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Tetanus

Overview

Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as "lockjaw."

Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and other parts of the developed world. However, the disease remains a threat to those who aren't up to date on their vaccinations, and is more common in developing countries.

There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve.

Symptoms

Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to 10 days.

Common signs and symptoms of tetanus include:

  • Spasms and stiffness in your jaw muscles (trismus)
  • Stiffness of your neck muscles
  • Difficulty swallowing
  • Stiffness of your abdominal muscles
  • Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light

Possible other signs and symptoms include:

  • Fever
  • Sweating
  • Elevated blood pressure
  • Rapid heart rate

When to see a doctor

See your doctor for a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot in five years. If you aren't sure of when your last booster was, get a booster.

Or see your doctor about a tetanus booster for any wound — especially if it might have been contaminated with dirt, animal feces or manure — if you haven't had a booster shot within the past 10 years or aren't sure of when you were last vaccinated.

Causes

Spores of the bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores grow into bacteria that can produce a powerful toxin, tetanospasmin, which impairs the nerves that control your muscles (motor neurons). The toxin can cause muscle stiffness and spasms — the major signs of tetanus.

Nearly all cases of tetanus occur in people who have never been vaccinated or adults who haven't kept up with their 10-year booster shots. You can't catch tetanus from a person who has it.

Risk factors

The following increase your likelihood of getting tetanus:

  • Failure to get vaccinated or to keep up to date with booster shots against tetanus
  • An injury that lets tetanus spores into the wound
  • A foreign body, such as a nail or splinter

Tetanus cases have developed from the following:

  • Puncture wounds — including from splinters, body piercings, tattoos, injection drugs
  • Gunshot wounds
  • Compound fractures
  • Burns
  • Surgical wounds
  • Injection drug use
  • Animal or insect bites
  • Infected foot ulcers
  • Dental infections
  • Infected umbilical stumps in newborns born of inadequately immunized mothers

Complications

Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires new nerve endings to grow, which can take up to several months.

Complications of tetanus infection may include:

  • Broken bones. The severity of spasms may cause the spine and other bones to break.
  • Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches.
  • Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death.

Diagnosis

Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.

Treatment

Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care

Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Medications

  • Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
  • Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
  • Vaccine. All people with tetanus should receive the tetanus vaccine as soon as they're diagnosed with the condition.
  • Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
  • Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as sedation.

Supportive therapies

Severe tetanus infection often requires a long stay in an intensive care setting. Since sedatives can inhibit breathing, you might temporarily need a ventilator.

Preparing for an appointment

If your wound is small and clean but you're concerned about infection or whether you're immune from tetanus, start by seeing your primary care provider. If your wound is severe or you or your child has symptoms of tetanus infection, seek emergency care.

What you can do

If possible, let your doctor know the following information:

  • When, where and how you were injured
  • Your immunization status, including when you received your last tetanus booster shot
  • How you've been caring for the wound
  • Any chronic illness or condition you have, such as diabetes, heart disease or pregnancy

If seeking care for an infant other than your own, let the doctor know the mother's country of origin, her immune status and how long she's been in the United States.

For tetanus, some basic questions to ask your doctor include:

  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I manage them together?
  • Do I need to see a specialist?
  • Are there restrictions I need to follow?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

If a wound is obvious, your doctor will inspect it. He or she will likely ask you a number of questions, including:

  • Have you had tetanus symptoms, such as muscle spasms, and, if so, when did they start?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve or worsen your symptoms?
  • When were you last vaccinated for tetanus and what type of vaccine did you receive?
  • Have you recently had a wound (if not obvious)?

Lifestyle and home remedies

Puncture wounds or other deep cuts, animal bites, or particularly dirty wounds put you at increased risk of tetanus infection. Get medical attention if the wound is deep and dirty, and particularly if you're unsure of when you were last vaccinated. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage.

Your doctor may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you've previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus.

If you have a minor wound, these steps will help prevent tetanus:

  • Control bleeding. Apply direct pressure to control bleeding.
  • Keep the wound clean. After the bleeding stops, rinse the wound thoroughly with clean running water. Clean the area around the wound with soap and a washcloth. If something is embedded in a wound, see your doctor.
  • Use an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as the multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics won't make the wound heal faster, but they can discourage bacterial growth and infection.

    Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.

  • Cover the wound. Exposure to the air might speed healing, but bandages can keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms.
  • Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.

Prevention

You can easily prevent tetanus by being immunized.

The primary vaccine series

The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (diphtheria), whooping cough (pertussis) and tetanus.

The DTaP vaccine is a series of five shots, typically given in the arm or thigh to children at ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years

The booster

A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine (Td). In 2005, a tetanus, diphtheria and pertussis (Tdap) vaccine was approved for use in teens and adults under age 65 to ensure continuing protection against pertussis, too.

It's recommended that adolescents get a dose of Tdap, preferably between the ages of 11 and 12, and a Td booster every 10 years thereafter. If you've never received a dose of Tdap, substitute it for your next Td booster dose and then continue with Td boosters.

If you're traveling internationally, particularly to a developing country where tetanus might be common, make sure your immunity is current.

To stay up to date with all of your vaccinations, ask your doctor to review your vaccination status regularly.

If you weren't vaccinated against tetanus as a child, see your doctor about getting the Tdap vaccine.

Last updated: August 8th, 2017

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