Tetanus is a serious but rare infection caused by bacteria. It usually occurs when a flesh wound becomes contaminated.
Without treatment, complications of tetanus are likely to develop, which can be fatal. However, vaccination and improvements in treatment mean deaths from tetanus are now rare in the UK. In England and Wales in 2011, there were only three recorded cases of tetanus.
What causes tetanus
Tetanus is caused by a type of bacteria called Clostridium tetani. The bacteria can live in many different substances including:
animal and human waste, such as manure
The tetanus bacteria usually enter the body through a wound in the skin or a serious burn. Once inside, they multiply and release a powerful type of poison, known as a neurotoxin.
The neurotoxin disrupts the normal workings of the nerves, causing symptoms such as stiffness and muscle spasms.
Other symptoms of tetanus include:
muscle stiffness and spasms in the jaw muscles – often referred to as lockjaw
difficulty swallowing (dysphagia)
A confident diagnosis can usually be made if someone has recently had a wound or similar injury and has painful muscle spasms and muscle stiffness.
A spatula test can help confirm tetanus if there is any doubt about the diagnosis. It involves inserting a spatula into the back of your throat. The spatula will cause a gag reflex and you will try to push the spatula out of your mouth. If you have the infection, the spatula will cause your throat muscles to spasm and you to bite down onto the spatula.
If you have a deep wound that could become contaminated by tetanus bacteria and you have been vaccinated, you will be given a medication called tetanus immunoglobulin (TIG) as a precaution.
If you have not been vaccinated and develop tetanus, you will need to be admitted to hospital for treatment. Treatment usually involves a combination of medications, such as antibiotics, muscle relaxants and antitoxins, to combat the effects of the infection.
A ventilator (a machine to assist with breathing) can be used to help prevent suffocation.
Most people survive the infection, although it can take up to four months to make a full recovery.
The full course of the tetanus vaccination consists of five doses. The first three doses are given in the 5-in-1 vaccine for babies at two, three and four months of age.
This is followed by a booster of tetanus vaccine in the 4-in-1 pre-school booster jab which is given around four years of age.
And a final booster against tetanus is given to children betweeen 13 and 18 years of age as part of the 3-in-1 teenager booster.
After the full course of five injections, you should have lifelong immunity against tetanus. However, if you or your child has a deep wound, it's best to get medical advice.
If you are not sure whether you've had the full course, for example because you were born in another country, contact your GP for advice.
Tetanus vaccination for travel
Tetanus is found throughout the world. Any location where medical attention may not be available if you hurt yourself is considered a high-risk area.
A tetanus vaccination is usually recommended for anyone who:
has not been vaccinated before
has not been fully vaccinated (in the UK you should receive five doses of the tetanus vaccine)
is travelling to a country with limited medical facilities, and whose last dose of the tetanus vaccine was more than 10 years ago
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Symptoms of tetanus
The symptoms of tetanus usually develop within 4 to 21 days after infection with the Clostridium tetani bacteria (the incubation period). The average incubation period is about 10 days.
Most tetanus cases occur in people who:
were never vaccinated against the infection
did not complete the entire vaccination schedule (three initial injections followed by two booster doses that are given 10 years apart)
inject illegal drugs such as heroin
Muscle spasms and stiffness
Stiffness in your jaw muscles is usually the first symptom of tetanus to develop. This is sometimes known as lockjaw. It can make it difficult for you to open your mouth.
Muscle spasms and stiffness spread from your jaw into your neck and limbs over 24 to 72 hours.
Muscle spasms in your neck can make swallowing difficult (dysphagia). In the most serious cases, severe breathing difficulties could develop. This may lead to suffocation.
Other symptoms associated with a tetanus infection include:
high temperature (fever) of 38C (100.4F) or above
rapid heartbeat (tachycardia)
high blood pressure (hypertension)
If tetanus is not treated, it can cause serious complications that can be fatal, for example because of heart failure.
Causes of tetanus
Tetanus is caused by the Clostridium tetani bacterium.
Clostridium tetani spores can live for a long time outside the body and are widespread in the environment. They are commonly found in the manure of animals such as horses and cows, and in contaminated soil.
After they enter the body, the tetanus bacteria quickly multiply and release tetanospasmin, a type of poison known as a neurotoxin. Tetanospasmin can slowly travel through nerves, until it reaches the spinal cord or brainstem.
The neurotoxin blocks the control of the nerve cells in the spinal cord and brainstem that control the muscles, causing them to be overactive. This leads to the muscle spasm and muscle stiffness associated with tetanus.
Cuts and wounds
One of the most common ways the tetanus bacteria enter the body is through a cut or a puncture wound. Even minor puncture wounds, such as piercing your skin with the thorn of a rose, could allow the bacteria to enter your body.
Tetanus bacteria thrive and breed in places where there is little or no oxygen. This is why the infection often occurs in deep cuts and wounds. To help prevent a tetanus infection developing, always ensure that cuts and wounds are thoroughly cleaned.
Other entry points
As well as entering the body through cuts and wounds, the tetanus bacteria can also enter through:
lacerations – tears or splits in the skin caused by blunt trauma such as a blow to the skin, or a sharp object such as a knife or broken glass
abrasions – wounds caused by friction damage, such as the type of wound you would get after falling off a bike and scraping your knee
body piercings and tattoos (if unsterilised equipments is used)
Some groups of people, such as travellers and people who inject drugs, may be at increased risk of developing tetanus.
If you are travelling abroad, make sure your vaccinations are up to date, according to the UK schedule. Depending on where you are travelling, you may need additional doses of certain vaccinations.
If you are travelling to a remote area where medical services may not be easily accessible, and you had your last tetanus vaccine more than 10 years ago, you need to have a booster dose (even if you have already had the full five doses). This is done as a precaution, in case you get a wound that is vulnerable to a tetanus infection and medical care isn't available.
Injecting drug users
People who inject illegal drugs such as heroin or methamphetamine have an increased risk of developing tetanus. Drug dealers often mix these types of drugs with a chemical called quinine. Quinine can be contaminated by the tetanus bacteria.