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Tetanus

Tetanus is an infection which is caused by bacteria. It affects the brain and nervous system causing spasms and convulsions which can be life threatening.

In the UK there is a national immunisation programme to protect you against tetanus. You will be immunised against it in the first few months of life. You should then receive vaccines during school and can have boosters to prevent tetanus.

  • About tetanus
  • Symptoms
  • Complications
  • Causes
  • Diagnosis
  • Treatment
  • Prevention
  • Further information
  • Sources
  • Related topics

About tetanus

The bacteria, Clostridium tetani, causes tetanus. It produces a toxin which affects the brain and nervous system. About 50 people in the UK will get tetanus each year.

Symptoms

There are different types of tetanus.

Generalised tetanus

This affects adults, is the most common type and is life threatening. You may have generalised tetanus for between two and 50 days (the average is about seven days) before you realise you have it. Symptoms may then include:

  • jaw muscle spasms or stiffness (lock jaw)
  • muscle stiffness or muscle pain which usually starts in the neck, shoulder and back
  • spasms or convulsions of the body which may be painful and can affect your breathing or digestion
  • fever
  • sweating

Symptoms can last for more than four to six weeks.

Localised tetanus

This affects adults and is rare. Sometimes the tetanus bacteria only affect muscles near the wound through which the bacteria enter. This causes the muscle to go hard and you may have painful spasms. This can be treated and is not usually life-threatening.


Cephalic tetanus

This is a rare form of tetanus. It affects adults who have had a head injury or more often children with an ear infection, and the tetanus bacteria enter the body this way. Cephalic tetanus causes the jaw to lock and may affect all the nerves in your head, which control your expression, senses and swallowing. These symptoms will come on quickly and are life threatening.

Neonatal tetanus

This affects newborn babies and is life threatening. The symptoms are the same as generalised tetanus and occur about three days after birth. You may notice your baby:

  • doesn't feed well
  • is stiff or rigid
  • has spasms

A mother who has no immunity to tetanus or hasn't been fully immunised can pass tetanus to a baby. It can also be passed via a healing umbilical wound which isn't cleaned properly or has been cut with an instrument that isn't sterile.

Complications

In four out of 10 people tetanus causes death. Spasms or convulsions may be violent and you can stop breathing or have a heart attack. Other complications of tetanus include:

  • pneumonia (lung infection) and other infections
  • fractures - due to spasms or convulsions
  • breathing problems
  • muscle problems (rhabdomyolysis)
  • coma

Causes

Tetanus bacteria are found in soil, animal faeces and sometimes in human faeces. The bacteria are most likely to cause an infection if you have a wound which was caused by something dirty such as a knife or nail, or an animal bite. Contaminated instruments during childbirth or abortion increase the risk of tetanus in women.

Most people who get tetanus have not been immunised or have not had their regular vaccines or booster of tetanus.

If you have not been immunised or had your booster, you can get tetanus if:

  • you have a wound and it becomes infected - this may be minor such as a scratch or cut, or you may have had a piercing
  • you have just had a baby and become infected (maternal tetanus)
  • if you inject drugs or medicines using a needle which isn't sterile and has tetanus bacteria on it

Diagnosis

If you think you have tetanus you should go to the accident and emergency department at the hospital. A recent wound and muscle stiffness or spasms may be the initial symptoms.

Sometimes the tetanus bacteria may be taken from the wound and sent to a laboratory for testing.

Treatment

In the hospital, your wound will be cleaned thoroughly to help prevent further infection. Medicines, such as immunoglobulin, will be given to work against the toxins produced by the bacteria which cause the disease. You will need to stay in hospital and may be linked to a heart monitor or given help breathing. Your doctor may give you antibiotics, such as metronidazole or benzypenicillin, to treat the infection. Muscle relaxants such as diazepam or lorazepam are used if you are having muscle spasms.

Prevention

Vaccination

There is a vaccine to prevent tetanus. This is given in the arm or the thigh. You will need three doses of the vaccine with a months break between each when you are first vaccinated. In the UK, this is usually given to babies when they are two, three and four months old.

Children will then receive a booster when they are about three, usually at pre-school entry, and again 10 years later before they leave school. You should then have protection from tetanus for life. You may need a booster of tetanus if you are travelling abroad and haven't had a booster in the last 10 years. Ask your GP for advice.

If you were not immunised as a child you can get the first three doses of the vaccine at any age. You will then need a booster 10 years later. Generally, only five doses of the vaccine are needed to protect you for life.

Women can be given the tetanus jab during pregnancy to prevent tetanus.

If you have had tetanus you can get it again and need to be immunised.

If you have a cut and haven't been immunised

If you have a cut or weeping wound, such as a burn, and you haven't ever had a vaccination or haven't had a tetanus jab for more than 10 years, you need to have a booster dose of tetanus as a precaution. You may also be given a dose of tetanus immunoglobulin which are proteins (antibodies) to help your body fight any tetanus infection you might develop.

Further information

Health Protection Agency

Sources

  • British National Formulary (BNF) September 2007. BMJ Publishing Group, 2007; 54
  • CDR Weekly. Health Protection Agency. Volume 13. Number 48. 27 November 2003
  • DTaP/IPV/Hib. Immunisation. www.immunisation.nhs.uk, accessed 1 November 2007
  • Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. 16th ed. USA, McGraw-Hill, 2005:840-842
  • Immunisation against infectious diseases 2006. The Green Book. The Department of Health. 20 October 2007. www.dh.gov.uk
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press 2005:484-485
  • Tetanus. World Health Organisation (WHO). www.who.int, accessed 1 November 2007

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