Tetanus

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 which is often found in soil. Symptoms usually begin 3 to 21 days after the infection, and include headache and muscular stiffness in the jaw, followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating and fever. As the toxin produced by the bacteria circulates more widely, it interferes with the normal activity of nerves throughout the body, leading to generalized muscle spasms. Without treatment, tetanus can be fatal. Vaccination is the best way to protect against tetanus.

Nearly all cases of tetanus occur in people who have never been vaccinated or in adults who have not kept up to date on their booster shots.

Signs and symptoms of tetanus appear anytime from 3 to 21 days after tetanus bacteria enter the body through a wound. Most cases occur within 14 days.

Symptoms can include: 

• jaw cramping or the inability to open the mouth
• muscle spasms often in the back, abdomen and extremities
• sudden painful muscle spasms often triggered by sudden noises
• trouble swallowing
• seizures
• headache
• fever and sweating
• changes in blood pressure or fast heart rate

In neonatal tetanus, symptoms include muscle spasms, which are often preceded by the newborn’s inability to suck or breastfeed, and excessive crying.

Tetanus is diagnosed on the basis of clinical features and does not require laboratory confirmation. Tetanus requires treatment in a medical facility, often in a referral hospital. People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.

Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV), which are included in routine immunization programmes globally and administered during antenatal care contacts.

To be protected throughout life, WHO recommends that an individual receives 6 doses (3 primary plus 3 booster doses) of TTCV. The 3-dose primary series should begin as early as 6 weeks of age, with subsequent doses given with a minimum interval of 4 weeks between doses.

The 3 booster doses should preferably be given during the second year of life (12–23 months), at 4–7 years of age, and at 9–15 years of age. Ideally, there should be at least 4 years between booster doses.

There are many kinds of vaccines used to protect against tetanus:

• diphtheria and tetanus (DT) vaccines
• diphtheria, tetanus, and pertussis (whooping cough) (DTaP) vaccines
• tetanus and diphtheria (Td) vaccines
• tetanus, diphtheria, and pertussis (Tdap) vaccines

Neonatal tetanus can be prevented by immunizing women of reproductive age with TTCV, either during pregnancy or outside of pregnancy. Additionally, robust medical practices can also prevent tetanus disease including clean delivery and cord care during childbirth, and proper wound care for surgical and dental procedures.