Can you die from tetanus

For Clinicians

Pathogenesis

Clostridium tetani (C. tetani) spores usually enter the body through a wound or breach in the skin. Neonatal tetanus usually occurs because of umbilical stump infections. In the presence of anaerobic conditions, the spores germinate. The bacteria produce very potent toxins, most of which the blood stream and lymphatic system disseminate through the body. Toxins act at several sites within the central nervous system, including peripheral motor end plates, spinal cord, and brain, as well as in the sympathetic nervous system. Tetanus toxin causes the typical clinical manifestations of tetanus by interfering with the release of neurotransmitters and blocking inhibitor impulses. This leads to unopposed muscle contraction and spasm. Seizures may occur, and the autonomic nervous system may also be affected.

Risk Groups

Nearly all cases of tetanus in the United States today are among people who

  • Have never received a tetanus vaccine
  • Didn’t stay up to date on their 10-year booster shots

Tetanus Prevention after a Disaster

In most settings, a disaster does not increase the risk for tetanus. This includes earthquakes, hurricanes, floods, and tsunamis.

However, you can minimize the risk of tetanus among your patients who are disaster survivors and emergency responders by following routine vaccination recommendations and providing proper wound care.

Most reported cases occur in adults. From 2009–2017, more than 60% of the 264 reported cases were among people 20 through 64 years of age. In addition, a quarter of those reported cases were among people 65 years old or older. The risk of death from tetanus is highest among people 65 years old or older.

Diabetes, a history of immunosuppression, and intravenous drug use may be risk factors for tetanus. From 2009 through 2017, persons with diabetes was associated with 13% of all reported tetanus cases, and a quarter of all tetanus deaths. Intravenous drug users accounted for 7% of cases from 2009 through 2017.

Risk during Natural Disasters

In most settings, a disaster (e.g., earthquake, hurricane, flood, tsunami) does not increase the risk for tetanus. Minimize the risk of tetanus among your patients who are disaster survivors and emergency responders by following routine vaccination recommendations and providing proper wound care.

Symptoms and Diagnosis

Tetanus is a clinical syndrome without confirmatory laboratory tests. Characteristic symptoms of tetanus are painful muscular contractions, primarily of the masseter and neck muscles and secondarily of trunk muscles. Trismus, or lockjaw, is a common sign of tetanus (see generalized tetanus under Clinical Features). A common first sign suggestive of tetanus in older children and adults is abdominal rigidity, although rigidity is sometimes confined to the region of injury. Generalized spasms occur, frequently induced by sensory stimuli. History of an injury or apparent portal of entry may be lacking. Clinicians rarely recover the organism from the site of infection.

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Clinical Features

The incubation period ranges from 3 to 21 days, averaging about 10 days. In general, the further the injury site is from the central nervous system, the longer the incubation period. A shorter incubation period is associated with more severe disease, complications, and a higher chance of death. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days.

There are three clinical forms of tetanus:

  • Generalized
  • Localized
  • Cephalic

Generalized Tetanus

Generalized tetanus is the most common form, accounting for more than 80% of cases. The most common initial sign is spasm of the muscles of the jaw or “lockjaw”. Other signs may follow “lockjaw.” These can include painful spasms in other muscle groups in the neck, trunk, and extremities and generalized, seizure-like activity or convulsions in severe cases. Nervous system abnormalities, as well as a variety of complications related to severe spasm and prolonged hospitalization, can accompany generalized tetanus. The clinical course of generalized tetanus is variable and depends on the

  • Degree of prior immunity
  • Amount of toxin present
  • Age and general health of the patient

Even with modern intensive care, generalized tetanus is associated with death rates of 10% to 20%.

Localized Tetanus

Localized tetanus is an unusual form of the disease consisting of muscle spasms in a confined area close to the site of the injury. Although localized tetanus often occurs in people with partial immunity and is usually mild, progression to generalized tetanus can occur.

Cephalic Tetanus

The rarest form, cephalic tetanus, is associated with lesions of the head or face and may also be associated with otitis media. The incubation period is short, usually 1 to 2 days. Unlike generalized and localized tetanus, cephalic tetanus results in flaccid cranial nerve palsies rather than spasm. Spasm of the jaw muscles may also be present. Like localized tetanus, cephalic tetanus can progress to the generalized form.

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Complications of Tetanus

  • Laryngospasms
  • Fractures
  • Hypertension
  • Nosocomial infections
  • Pulmonary embolism
  • Aspiration pneumonia
  • Death

Treatment

Tetanus is a medical emergency requiring

  • Hospitalization
  • Immediate treatment with human tetanus immune globulin (TIG)
  • Agents to control muscle spasm
  • Aggressive wound care
  • Antibiotics
  • A tetanus toxoid booster

If TIG is unavailable, clinicians can use Immune Globulin Intravenous (IGIV).

Clinicians should maintain a patent airway. Depending on the severity of disease, endotracheal intubation or tracheostomy and mechanically assisted respiration may be lifesaving. Clinicians should use sedation and muscle relaxant drugs as indicated to control muscle spasms. Agents to control autonomic nervous system instability may be required. Initiate active immunization concurrently with treatment.

Treatment of tetanus cases with TIG

Medical experts recommend a single dose of human TIG for treatment of persons with tetanus. Researchers have not established the optimal therapeutic dose. However, experts recommend 500 international units (IU), which appears to be as effective as higher doses ranging from 3,000 to 6,000 IU and causes less discomfort.

Clinicians must administer available preparations intramuscularly; TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use.

Some medical experts recommend infiltration of part of the dose locally around the wound (see Red Bookexternal icon), although its efficacy has not been proven.

If TIG is not available, clinicians can use IGIV at a dose of 200 to 400 milligrams per kilogram (mg/kg). However, the Food and Drug Administration has not approved IGIV for this use. In addition, anti-tetanus antibody content varies from lot to lot.

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Vaccination during Recovery

Tetanus disease does not result in tetanus immunity. Clinicians should begin or continue active immunization with a tetanus toxoid-containing vaccine as soon as the person’s condition has stabilized.

Wound Management for Tetanus Prevention

Risk of tetanus disease depends on the type and condition of the wound and immune status of the patient. Clinicians should take the following steps to prevent tetanus:

  • Assess the type of wound and provide appropriate wound care.
    Wounds may be clean or contaminated and dirty, superficial or deep and penetrating. Dirty wounds pose an increased risk for tetanus. Clinicians should consider wounds dirty if contaminated with dirt, soil, feces, or saliva (e.g., animal or human bites). Consider penetrating or puncture wounds contaminated, possibly posing a higher risk for tetanus. Wounds containing devitalized tissue (e.g., necrotic or gangrenous wounds), frostbite, crush injuries, avulsion fractures, and burns are particularly conducive for proliferation of C. tetani. Clinicians should clean all wounds, remove dirt or foreign material, and remove or debride necrotic material.
  • Evaluate the immunization status of the patient. Unvaccinated persons should start and complete a primary series with an age-appropriate tetanus toxoid-containing vaccine (i.e., DTaP, TdaP, Td) as currently recommended by CDC. Consider persons with unknown or uncertain history of receiving previous prior doses tetanus toxoid-containing vaccines to have had no previous tetanus toxoid-containing vaccine. They should complete a primary series. This is because early doses of toxoid may not induce adequate immunity, but only prime the immune system. Persons who have completed a 3-dose primary tetanus vaccination series:
    • If the last dose of a tetanus toxoid-containing vaccine was received less than 5 years earlier, consider them protected against tetanus. They do not require another dose of tetanus toxoid-containing vaccine as part of the current wound management.
    • If the last dose of a tetanus toxoid-containing vaccine was received 5 or more years earlier, then administer a booster dose of an age-appropriate tetanus toxoid-containing vaccine.
    • Rarely have cases of tetanus occurred in persons with a documented primary series of tetanus toxoid.
  • Assess need for administering TIG for prophylaxis.
    TIG provides temporary immunity by directly providing antitoxin. TIG can help remove unbound tetanus toxin but cannot neutralize toxin that is already bound to nerve endings. Persons who have contaminated and dirty wounds and are either unvaccinated or have not received a primary series of tetanus toxoid-containing vaccines should receive TIG for prophylaxis. The dose of TIG for prophylaxis is 250 IU administered intramuscularly. Persons with HIV infection or severe immunodeficiency who have contaminated wounds (including minor wounds) should also receive TIG, regardless of their history of tetanus immunizations.
  • Do not use antibiotics for prophylaxis against tetanus.
    Medical experts do not recommend antibiotic prophylaxis against tetanus. However, clinicians should observe wounds for signs of infection and promptly treated if they detect signs of infection.

Guide to Tetanus Prophylaxis with TIG in Routine Wound Management

Guide to Tetanus Prophylaxis with TIG in Routine Wound Management

History of adsorbed tetanus toxoid-containing vaccines (doses) Clean, minor wound All other wounds*
DTaP, Tdap or Td† TIG‡ DTaP, Tdap or Td† TIG‡
Unknown or <3 Yes No Yes Yes
≥3 No§ No No¶ No

Footnotes

Abbreviations: DTaP = Diphtheria and Tetanus toxoids and acellular pertussis vaccine; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; Td = tetanus and diphtheria toxoids; TIG = Tetanus immune globulin
*Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite.
† DTaP is recommended for children <7 years of age. Tdap is preferred to Td for persons aged 11 years or older who have not previously received Tdap. Persons aged 7 years or older who are not fully immunized against pertussis, tetanus, or diphtheria should receive one dose of Tdap (preferably the first) for wound management and as part of the catch-up series; if additional tetanus toxoid-containing doses are required, either Td or Tdap vaccine can be used.
‡ People with HIV infection or severe immunodeficiency who have contaminated wounds (including minor wounds) should also receive TIG, regardless of their history of tetanus immunizations.
§ Yes, if ≥10 years since the last tetanus toxoid-containing vaccine dose.
¶ Yes, if ≥5 years since the last tetanus toxoid-containing vaccine dose.

Prevention through Routine Vaccination

Since people cannot naturally acquire immunity to tetanus, the best way to prevent tetanus is to vaccinate your patients. CDC recommends tetanus vaccines for all infants and children, preteens and adolescents, and adults. See Diphtheria, Tetanus, and Pertussis Vaccination: Information for Healthcare Professionals for information on all tetanus vaccine recommendations by vaccine and age.

  1. Havers FP, Moro P, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccines — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2020;69(3);77-83.
  2. Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2018;67(2):1–44.
  3. American Academy of Pediatrics. Tetanusexternal icon. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book®: 2018–2021 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018; 793–8.
  4. Pink Book’s Chapter on Tetanus
    Epidemiology & Prevention of Vaccine-Preventable Diseases

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    • Symptoms and Complications
    • Diagnosis and Treatment
    • Prevention

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What Is Tetanus?

Most cases occur in people who have not been vaccinated, and the disease can lead to serious complications, even death.

Tetanus is a serious disease that attacks the nervous system with the potentially deadly bacteria called Clostridium tetani.

It’s often referred to as “lockjaw” because it can cause painful spasms and stiffness in your jaw muscles.

In addition to the jaw, C. tetani bacteria can lead to painful muscle contractions in the neck, as well as cause breathing difficulties.

Due to the tetanus vaccine, the disease is rare in the United States and other developed countries, though about one million cases are reported around the world each year.

Most U.S. cases occur in people who have not received the tetanus vaccination.

When tetanus does occur, it can take months to fully recover, and one out of five people who get tetanus die. Children who get tetanus may need several weeks of hospital care.

Tetanus Causes

Tetanus does not spread between people. Spores of the C. tetani bacteria are found in soil, animal feces, and dust. While the spores are inactive in the soil, they can remain infectious for more than 40 years.

If the spores get into your body through an injury, burn, or wound, they release bacteria that make a poison called tetanospasmin (also called tetanus toxin).

This poison blocks nerve signals from your spinal cord to your muscles, causing severe muscle stiffness and spasms, which in some cases can injure muscle tissue or cause fractures of the spine.

People may be infected following:

  • Animal bites
  • Puncture wounds, such as splinters, body piercings, and tattoos
  • Gunshot wounds
  • Compound fractures
  • Crush injuries
  • Surgical wounds
  • Injection drug use
  • Ear infections
  • Infected foot ulcers
  • Infected umbilical stumps in infants born from mothers who weren’t immunized

The following factors are necessary for tetanus bacteria to proliferate in your body:

  • Not getting immunized or not receiving booster tetanus shots
  • The existence of a penetrating injury that results in tetanus spores getting into the wound
  • The presence of other infective bacteria
  • Injured tissue
  • A foreign object, such as a nail or splinter
  • Swelling around the injury

Tetanus Prevention

Tetanus is easily preventable by being immunized with the DTaP vaccine, which also provides immunity against the bacteria that cause diphtheria and pertussis (whooping cough). Immunization usually protects against tetanus infection for 10 years, and then a booster shot is needed for continued protection.

If you get a deep wound or other injury listed above that could cause tetanus, as long as you’ve been immunized prior to the incident, your body should quickly make the needed antibodies to protect you against the disease.

If you have a minor wound, these steps can help prevent you from getting tetanus:

Stop the bleeding: Apply direct pressure to a bleeding wound.

Clean the wound: If there are no objects embedded in the wound, once bleeding has stopped, use clean running water or saline solution to rinse the wound.

You can use soap and a washcloth to clean the area around the wound.

Apply a topical antibiotic: Antibiotics can ward off bacterial growth and infection, so after you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as Neosporin and Polysporin.

Protect the wound: Bandages can protect the wound against harmful bacteria. Keep blisters that are draining covered until a scab forms.

Whenever a dressing is wet or dirty, change it, and change dressings at least once a day.

Tetanus Symptoms

The first symptoms can occur about 7 to 21 days after being infected with the bacteria C. tetani.

However, the average incubation period is 7 to 8 days.

Mild spasms and stiffness in the jaw muscles are usually the first signs of tetanus; with the below symptoms following shortly thereafter:

  • Stiffness in neck muscles
  • Difficulty swallowing
  • Stiffness in abdominal muscles
  • Spasms in the back, which often cause arching called opisthotonos, and spasms in other body parts (called tetany)
  • Spasms that affect muscles that help with breathing, leading to breathing problems

Other signs and symptoms may include:

  • Drooling
  • Fever
  • Excessive sweating
  • Elevated blood pressure
  • Rapid heart rate
  • Hand or foot spasms
  • Irritability
  • Uncontrolled urination or defecation

Tetanus in Infants and Children

Newborn babies whose mothers weren’t immunized can catch neonatal tetanus, a form of generalized tetanus that usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument.

This form of tetanus causes the death of around 200,000 newborns annually around the world.

Tetanus Complications

Complications from tetanus may include the following:

Fractures and broken bones: Intense muscle spasms can cause the spine and other bones to break.

Disability: Prolonged use of strong sedatives to control muscle spasms can lead to permanent disability.

Brain damage: Since spasms can restrict oxygen, tetanus may cause lasting brain damage in infants, from minor mental deficits to more serious conditions like cerebral palsy.

Death: Severe muscle spasms from tetanus can cause airway obstruction and the inability to breath. Respiratory failure is the most common cause of death in people with tetanus.

Cardiac arrest may also occur from lack of oxygen, as well as pneumonia. With proper treatment, less than 15 percent of people with tetanus die.

Neonatal tetanus: This can occur in a newborn whose mother has not been immunized.

To avoid these and other complications, call your doctor if:

  • You have a deep open wound and haven’t been immunized for tetanus or you have not received a booster shot within 5 years.
  • You got injured outdoors, and the wound has been in contact with soil.

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Tetanus

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Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.

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WHAT YOU NEED TO KNOW:

Tetanus is a disease caused by a bacterial infection. The bacteria are usually found in soil, dust, and the bowel movements of some animals and humans. The bacteria often enter the body through a puncture wound or burn. The bacteria produce a toxin that damages nerves. This causes severe muscle spasms. Left untreated, tetanus can be life-threatening.

What are the signs and symptoms of tetanus?

You may have stiff and weak muscles only in the area of the wound. This is called localized tetanus. Symptoms may go away without treatment, or they may spread. Infection that spreads is called generalized. You may develop any of the following within days or weeks of the infection:

  • Lockjaw (a muscle spasm in the jaw and neck that locks your jaw closed)
  • Muscle spasms that are severely painful, often triggered by noise, light, or touch
  • Rigid facial muscles, or raised eyebrows with lips pulled into a grin
  • Rigid abdomen, arm, and leg muscles
  • Trouble breathing or swallowing
  • Feeling restless or irritable, or a fast heartbeat or breathing
  • A headache or seizures
  • Sweating, trouble urinating, or a low fever

How is tetanus diagnosed and treated?

Your healthcare provider will examine your wound and ask about your symptoms. Tell him if the wound was not cleaned immediately or you saw dirt or other objects in the wound. No tests are available to check for tetanus. Your healthcare provider will look for certain signs or symptoms, such as lockjaw, to help diagnose tetanus. If the infection becomes generalized, you will need to be treated in a hospital. You will be kept in a dark, quiet room to prevent muscle spasms. You may also need the following:

  • Medicines may be given to stop or prevent seizures and muscle spasms. Antitoxin may also be given to stop the toxin from spreading in your body. Medicine may be given to fight a bacterial infection or to control pain. Your healthcare provider may also give you a dose of the tetanus vaccine.
  • Surgery may be used to remove tissue affected by tetanus. Debridement is a type of surgery used to clean a wound and remove dead tissue. Objects such as dirt or glass will also be removed.

What can I do to prevent tetanus?

  • Clean every wound immediately. Apply pressure to the wound to stop any bleeding. Clean the wound with soap and water. Remove dirt or other objects from the wound. Cover the wound with a clean bandage. Change the bandage every day and if it gets wet or dirty.
  • Talk to your healthcare provider about vaccines. A tetanus infection does not make you immune from another infection. The DTaP, Tdap, and Td vaccines help protect against tetanus. Your provider can recommend the vaccines that are right for you based on your age and health. The Td vaccine is usually given every 10 years. You will also need Td after a wound if you did not get a booster in the past 5 years. Pregnant women should get 1 dose of Tdap with each pregnancy, during weeks 27 to 36.

Call your local emergency number (911 in the US) if:

  • You have trouble breathing or swallowing.

Call your doctor if:

  • Your heartbeat is very fast or not regular.
  • You have muscle spasms in your face.
  • You start to feel muscle cramps or spasms near a wound.
  • You have a wound that is large or cannot be cleaned.
  • You have an open wound or a puncture wound.
  • You do not know if your tetanus vaccines are current.
  • You need a tetanus booster shot.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Symptoms and treatments

  • Tetanus

Mayo Clinic Reference

  • Tetanus

It is important that tetanus is treated quickly to prevent complications from developing.

There are two types of treatment for tetanus:

  • preventative treatment – for people who are thought to be fully or partially vaccinated against tetanus and who have an injury that makes them vulnerable to a tetanus infection
  • symptomatic treatment – for people who have developed the symptoms of an active tetanus infection

Preventative treatment

Wounds that are vulnerable to a tetanus infection are called tetanus-prone wounds.

Tetanus-prone wounds

Tetanus-prone wounds include:

  • wounds or burns that required surgery to repair, but access to surgery was delayed for six hours or more
  • wounds or burns that cause a significant amount of tissue loss
  • puncture injuries, particularly if they may have become contaminated with soil or manure
  • wounds that contain foreign bodies, such as an animal’s tooth
  • severe bone fractures that may have left the bones vulnerable to infection
  • wounds and burns in patients who have systemic sepsis (a fall in blood pressure as a result of a serious bacterial infection)

Medication called tetanus immunoglobulin (TIG) is recommended if you have a tetanus-prone wound and there is a high risk that it could be contaminated by tetanus bacteria. This might be the case if the wound came into contact with soil or animal waste.

The use of TIG is recommended even if your vaccinations are up to date. There may be a very small chance that the vaccine did not give you total immunity against tetanus.

Tetanus immunoglobulin

Tetanus immunoglobulin (TIG) is a medication that contains antibodies that kill the tetanus bacteria. Antibodies are infection-fighting cells. Tetanus immunoglobulin is given as an injection into a muscle and gives immediate, short-term protection against tetanus. It is thought to be safe to use in pregnant and breastfeeding women.

After having tetanus immunoglobulin, you are likely to have some short-term discomfort at the site of the injection. Other side effects are thought to be uncommon but may include:

  • chest pain
  • shortness of breath
  • dizziness
  • swelling of your face
  • mouth ulcers
  • shaking
  • joint pains

Speak to the doctor in charge of your care if you develop any of these side effects.

Depending on whether your vaccinations are up to date, you may also be given a booster dose of the tetanus vaccine.

Treating tetanus symptoms

If someone develops the symptoms of tetanus, they will need to be admitted to hospital.

The three main types of medication used to treat the symptoms of tetanus are:

  • sedatives
  • muscle relaxants
  • neuromuscular blocking agents (NBAs)

Sedatives

Sedatives are a type of medication that make you feel physically and mentally relaxed. They relax the muscles, which can help relieve and prevent muscle stiffness.

Side effects of sedatives include:

  • drowsiness
  • irritability
  • depression
  • shaky movements and an unsteady walk (ataxia)
  • hyperactivity
  • seeing or hearing things that are not real (hallucinations)

Muscle relaxants

Muscle relaxants are a type of medication that help relax the muscles. They are often used when treatment with sedatives is withdrawn (sedatives can be addictive so they are not usually recommended as a long-term treatment).

You will be given muscle relaxants to stop your symptoms returning when your dose of sedatives are reduced.

Neuromuscular blocking agents (NBAs)

Neuromuscular blocking agents (NBAs) are a type of medication that block nerve signals sent from the brain to the muscles. This leads to an inability to move certain muscles (paralysis), which can be useful in people with severe muscle spasms and stiffness.

A neuromuscular blocking agent called vecuronium is usually prescribed. Vecuronium causes paralysis of the muscles used for breathing, so assistance with breathing is provided before it can be given.

Preventing further spread of neurotoxins

Tetanus immunoglobulin can be used to prevent the tetanospasmin neurotoxin causing further damage and disruption to your nervous system. Antibiotics such as penicillin (or metronidazole if you are allergic to penicillin) are also used to try to kill any bacteria and prevent any further toxins being released.

Surgery

If a tetanus-prone wound is particularly large, it may be necessary to remove as much of the damaged and contaminated muscle as possible using a surgical procedure called debridement.

Debridement involves cleaning an open wound by removing foreign material, such as dirt and manure, as well as any dead tissue. In the case of a tetanus infection, debridement will remove any remaining tetanus bacteria.

Nutrition and breathing

The increased muscle activity caused by tetanus means that a person with the infection needs to consume a high amount of calories. An intake of 3,500 to 4,000 calories a day is often required, plus 150g of protein a day.

If swallowing is difficult or not possible, it may be necessary to give a liquid feed through a tube connected to the stomach or through a drip into a vein. Help with breathing may also be required using a ventilator (a machine that helps you breathe).

Medically reviewed by Drugs.com. Last updated on May 2, 2019.

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What Is It?

Tetanus, also called lockjaw, is a life-threatening infection caused by Clostridium tetani bacteria. Although these bacteria are especially common in the soil and manure of farms, they can be found almost anywhere. They live in the dirt of suburban gardens and in the dirty waters of floods. They also contaminate dust in cities.

Tetanus bacteria usually enter the body through a dirty puncture wound, cut, scrape or some other break in the skin. Once inside the skin, they multiply and produce a toxin, or poison, that affects the body’s nerves. This toxin causes severe muscle spasms, cramps and seizures. Spasms in the jaw muscles produce lockjaw. Spasms also occur in muscles of the throat, chest, abdomen and extremities. If you don’t receive proper treatment, the toxin’s effect on respiratory muscles can interfere with breathing. If this happens, you may die of suffocation.

A tetanus infection may develop after almost any type of skin injury, major or minor. This includes cuts, punctures, crush injuries, burns and animal bites. In rare cases, a tetanus infection also can occur after surgery, an ear infection, a dental infection or an abortion. Among drug users, tetanus infections have followed heroin injections, especially if the heroin was mixed with quinine. Tetanus also can develop after body piercing, tattooing, an insect sting or even a tiny splinter.

In the United States, only 50 cases of tetanus occur each year, because so many Americans have been immunized against the infection. Almost everyone who develops tetanus in the United States has been inadequately immunized against tetanus. Some have immigrated from developing countries where vaccines are not available to everyone. Others were born in the United States but never received the primary series of injections. Still others simply failed to keep up with the normal schedule of tetanus shots. This is a common problem among adults, especially those older than 60.

On average, symptoms of tetanus begin seven to eight days after tetanus bacteria enter the body. These symptoms may include:

  • Spasms in the jaw muscles (lockjaw)

  • Stiff muscles in the neck, shoulder and back

  • Difficulty swallowing

  • Prolonged contraction of the facial muscles, which may produce what looks like a sneer or grimace

  • An arched back resulting from contraction of the back muscles

  • Muscle spasms and muscle rigidity in the chest, abdomen and extremities

  • Fever and profuse sweating

  • High blood pressure

  • Rapid or irregular heartbeat

  • Seizures

  • Difficulty breathing

  • Fractured bones and ruptured muscles caused by severe muscle spasms

There is no laboratory test for tetanus. A doctor will diagnose tetanus based on your symptoms, a history of a recent cut or puncture wound, and immunization history.

Expected Duration

People who have tetanus must be treated in a hospital. Severe muscle spasms may last for about three to four weeks and then slowly get better. Once these spasms subside, recovery takes several months.

Immunization can prevent almost all cases of tetanus.

In the United States, babies are immunized against tetanus through a series of four vaccinations. This primary series is given in the form of DTaP shots. In addition to the vaccine for tetanus, each DTaP shot contains vaccines against diphtheria, which is a severe respiratory infection, and pertussis, also called whooping cough. The usual schedule for DTaP shots is as follows:

  • First shot: age 2 months

  • Second shot: age 4 months

  • Third shot: age 6 months

  • Fourth shot: age 15 to 18 months

Once the primary series of tetanus immunizations is complete, a child usually receives two tetanus booster shots. One is given between the ages of 4 and 6 years, just before the child starts school. The second is given between the ages of 11 and 12 years. Booster shots enhance (boost) a child’s level of tetanus immunity.

After age 12, a tetanus booster shot usually is recommended every 10 years. Under special circumstances, however, a doctor may give the booster dose sooner. For example, a tetanus booster is usually given if you get a severe cut or puncture wound and it has been more than 5 years since your last tetanus shot. This is because some people show a decrease in tetanus immunity within 5 to 10 years after the last tetanus booster.

In adults and children older than 7 who have never been immunized against tetanus, doctors use a primary series of Td shots. Once the primary Td series is finished, booster shots are usually given every 10 years. Because of the recent increase in pertussis cases, at least one of the shots should be a DTaP during adulthood.

All adults and children should receive routine tetanus immunizations. However, certain groups of people must be especially careful to keep their tetanus shots up to date. These people have jobs or hobbies that expose them to dirt, dust, manure or dirty water. Some examples include farm workers, landscapers, gardeners, firefighters and people who are exposed to sewage or flood water. Veterinary workers and people who deal with animal waste are also at high risk.

Doctors review a patient’s tetanus immunizations before surgery and before childbirth. All women of childbearing age should be immunized against tetanus. Newborns rely on their mother’s tetanus immunity to protect them from tetanus until their own DTaP shots begin. An infant who is not properly protected against tetanus can develop a tetanus infection even from having his or her umbilical cord cut.

Any wound should be cleaned well as soon as possible, especially if it is contaminated with dirt, to reduce the risk of infection with the bacteria that cause tetanus.

If you seek medical care for a wound, your doctor will ask you when you had your last tetanus shot. If your tetanus immunization is not up-to-date, the doctor will give you a tetanus booster. However, this booster shot will not produce immunity right away, so you may receive tetanus immune globulin as well. Tetanus immune globulin contains an antitoxin that neutralizes the tetanus toxin, temporarily protecting you until your immune system responds to the tetanus booster.

If you have full-blown tetanus, you will be treated in a hospital. There you will receive tetanus immune globulin to neutralize the tetanus toxin. Your muscle spasms will be treated with muscle relaxants, and you also may be sedated. If necessary, you will be placed on a ventilator to help you breathe. If you have an obvious wound infection, you will probably receive antibiotics as well. Once your condition begins to improve, you will begin a schedule of shots to restore your tetanus immunity, because a tetanus infection does not make you immune to the disease.

When To Call a Professional

Call your doctor immediately if you develop symptoms of tetanus. Also, seek medical care immediately for any deep cut, serious puncture wound or any wound contaminated by dirt or manure.

If you are an adult, check your immunization records for the date of your last tetanus shot. If it has been more than 10 years since your last tetanus booster, schedule an appointment with your doctor. Also contact your doctor if your health records show that you never received a full primary series of tetanus immunizations.

If you are a parent, be sure your child’s immunizations are all up-to-date. This is especially true for DTaP shots and other vaccines that are given in a series.

Prognosis

Most patients with tetanus survive and return to previous function. Older people and those who have a rapid progression from time of infection to severe symptoms have a higher risk of death.

  • Tetanus
  • Tetanus
  • Tetanus

External resources

Centers for Disease Control and Prevention (CDC)
National Immunization Program
NIP Public Inquiries
Mailstop E-05
1600 Clifton Road, NE
Atlanta, GA 30333
Toll-Free: 1-800-232-2522
TTY: 1-800-243-7889

National Network for Immunization Information
301 University Blvd.
CH 2.218
Galveston, TX 77555-0351
Phone: 409-772-0199
Fax: 409-747-4995

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Tetanus is an acute infectious disease caused by spores of the bacterium Clostridium tetani. The spores are found everywhere in the environment, particularly in soil, ash, intestinal tracts/feces of animals and humans, and on the surfaces of skin and rusty tools like nails, needles, barbed wire, etc. Being very resistant to heat and most antiseptics, the spores can survive for years.

Anyone can get tetanus, but the disease is particularly common and serious in newborn babies and pregnant women who have not been sufficiently immunized with tetanus-toxoid-containing vaccines. Tetanus during pregnancy or within 6 weeks of the end of pregnancy is called “maternal tetanus”, and tetanus within the first 28 days of life is called “neonatal tetanus”.

The disease remains an important public health problem in many parts of the world, but especially in low-income countries or districts, where immunization coverage is low, and unclean birth practices are common. Neonatal tetanus occurs when nonsterile instruments are used to cut the umbilical cord or when contaminated material is used to cover the umbilical stump. Deliveries carried out by people with unclean hands or on a contaminated surface are also risk factors.

In 2015, approximately 34 000 newborns died from neonatal tetanus, a 96% reduction from 1988 when an estimated 787 000 newborn babies died of tetanus within their first month of life. However, there is increased risk of tetanus in adolescent and adult males who undergo circumcision due to waning immunity and limited opportunity for receiving booster doses in males in many countries.

Symptoms and Diagnosis

The incubation period of tetanus varies between 3 to 21 days after infection. Most cases occur within 14 days.

Symptoms can include:

  • jaw cramping or the inability to open the mouth
  • muscle spasms often in the back, abdomen and extremities
  • sudden painful muscle spasms often triggered by sudden noises
  • trouble swallowing
  • seizures
  • headache
  • fever and sweating
  • changes in blood pressure or fast heart rate.

In neonatal tetanus, symptoms include muscle spasms, which are often preceded by the newborn’s inability to suck or breastfeed, and excessive crying.

Tetanus is diagnosed on the basis of clinical features and does not require laboratory confirmation. The WHO definition of a confirmed neonatal tetanus case is an illness occurring in an infant who has the normal ability to suck and cry in the first 2 days of life, but who loses this ability between days 3 and 28 of life and becomes rigid or has spasms.

The WHO definition of non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning, or painful muscular contractions. Although this definition requires a history of injury or wound, tetanus may also occur in patients who are unable to recall a specific wound or injury.

Tetanus is a medical emergency requiring:

  • care in the hospital
  • immediate treatment with medicine called human tetanus immune globulin (TIG)
  • aggressive wound care
  • drugs to control muscle spasms
  • antibiotics
  • tetanus vaccination.

People who recover from tetanus do not have natural immunity and can be infected again, and therefore need to be immunized.

Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV), which are included in routine immunization programmes globally and administered during antenatal care contacts.

To be protected throughout life, WHO recommends that an individual receives 6 doses (3 primary plus 3 booster doses) of TTCV. The 3-dose primary series should begin as early as 6 weeks of age, with subsequent doses given with a minimum interval of 4 weeks between doses. The 3 booster doses should preferably be given during the second year of life (12–23 months), at 4–7 years of age, and at 9–15 years of age. Ideally, there should be at least 4 years between booster doses.

There are many kinds of vaccines used to protect against tetanus, all of which are combined with vaccines for other diseases:

  • Diphtheria and tetanus (DT) vaccines
  • Diphtheria, tetanus, and pertussis (whooping cough) (DTaP) vaccines
  • Tetanus and diphtheria (Td) vaccines
  • Tetanus, diphtheria, and pertussis (Tdap) vaccines

Neonatal tetanus can be prevented by immunizing women of reproductive age with TTCV, either during pregnancy or outside of pregnancy. Additionally, robust medical practices can also prevent tetanus disease including clean delivery and cord care during childbirth, and proper wound care for surgical and dental procedures.

In countries where national programmes have maintained high immunization coverage for several decades, tetanus incidence rates are very low.

WHO Response

The global neonatal tetanus elimination goal was launched at the World Health Assembly in 1989 to reduce neonatal tetanus as a public health problem (defined as less than one case of neonatal tetanus per 1000 live births in every district) in all countries.

The Maternal and Neonatal Tetanus Elimination (MNTE) Initiative was launched by UNICEF, WHO and the United Nations Population Fund (UNFPA) in 1999, revitalizing the goal of MNTE as a public health problem.

As of April 2018, there are 14 countries that have not achieved MNTE.

Once MNTE has been achieved, maintaining elimination will require continued strengthening of routine immunization activities for both pregnant women and children, maintaining and increasing access to clean deliveries, reliable neonatal tetanus surveillance, and introduction and/or strengthening of school-based immunization, where feasible.

To sustain MNTE and protect all persons from tetanus, WHO recommends that 6 doses of tetanus-containing vaccine be given to all persons from childhood to adolescence.

Tetanus (Lockjaw)

Tetanus, commonly called lockjaw, is a bacterial disease that affects the nervous system. It is contracted through cuts or wounds that become contaminated with tetanus bacteria. The bacteria can get in through deep puncture wounds or cuts like those made by nails or knives, but even a scratch can provide an entryway. Tetanus bacteria are present worldwide and are commonly found in soil and most surfaces. The infection causes severe muscle spasms, leading to “locking” of the jaw, making it hard to open the mouth or swallow. In severe cases, tetanus infections can lead to death by suffocation.

Tetanus is a vaccine-preventable disease that is not transmitted from person to person.

Common initial symptoms of tetanus are a headache and muscular stiffness in the jaw (lockjaw) followed by stiffness of the neck, difficulty swallowing, hardening of abdominal muscles, spasms, sweating, and fever. Symptoms usually begin around eight days following infection, but onset may range from three days to three weeks.

Vaccination is the best way to prevent tetanus. Due to widespread immunization, tetanus is a rare disease in the US. Most people receive their first dose as children in the form of a combined vaccine called DTaP (diphtheria-tetanus-acellular pertussis). Health officials now recommend that adults and adolescents receive a Tdap (tetanus-diphtheria-acellular pertussis) or Td (tetanus-diphtheria) booster vaccine every 10 years.

Fact: Tetanus can be prevented with a safe and effective vaccine.

Fact: People with tetanus may have to spend several weeks in the hospital under intensive care.

Fact: Tetanus is not transmitted from one person to another.

Fact: Recovery from tetanus illness may not result in lifelong immunity. Another infection could occur unless immunization is provided soon after the person’s condition has stabilized.

Additional Resources

Information about the diseases that Tdap vaccine protects against

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