TETANUS

Key facts

Tetanus is a serious, life-threatening condition caused by bacteria getting into a wound
The bacteria that causes tetanus, Clostridium tetani, is found in the environment, particularly in soil, saliva, dust and manure
Tetanus cannot be transmitted from person to person
Vaccines are the best way to protect against tetanus
Infection leads to painful muscle contractions, particularly in the jaw and neck – hence the old name, lockjaw

Overview

Tetanus is an infectious disease caused by spores of the bacterium Clostridium tetani. These spores are found in soil, ash, and the intestinal tracts and faeces of animals and humans. They can also be found on skin and rusty tools. The spores are very resistant to heat and most antiseptics, and can survive for years.

Tetanus is uncommon, but very serious, and requires immediate hospital treatment. Anyone can get tetanus; however, the disease is especially serious in newborn babies and pregnant women who have not been vaccinated. The disease remains an important public health problem in many parts of the world, especially in countries where immunisation coverage is low.

Signs and symptoms

Symptoms of tetanus usually start around 4 to 21 days after infection, with most people getting symptoms after about 10 days. Most cases occur within 14 days. The first sign is usually spasms of the jaw muscles, commonly known as lockjaw.

Symptoms include:

A stiff jaw (lockjaw), which can make opening the mouth difficult.
Painful muscle spasms
Difficulty breathing.
Difficulty swallowing
High temperature
A rapid heartbeat
Seizures.
Headache
Changes in blood pressure

In neonatal tetanus, symptoms include muscle spasms, and the baby may have trouble feeding and cry excessively

Dangers and complications

Tetanus can cause serious health problems, including laryngospasm (uncontrolled tightening of the vocal cords). It can also lead to fractures, pulmonary embolism, lung infection from inhaling spit or vomit and breathing difficulties. Tetanus can be fatal.

Transmission

Tetanus is acquired through the infection of a cut or wound with the spores of the bacterium Clostridium tetani. Tetanus bacteria can get into someone’s body through broken skin, usually through injuries. There is a risk of tetanus if soil or manure containing bacteria gets into a wound, such as a bite, burn or scratch. Neonatal tetanus occurs during childbirth if dirty instruments are used or babies are delivered by people with dirty hands. Tetanus is not transmitted from person to person.

Treatment

Tetanus is a medical emergency requiring immediate hospital treatment. Treatments for tetanus include cleaning the wound to remove any dirt, soil, or dead tissue. An injection of tetanus immunoglobulin is also a key part of treatment. Other medicines, such as antibiotics and medicines to help control painful muscle spasms and stiffness may be given. Some individuals may need help with breathing.

In the UK tetanus is incredibly rare thanks to the success of the vaccination programme – there were just five cases of the disease in 2023. If you were born before 1961, when routine tetanus immunisation was introduced in the UK, you may need a tetanus vaccination.

Prevention

The best way to avoid getting tetanus is to ensure you are fully vaccinated against it. In the UK babies get a dose at eight, 12 and 16 weeks and another just before starting school. Another dose is given at age 14.

Tetanus vaccinations may be recommended before travelling to an area where it may be difficult to get medical help quickly. Immediate and good wound care can also help prevent infection. This includes applying first aid to even minor, non-infected wounds, and washing hands with soap and water or using an alcohol-based hand rub.

History

Cases of tetanus were first described by Hippocrates in the 5th century BC, but the bacteria that causes it was not discovered until the end of the 19th century. In 1924, the first vaccine for tetanus was developed.

The World Health Organization pledged to eliminate neonatal tetanus in 1989 and stepped up its vaccination drive 10 years later. In 2000 an estimated 787,000 babies died from tetanus within their first month of life compared to approximately 25,000 in 2018 (the last year for which figures are available).