Overview
Tetanus is a serious infection caused by Clostridium tetani bacteria. Their spores are found in soil, dust, ash and the waste of animals and humans, and can survive for years. When spores get into a wound they become active bacteria, causing the muscles to stiffen and go into painful spasms.
Tetanus does not spread from person to person. It is a medical emergency that needs hospital care, but vaccination prevents it.
Symptoms
Symptoms usually appear 3 to 21 days after the injury, most often within about two weeks. They can include:
- A stiff jaw that makes it hard to open the mouth (lockjaw)
- Stiffness of the neck and body
- Painful muscle spasms, sometimes set off by a sudden noise
- Difficulty swallowing or breathing
- Headache, fever, sweating and a fast heartbeat
- Fits
In newborns, the first signs are often being unable to feed and crying a lot, followed by stiffness and spasms.
When to see a doctor
Get a wound checked soon if you are not fully vaccinated or are unsure, if dirt or an object is still in it after cleaning, if it is a puncture wound or an animal bite, or if it is red, hot, swollen or painful. A doctor will decide what you need.
Causes
Spores enter through broken skin: a cut, scratch, burn, animal bite, or a deep or dirty wound, including one from a nail. The wound may be small, and some people cannot remember being injured at all.
In newborns, tetanus follows cutting the cord with unclean instruments or covering the stump with unclean material. Unvaccinated mothers can also get it in pregnancy or in the six weeks after.
Risk factors
- Never having been vaccinated, an incomplete course, or missed boosters
- A deep, large or dirty wound, or one with soil, dung or saliva in it
- A puncture wound, burn or animal bite
- Diabetes or a weak immune system
- Injecting drugs
- Birth in unclean surroundings, or a mother who has not been vaccinated
Complications
Tetanus can be fatal, and newborns are at particular risk. Serious problems include:
- Spasm of the voice box that blocks breathing
- Broken bones caused by severe spasms
- Pneumonia from breathing in saliva or food
- A blood clot in the lung
- Fits, and changes in and heart rate
Recovery can take several weeks, sometimes months.
Prevention
- Vaccination is the best protection. India's national schedule gives tetanus-containing vaccines in infancy, as boosters at 16 to 24 months, 5 to 6 years, 10 years and 16 years, and during pregnancy
- Adults need a booster about every 10 years, and sooner after some wounds if a doctor advises
- Wash every wound with clean water and soap, and cover it
- Do not put soil, ash, dung or other material on a wound
- Choose clean childbirth: clean hands, sterile tools for cutting the cord, and clean cord care
Diagnosis
Tetanus is diagnosed from the symptoms and the history of injury. No laboratory test can confirm it, and the person may not remember a wound. Treatment starts at once, without waiting for any test.
Treatment
Tetanus needs hospital care, often in intensive care. Treatment includes cleaning the wound and removing dirt and dead tissue, an injection of tetanus antibodies (immune globulin), , medicines to control muscle spasms and stiffness, and breathing support when needed. A tetanus is also given, because having tetanus does not give lasting immunity.
For a fresh wound, a person who is not fully vaccinated may be given a vaccine dose and, for a dirty wound, an antibody injection as well, to stop tetanus from developing.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Tetanus comes only from rusty nails.”What is true?
Fact
Rusty metal can carry the spores, but so can soil, dust, ash and the waste of animals and humans. What matters is that these get into a wound, not what caused the wound. Tetanus can even occur when the person cannot remember any injury.
Myth“A small cut or scratch does not need any attention.”What is true?
Fact
Even minor wounds should be washed. Deep, dirty, puncture or bitten wounds, and wounds with dirt left in them, need a doctor. How soon you need a tetanus vaccine depends on the wound and on your vaccination history.
Myth“Putting ash, soil or dung on a wound, or on a baby's cord stump, helps it heal.”What is true?
Fact
These can carry the spores that cause tetanus. Newborn tetanus happens when the cord is cut with unclean instruments or the stump is covered with contaminated material. Keep wounds clean and use clean cord care.
Myth“One tetanus injection in childhood protects for life.”What is true?
Fact
Protection fades over time. WHO recommends six doses in all for lifelong protection, three in infancy and three boosters. Adults should keep up with boosters about every 10 years, as a doctor advises.
Myth“A person who has recovered from tetanus cannot get it again.”What is true?
Fact
Recovering from tetanus does not give natural immunity. People who recover still need to be vaccinated.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Does tetanus spread from one person to another?
No. Tetanus is not passed between people. The bacteria come from the environment, such as soil, dust and animal waste, and enter the body through a wound.
I have a small cut. Do I need a tetanus injection?
It depends on the wound and on your vaccination history. Wash it well. See a doctor soon if it is deep, dirty or from a bite, if dirt remains in it, or if you are not fully vaccinated or are unsure.
Can tetanus happen if I cannot remember being injured?
Yes. Tetanus can occur even when the person cannot recall a wound. A stiff jaw or painful spasms need emergency care whether or not an injury is remembered.
How long does recovery take?
Recovery can take several weeks, sometimes months, and starts with hospital treatment. A vaccine is given afterwards, because having tetanus does not protect against getting it again.
