Health News / September 2006
Take Another Shot
Anyone who steps on a rusty nail is bound to be dutifully presented to the doctor for a tetanus shot. But, it isn’t the nail or the rust that is the issue. Tetanus is an acute, often fatal, condition that affects the nervous system and causes painful, uncontrolled muscle spasms. People get tetanus when spores of the tetanus bacteria, Clostridium tetani, enter the body through any open wound and produce their powerful neurotoxin or nerve poison. Spores are hardy forms of the bacteria that can survive in the environment in an inactive state for a long time. Tetanus spores are found worldwide, generally outdoors, but particularly in soil, dust, and animal waste. Even a shiny nail can create a wound that is contaminated with soil, dust, or animal waste and will allow tetanus spores into the body.
It is the open wound that is dangerous.
Spores can get into the body through even a tiny pinprick or scratch, but they usually enter through deep puncture wounds or cuts, like those made by nails or knives. Tetanus spores can also get into the body when skin is damaged by burns.
The first signs of tetanus infection are usually a headache and spasms or cramping of the jaw muscles, which gives tetanus its common name of lockjaw. As the poison spreads, it progressively attacks more groups of muscles, causing spasms in the neck, arms, legs, and stomach, and sometimes violent convulsions. In the United States, 3 of every 10 persons who get tetanus die from it. For those who survive, recovery can be long (1-2 months) and difficult. Muscle spasms usually decrease after about 2 weeks and disappear after another week or two, but the person may be weak and stiff for a long time. Other complications include breathing problems, bone fractures, high blood pressure, abnormal heartbeats, clotting in the blood vessels of the lung, pneumonia, and coma.
The time between the contamination of a wound and the first symptoms is usually less than 2 weeks but can range from 2 days to months. In general, the shorter the time between exposure and symptoms, the more severe the disease.
In the United States, tetanus occurs mostly in newborns, children, young adults, and older adults who are either not immunized or not adequately immunized. There are between 50-100 cases each year, mostly in under-immunized adults. The fatality rate for tetanus ranges from 20% to 90%, and is highest in infants and the elderly.
Tetanus is completely preventable through immunization and because of widespread use of the tetanus vaccine, the condition is now rare. Immunization against tetanus is highly effective and provides long-lasting immunity.
However, the shots don’t last forever.
Adults need to maintain their protection with boosters, every ten years. Gardeners, hikers, bicyclists, motorcycle riders, mothers, grandmothers, fathers and anyone who plays outdoor sports are candidates for tetanus.
Anyone with deep or dirty wounds may need a tetanus booster shot if more than 5 years have passed since the last dose. An injection of tetanus immune globulin (TIG) given as soon as possible after a tetanus-prone injury can also help neutralize poison that hasn’t entered the nervous system. Tetanus immunity is lost in approximately half of patients undergoing chemotherapy for lymphoma or leukemia. Patients undergoing bone marrow or stem cell transplantation should be re-immunized with two doses, 12 and 24 months after the procedure.
It is important for adults to keep an up-to-date record of their immunizations. Without a record, physicians must err on the side of caution. Although it is vital to be adequately protected against tetanus, receiving more doses than recommended can lead to increased local reactions, like painful swelling or soreness or systemic reactions.
Even individuals who have survived the disease should take the shot. Having tetanus doesn’t provide immunity for the next time.
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