Tetanus, often called “lockjaw,” is caused by a specific bacterium (called Clostridium tetani) usually found as spores in soil, dust, and manure. These spores can enter the body through a break in the skin, most commonly through a cut or puncture wound by a contaminated object (such as from a rusty nail). Tetanus cannot be transmitted person-to-person and is now relatively uncommon in the United States. Between 1996 and 2009, 29 cases were reported.
The time from exposure to Clostridium tetani spores and the onset of illness is usually 3-21 days with most cases occurring within 8-10 days. The most common initial symptom is spasms of the jaw muscles and difficulty opening the mouth, thus the term “lockjaw.” Other symptoms may include headache, stiffness in the neck and abdominal muscles, swallowing difficulty, generalized body spasms, and fever. Without treatment, tetanus can lead to difficulty breathing and even fractures of bones. At least one in 10 who contract tetanus will die, even with the best medical care.
Tetanus is diagnosed by physical examination and a supportive history (usually with known exposure to a contaminated object). Currently, there are no blood tests to confirm tetanus. Admission to a hospital is usually warranted. A person with suspected tetanus will receive tetanus immune globulin (TIG), which induces specific antitoxins. Antibiotics will be given to decrease the number of spores. Administration of muscle relaxants is often helpful in relieving painful spasms. In severe cases, assisted respiratory support with a special breathing machine, called a mechanical ventilator, may be required.
The best way to prevent tetanus is to be vaccinated against the disease. Tetanus vaccines are recommended for all age groups, beginning at 2 months of age. A tetanus vaccine is recommended at the following ages: 2 months, 4 months, 6 months, 15 –18 months and 4–6 years. One dose of the tetanus vaccine is administered at age 11 or 12. A booster of tetanus vaccine (either Td or TDaP) is then given every 10 years. Unvaccinated pregnant women should also receive TDaP to pass along antibodies against tetanus to the unborn fetus. Besides vaccination, immediate and proper wound care can help prevent infection. Even if fully vaccinated, a booster dose of tetanus vaccine may be recommended if a person sustained a severe cut or burn.
Reviewed by Dr. Sara Connolly, April 2019
- Tetanus is contracted from spores entering the body through a break in the skin, usually from a cut or puncture wound by a contaminated object.
- Common symptoms include lockjaw, headache, stiffness in the muscles, swallowing difficulty, generalized muscle spasms, and fever.
- Vaccination against tetanus and immediate and proper wound care are the best prevention strategies.