|SSM Cardinal Glennon Children's Medical Center|
Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body's muscles and nerves. It typically arises from a skin wound that becomes contaminated by a bacterium called Clostridium tetani, which is often found in soil.
Once the bacteria are in the body, they produce a neurotoxin (a protein that acts as a poison to the body's nervous system) that causes muscle spasms. The toxin can travel throughout the body via the bloodstream and lymph system. As it circulates more widely, the toxin interferes with the normal activity of nerves throughout the body, leading to generalized muscle spasms. Spasms can be so forceful that they tear muscles or even cause spine fractures. Without treatment, tetanus can be fatal.
In the United States, most cases of tetanus follow a contaminated cut or deep puncture injury, such as a wound caused by stepping on a nail. Sometimes the injury is so small the person never even sees a doctor. Injuries that involve dead skin (such as burns, frostbite, gangrene, or crush injuries) are more likely to cause tetanus. Wounds contaminated with soil, saliva, or feces — especially if not properly cleaned — and skin punctures from nonsterile needles (such as with drug use or self-performed tattooing or body piercing) are also at increased risk.
Another form of tetanus, neonatal tetanus, occurs in newborns who are delivered in unsanitary conditions, especially if the umbilical cord stump becomes contaminated. Prior to immunizations, neonatal tetanus was much more common in the United States. Now, routine immunizations for tetanus produce antibodies that mothers pass to their unborn babies. These maternal antibodies and sanitary cord-care techniques have made newborn tetanus very rare in developed countries.
In fact, tetanus in general is rare in the United States and other nations with tetanus vaccination programs — fewer than 50 cases of tetanus are reported each year in the United States. However, many developing countries have less effective prevention and immunization programs against tetanus, so the disease is much more common there.
Signs and Symptoms
Tetanus often begins with muscle spasms in the jaw (called trismus), and can be accompanied by difficulty swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. These spasms can spread to the muscles of the abdomen, upper arms, and thighs. The symptoms can occur anywhere from days to months after exposure to the bacteria.
There are two important ways to prevent tetanus:
Tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. Kids usually receive a series of four doses of DTaP vaccine before 2 years of age, followed by a booster dose at 4 to 6 years of age. After that, a booster (Tdap) is recommended at 11 to 12 years of age, or later if it was missed, followed by a tetanus and diphtheria booster every 10 years through adulthood. The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.
Neonatal tetanus can be prevented by making sure that all pregnant women have had their tetanus immunizations, by delivering babies in sanitary conditions, and by proper umbilical cord care. If you are pregnant, discuss your immunization record with your obstetrician well before your due date.
And be sure your kids don't miss their appointments so that the immunizations are given on time. As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.
Post-exposure tetanus prophylaxis also involves getting tetanus shots, but after an injury occurs. Shots given will depend on the number of years since the patient's last booster, the total number of tetanus vaccinations the patient has received, and the nature of the wound. The doctor may recommend a tetanus booster (Td , DTaP, or Tdap, depending on the patient's age and previous immunizations) and/or an injection of tetanus immune globulin (TIG) to neutralize any toxin released by the bacteria.
Any skin wound — especially a deep puncture or a wound that may be contaminated with feces, soil, or saliva — should be cleaned and dressed right away. Although it's important to clean all wounds, remember that cleaning is not a substitute for immunization.
Doctors play an important role in preventing tetanus by making sure kids' immunizations are up to date and providing post-exposure prophylaxis if a child has a wound that's at risk for tetanus.
A child who does develop tetanus will be treated in a hospital, usually in the intensive care unit (ICU). There, a child typically receives antibiotics to kill bacteria and TIG to neutralize the toxin that the bacteria have already released. The child will also receive medicines to control muscle spasms and may be given treatment to support vital body functions.
When to Call the Doctor
If you're not sure whether your kids have been immunized against tetanus, or if you know they're not fully immunized, call your doctor. If it's been more than 10 years since someone in your family has had a tetanus booster, schedule an office visit to bring immunizations up to date.
If the event of a puncture or other deep wound, clean the wound and call the doctor to discuss whether your child should receive post-exposure tetanus prophylaxis. If your child develops lockjaw or muscle spasms — particularly after sustaining a wound — seek medical attention right away.
Reviewed by: Elana Pearl Ben-Joseph, MD