Tetanus is an acute, often fatal, infection caused by the bacteria Clostridium tetani. Tetanus bacteria are found in soil, dust, and manure and enter the human body through broken skin, usually through injuries from contaminated objects. The bacteria produce and disseminate toxins via blood and lymphatics. The toxins act at several sites within the central nervous system including peripheral motor end plates, spinal cord, and brain and in the sympathetic nervous system. The most common initial symptom is spasms of the muscles of the jaw, or “lockjaw,” which renders the victim unable to open the mouth or swallow. Other symptoms include headache, sudden muscle spasms, painful muscle stiffness, trouble swallowing, seizures, fever and sweating, high blood pressure, and fast heart rate. Complications of tetanus infection include laryngospasm, fractures, hospital-acquired infections, pulmonary embolism, aspiration pneumonia, breathing difficulty, and death.
Infection with tetanus kills almost one-third of infected individuals. Between 1900 and the 1940s, tetanus infected between 500 and 600 individuals each year in the United States. After the introduction of the tetanus vaccine in the late 1940s, infection rates declined to between 40 and 60 cases per year. An all-time low of 18 cases was reported in 2009. Almost all present-day reported cases of tetanus occur in unvaccinated individuals and individuals who completed a primary series but have not had a booster in the preceding ten years. Neonatal tetanus is a form of the disease that occurs in newborn infants and is the most common lethal consequences of unclean deliveries and umbilical cord care practices. Neonatal tetanus is rare in the United States, with only two cases reported since 1989, both in newborns of unvaccinated mothers.
The Tetanus Vaccine
Tetanus is highly preventable with vaccination. Four combinations of vaccines are available in the United States to prevent the illness: DTaP, Tdap, DT, and Td. All four of the vaccines prevent both diphtheria and tetanus. The DTap and Tdap vaccines also prevent pertussis, or the whooping cough. Children under the age of 7 years old receive the DTap and DT vaccines while older children, teenagers, and adults receive the Tdap and Td vaccines.
The current vaccination schedule recommends that children receive five doses of the DTaP vaccine, one dose each at two months old, four months old, six months old, between fifteen and eighteen months old, and between four and six years old. Preteens should receive a booster shot between eleven and twelve years old. Adults should receive a tetanus booster every ten years. Pregnant women should receive the Tdap vaccine in the third trimester between the twenty-seventh and thirty-sixth weeks of pregnancy. All individuals, barring a legitimate medical issue contraindicative to vaccination such as an allergy to the ingredients in the vaccine or a compromised immune system, should receive the tetanus vaccine. DT and Td do not contain the pertussis vaccine and should be given as a substitute for DTaP and Tdap for children who cannot tolerate the pertussis vaccine.
Tetanus Vaccine Complications
As with all vaccines, minor reactions to the tetanus vaccine include pain (1 in 4) and redness (1 in 4) at the injection site, fussiness (1 in 3), headache, fatigue and loss of appetite (1 in 10), low fever (1 in 4), vomiting or diarrhea (1 in 20), body aches, or a vague feeling of discomfort. The minor side effects of the vaccine usually occur within three days of receiving the vaccine and generally do not require medical attention.
Less common but serious side effects include crying for more than three hours in young children, seizures, and high fever. Rare but serious side effects include confusion, seizures, difficulty breathing or swallowing, high fever, severe or continuing headache, hives, itching, low blood pressure, reddening of the skin, shock, unusual and continuing sleepiness, facial swelling, unusual and severe tiredness, and severe vomiting. The serious side effects of the tetanus vaccine generally require medical attention but are extremely rare. The benefits of tetanus vaccination far outweigh any potential risk of side effects.
About Tetanus: http://www.cdc.gov/tetanus/about/index.html
Maternal and Neonatal Tetanus (MNT) Elimination: http://www.who.int/immunization/diseases/MNTE_initiative/en/
Tetanus: Causes and Transmission: http://www.cdc.gov/tetanus/about/causes-transmission.html
Tetanus: Diagnosis and Treatment: http://www.cdc.gov/tetanus/about/diagnosis-treatment.html
The Tetanus Disease Villain: http://www.cdc.gov/tetanus/about/bam-villain-for-kids-fs.html
Tetanus (Lockjaw) Vaccination: http://www.cdc.gov/vaccines/vpd-vac/tetanus/
Tetanus Vaccination: http://www.cdc.gov/tetanus/vaccination.html
Tetanus Shot Time: https://www.flickr.com/photos/blakespot/4919795171/ (CC BY 2.0)