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Tetanus, sometimes known as lockjaw, is a disease manifested by uncontrolled muscle spasms. The disease is frequently fatal, especially to the very old or very young, and is preventable by immunization. It occurs predominantly in developing countries among newborn infants, children, and young adults, but it is still encountered in the United States, especially in unimmunized or inadequately immunized adults over fifty years of age.

The tetanus bacterium depends upon the introduction of its spores into damaged tissue along with foreign bodies and/or another bacteria to provide the necessary conditions favorable for its growth. Tetanus is not directly transmitted from person to person. Instead tetanus spores may be introduced into the body through a puncture wound contaminated with soil, street dust, animal feces, injected contaminated street drugs, lacerations, burns and even trivial or unnoticed wounds.

Tetanus disease is due to a potent poison produced by the bacteria. The poison has a stimulating effect on certain muscle groups. Most of the time the muscles of the jaw, face, and neck are affected first and then progressively more distant muscles such as the arms and legs. In this type of generalized tetanus, which is the most frequent form of the disease, the release of larger quantities of poison from a wound into the bloodstream will tend to produce both a quicker onset and a more rapid progression of symptoms, as well as more severe disease.

The tetanus bacteria spores are found everywhere. Any wound can serve as an entry point for the disease. The number of cases of tetanus in any given population decreases as more of the population receives effective immunization. Thus, tetanus is a major problem in developing countries where compulsory immunization of children is not required or enforced. It is often among the ten most frequent causes of death in such countries, and the number of cases per year worldwide has been estimated at one million.

In the United States, tetanus cases average between fifty and one hundred per year, mostly in under-immunized older adults, and the source is usually a wound. About thirty percent of the people who get tetanus die from it.

The time between an injury and the occurrence of first symptoms is typically less than two weeks but may range from two days to months. Usually the shorter the period the more severe the disease. Initially symptoms of tetanus may include such complaints as localized or generalized weakness, stiffness or cramping, or difficulty chewing and swallowing food. An early sign is often the complaint of “lockjaw.” Increasing muscle rigidity follows in the generalized disease and progressively involves more muscle groups.

For patients who survive tetanus, recovery can be long (1-2 months) and arduous. Muscle spasms may begin to decrease after ten to fourteen days and disappear after another week or two. Residual weakness, stiffness, and other complaints may persist for a prolonged period, but complete recovery can occur from uncomplicated tetanus.

Vaccine Information

Illness with tetanus usually does not result in immunity, therefore immunization for all recovered patients is recommended. Tetanus toxoid has proved to be safe and effective since its introduction during the 1920’s. Tetanus toxoid consists of inactivated tetanus toxin. For practical purposes tetanus should be considered a disease against which there is not naturally acquired immunity and one that is entirely preventable with appropriate immunization and wound care.

Tetanus toxoid is very effective in preventing illness. There are two types of tetanus toxoid available and both produce immunity to the tetanus toxin poison. Tetanus toxoid is available by itself, or frequently is administered as one of two or three components in a vaccine

Completion of the primary series will produce immunity to tetanus for at least 10 years in 95 percent or more to the vaccinated. Booster doses are recommended every 10 years to ensure the maintenance of protective antitoxin levels.

However anyone who sustains a wound other than a minor cut –especially a wound that is deep or becomes contaminated with dirt – should receive a tetanus booster if more than 5 years have elapsed since the last dose. If you aren’t sure whether your wound is serious enough to require a dose of tetanus toxoid, check with your doctor.

Normal side effects

Reactions to tetanus vaccine are generally minor and local, such as redness, swelling or tenderness at the site of injection, but the administration of more frequent booster vaccinations increases the risk of these and also generalized reactions such as fever. Severe local reactions, for example painful swelling from shoulder to elbow, generally beginning 2-8 hours after injections, have reported in some adults, particularly those who have received frequent, which means annual doses of the tetanus toxoid.

Less severe local, allergic reactions may occur in persons who have had multiple prior boosters. Any person who experiences difficulty in breathing following a previous dose of tetanus toxoid should not receive any further doses of tetanus toxoid.