Tetanus

Minor Cuts and Scrapes

          With the approach of summer many of us are already looking forward to all the outdoor activities available during this warm weather period.  Whether you enjoy hiking, camping, swimming, fishing, gardening, sports or what-have-you, minor cuts and scrapes are an inevitable part of summer fun.  Cuts, scrapes, burns and even insect bites are exactly how the spores of the bacterium Clostridium tetani enter the body.  The spores are present in soil and in the intestines and feces of some animals and can contaminate objects such as the proverbial ‘rusty nail’.  Spores can remain infectious in the soil for more than forty years. 

Symptoms of Tetanus

          The spores enter the body when a contaminated object punctures the skin and if they are deposited deep enough in the tissue where oxygen is not available, they can germinate, producing a powerful exotoxin (tetanospasm).  This toxin can spread throughout the body in the blood stream.  Its effect on the central nervous system produces a spasm or rigidity which begins in the head and neck and may progress to the abdominal muscles and eventually inhibit the ability to breathe.  Symptoms begin from three days to three weeks (average ten days) after the spores enter the body.  Because the jaw muscles are often the first to manifest the spasm, the condition is frequently referred to as ‘lockjaw’.  While tetanus is often fatal, it cannot be spread from one person to another. 

Still a Major Health Problem

          Fortunately, disease and deaths throughout the world due to tetanus have declined dramatically since the advent of tetanus toxoid vaccines.  Nevertheless, neonatal and maternal tetanus are still a major concern in some parts of the world, particularly Asia and Africa.  Maternal tetanus can occur during an abortion, miscarriage or delivery under unsterile conditions in an unimmunized mother.  Neonatal tetanus can occur in an infant when the umbilical cord is cut under unsterile conditions and the mother is not immunized.  It is estimated that more than 55,000 infants die each year from neonatal tetanus.  Tetanus has become rare in the United States, where fewer than 50 cases are reported each year.  Older adults are more likely to die from tetanus and a majority of adults over 70 years old are not adequately immunized.

Preventable with Vaccine

          Tetanus toxoid was first produced in 1924 and was successfully used to prevent tetanus during World War II.  Current vaccines are composed of deactivated tetanus toxins and are usually combined with diphtheria and pertussis vaccines.  The recommended schedule for children is to receive the vaccine at 2, 4 and 6 months of age with a fourth dose given at 15 to 18 months of age and a fifth dose between four and six years of age.  To maintain adequate immunity a booster dose must be given every ten years throughout life.