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What is Tetanus?


Tetanus (lockjaw) disease is caused by Clostridium tetani (C. tetani), an anerobic, gram-positive, bacteria with the ability to develop into a spore. Tetanus spores can be found in soil, manure, and in the digestive tracts of animals and humans. Additionally, tetanus has also been reportedly found in contaminated heroin and on skin surfaces.1  

The tetanus bacteria, C. tetani, produces two exotoxins, tetanolysin and tetanospasmin. At this time, the exact function of tetanolysin is unknown, however, the tetanospasmin exotoxin has been determined to be the neurotoxin responsible for the clinical symptoms of tetanus.2

Tetanus bacteria do not survive in the presence of oxygen, however, are quite resistant to most chemicals and even heat.3 Puncture wounds, which do not bleed very much and are protected by tissue and skin from direct exposure to oxygen, can be the perfect environment for tetanus bacteria to multiply and cause infection.4

When tetanus enters the body, the tetanus spores can multiply in low oxygen conditions, producing toxins that spread throughout the body. The incubation period for tetanus infection, from time of exposure to appearance of the first symptoms, ranges from three days to three weeks.5 Initial symptoms include muscular stiffness of the jaw and neck, headache, seizures, changes in heart rate and blood pressure, fever, and chills. Complications include fractures, vocal cord spasms, impaired breathing, pulmonary embolism, pneumonia, infections acquired in the hospital during the course of treatment, and death.6

There are four recognized forms of tetanus disease. The most common form of tetanus is referred to as generalized tetanus and is responsible for approximately 80 percent of cases. The initial sign of generalized tetanus usually involves muscle spasms of the jaw, frequently referred to as “lockjaw”. Muscle spasms involving the extremities, neck, and trunk may also occur. Complications of generalized tetanus can include severe muscle spasms and neurological abnormalities, resulting in prolonged hospital stays and even death. Localized tetanus, a less common form of the disease, involves muscle spasms in close proximity to a wound. While considered a mild form of the disease and often associated with persons previously vaccinated against tetanus, it has the potential to progress into generalized tetanus. Cephalic tetanus, a rare but serious form of the disease, is associated with ear infections or head wounds. Cephalic tetanus typically presents as a cranial nerve palsy and may progress to localized or even generalized tetanus. Neonatal tetanus, while nearly non-existent in the United States, continues to be a threat to infants born in developing countries. Neonatal tetanus results primarily when childbirth occurs in unsanitary conditions and the umbilical cord becomes contaminated. Symptoms typically develop within one week, with infants noted to be irritable, difficult to feed, and may have rigidity with spasms.7

Treatment for tetanus includes immediate hospitalization and the use of human tetanus immune globulin (TIG). Additional measures include wound management, medications to control muscle spasms, airway management, and antibiotics.8 Complete recovery from tetanus disease may take several months.9

There are no laboratory findings to confirm tetanus and a diagnosis is based clinical symptoms. Additionally, only about 30 percent of wounds in patients diagnosed with tetanus are found to be positive for the tetanus bacteria.10

Tetanus became a nationally notifiable disease in 194711 and in 1948, 601 tetanus cases were reported, the highest number ever reported.12 However, since 1947, the incidence of tetanus in the United States has declined by more than 95 percent and deaths from the disease have decreased by over 99 percent.13 In 2015, there were 29 cases of tetanus and 2 deaths reported in the U.S.14 Tetanus is a much more serious problem in underdeveloped countries, especially among newborn babies born in unsanitary conditions whose umbilical cords can become infected with tetanus.15

IMPORTANT NOTE: NVIC encourages you to become fully informed about Tetanus and the Tetanus vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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1 CDC Tetanus - Clostridium tetani Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

2 Ibid

3 Ibid

4 CDC Tetanus – Pathogenesis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

5 CDC Tetanus - Clinical Features Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

6 CDC Symptoms and Complications Feb. 28, 2019

7 Hinfey PB Tetanus – Background Medscape Jan 18, 2019

8 CDC Tetanus For Clinicians – Treatment Feb. 28, 2019

9 WHO Western Pacific Region Q & A - What are the symptoms of tetanus? 2019

10 CDC Tetanus – Laboratory Diagnosis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

11 CDC Tetanus- Surveillance Feb. 28, 2019

12 CDC Reported incidence of notifiable diseases in the United States, 1952 MMWR Oct. 26, 1953 1 (54); 1-10

13 CDC Tetanus- Surveillance Feb. 28, 2019

14 CDC Surveillance Manual – Chapter 16 – Tetanus – Background Nov. 17, 2017

15 WHO Tetanus Jan. 21, 2019

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