Tetanus
Definition
Tetanus, also called “lockjaw”, is a vaccine-preventable disease caused by a toxin formed by the bacterium Clostridium tetani. It attacks the nervous system and results in painful muscle contractions. The bacterium typically enters the body through wounds contaminated with soil or human or animal feces. It does not require oxygen to grow and the disease course is often short, severe, and can be fatal.
Tetanus is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of tetanus begin between 1 to 21 days after exposure. Symptom onset depends on the location of the wound. A shorter time to illness and more severe disease has been observed with dirtier wounds.
A common first symptom in older children and adults is painful contraction of stomach muscles. Other symptoms include painful muscle contractions, especially stiffness and convulsive spasms of the jaw and neck muscles and the upper body or trunk muscles. Symptoms may progress to generalized seizure-like activity.
Causes
Tetanus is caused by toxic spores formed by the bacterium Clostridium tetani. Spores typically enter the body through a puncture wound contaminated with soil or human or animal feces. Less commonly, spores may also enter the body via one of the following routes:
- Cuts, scrapes, burns, or unnoticed wounds
- Infected, contaminated street drugs
- Following elective surgery, ear infections, or dental infections
Tetanus is not spread from person to person.
Risk Factors
Individuals who have suffered a wound or injury and are inadequately vaccinated against tetanus and have not received a booster vaccine every ten years are at an increased risk of becoming infected. Most current cases are identified in older adults who have not received a tetanus booster to maintain protection against this disease.
Prevention
There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines contain DTaP along with other childhood vaccines.
Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.
Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received.
[Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.]
Treatment
There is no cure for tetanus. Treatment consists of proper wound care and medications to ease symptoms. If you are wounded, especially if your wound is contaminated with dirt or human or animal feces, you should seek treatment from your health care provider immediately.
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