Tetanus

What is tetanus?

Tetanus is a sudden and often fatal infection caused by bacteria that is normally found in dirt, soil, manure and dust. Bacteria can enter the body through a cut, animal bite or injury. Days to weeks after the bacteria enters the body, it begins to produce a toxin that causes permanent nerve damage.

Signs and symptoms of tetanus

The toxin produced by the bacteria that causes tetanus damages the brain and spinal cord. This leads to severe muscle rigidity and painful spasms, sweating, fast heart rate, fever and high or low blood pressure and can interfere with breathing and swallowing. Usually, muscles throughout the body are affected, beginning with the jaw muscles. In rare instances, people with tetanus may initially suffer spasms in only one group of muscles before the toxin affects the rest of body.

It takes an average of eight days to show symptoms, but tetanus usually occurs between 3 and 21 days from the initial exposure to the bacteria.

Signs and symptoms may include:

• being unable to open the mouth
• trouble swallowing
• tightening of facial muscles
• painful muscle spasms in the neck, back or belly
• difficulty breathing
• fever
• sweating

Causes

The bacteria that cause tetanus are found in dirt, soil, manure and dust. People of all ages are at risk for tetanus when bacteria enter an untreated wound.

Risk factors

• fewer than 3 doses of tetanus vaccine
• more than 10 years since last booster
• international travel without being vaccinated
• a wound that has not been well-cleaned

Newborns born to an unimmunized pregnant individual can develop neonatal tetanus from an infected umbilical stump and are at high risk of developing a fatal infection.

Treatment of tetanus

Tetanus is diagnosed by a physical exam. If your child is diagnosed with tetanus, they will be admitted to the hospital. While antibiotics are given to treat the infection, they have no effect on the toxin. There are very few effective treatments available to inactivate or reduce the damage the toxin causes. Other medications, such as sedatives, muscle relaxants and pain medication, may be used to control the muscle spasms. Medications to control heart rate and blood pressure as well as machines to help with breathing are usually needed.

Tetanus can be fatal even with treatment and some nerve damage from the toxin can be permanent. Children who live through tetanus can have long-term problems with speech, memory or thinking.

Prevention

Immunization is the only safe and reliable way to avoid tetanus. Updated immunizations in children and adults can prevent tetanus. This includes receiving all recommended immunizations in infancy and childhood and getting regular tetanus boosters every 10 years as teens and adults.

In Canada, the tetanus vaccine is part of a combination immunization and is given:

• at two months, four months and six months of age
• once at 18 months
• once between four and six years of age
• once every 10 years thereafter (booster shots)

If your child was not immunized as a baby, speak to their health-care provider or call the immunization info line about catching up.

Make sure all wounds (even minor cuts) are cleaned well and heal properly.

When to seek medical assistance

Any unimmunized (or incompletely immunized) person with wounds that are deep or dirty need treatment as well as cleaning. Depending on an individual’s immunization history and the type of wound, they may require emergency immunization to prevent tetanus. This includes tetanus immune globulin and a tetanus vaccine booster.

Tetanus is a medical emergency. Go to the nearest Emergency Department if you think your child may have tetanus. People who are planning a pregnancy should make sure their tetanus booster is up to date.

References

Public Health Agency of Canada. (June 28, 2023). Tetanus. Retrieved from https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/tetanus/health-professionals.html