’t been immunized, seek medical attention if your wound is deep and dirty so the health care provider can properly clean the wound, prescribe an antibiotic, and provide other necessary treatment.

Injuries that might be cause for concern include the following:

  • Animal bites
  • Puncture wounds, such as splinters, body piercings, and tattoos
  • Gunshot wounds
  • Compound fractures
  • Crush injuries
  • Surgical wounds
  • Injection drug use
  • Ear infections
  • Infected foot ulcers
  • Infected umbilical stumps in infants born from mothers who weren’t immunized

If you have a minor wound, these steps can help prevent you from getting tetanus:

  • Stop bleeding: Apply direct pressure to a bleeding wound.
  • Clean the wound: If there are no objects embedded in the wound, once there is no more bleeding, use clean running water or saline solution to rinse the wound. You can use soap and a washcloth to clean the area around the wound.
  • Apply a topical antibiotic: While antibiotics won’t quicken the healing process, they can ward off bacterial growth and infection, so after you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as Neosporin and Polysporin.
  • Protect the wound: It’s true that air can speed healing, but bandages can protect the wound against harmful bacteria. Keep blisters that are draining covered until a scab forms.
  • Apply clean dressings: Whenever a dressing is wet or dirty, change it, and at the very least, change your dressing once a day.

Sources:

  • Tetanus; Mayo Clinic.
  • Tetanus; National Institutes of Health.
  • Tetanus-Fact Sheet for Parents; Centers for Disease Control and Prevention.
  • Tetanus: Who Needs to be Vaccinated?; Centers for Disease Control and Prevention.
  • Vaccines for Pregnant Women; National Network for Immunization Information.

Source: http://www.everydayhealth.com

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