Tetanus is caused by the bacterium Clostridium tetani, which is found in all soils. This bacterium becomes infected when soil enters a wound or cut.
The bacterium’s toxin causes severe, painful muscle spasms that can lead to death.
Tetanus (in newborns) and maternal tetanus (in mothers) are serious problems in areas where home deliveries are common without sterile procedures.
How is tetanus spread?
Tetanus is not transmitted from person to person. In people of all ages, the bacterium can enter a wound or cut from items such as dirty nails, knives, tools, wood splinters, dirty tools used during childbirth, or deep puncture wounds from animal bites.
It grows well in deep wounds, burns and crush injuries.
In newborn babies, infection can occur when delivery occurs on dirty mats or floors, a dirty tool is used to cut the umbilical cord, dirty material is used to dress the cord or when the hands of the person delivering the baby are not clean.
Infants and children may also contract tetanus when dirty tools are used for circumcision, scarification and skin piercing, and when dirt, charcoal or other unclean substances are rubbed into a wound.
What are the symptoms and signs of tetanus?
The incubation period (time between getting infected and showing symptoms) is usually three to 21 days, but can be as much as several months depending on the wound.
The risk of death from the disease increases as the incubation period decreases.
In children and adults, muscular stiffness in the jaw (trismus or lock-jaw) is a common first sign of tetanus.
This is followed by stiffness in the neck, abdomen and/or back, difficulty swallowing, muscle spasms, sweating and fever.
Newborns with tetanus are normal at birth but stop feeding at three to 28 days of age. They then become stiff and severe muscle spasms occur.
What are the complications of tetanus?
When muscles used in breathing are affected, respiratory failure and death can occur.
Neonates and elderly patients are at highest risk. Pneumonia is also common. Fractures of the spine or other bones may occur as a result of muscle spasms and convulsions.
Long-term neurologic impairment has been described in survivors of neonatal tetanus.
What is the treatment for tetanus?
Tetanus at any age is a medical emergency best managed in a referral hospital. Antitetanus immunoglobulins, antibiotics, wound care and supportive measures are needed.
How is tetanus prevented?
Tetanus toxoid-containing (TTCV) vaccine protects against tetanus.
Infants and children may receive combination vaccines, such as DTP, pentavalent (DTP+HepB+Hib) or DT.
Anyone older than seven years of age should receive dT, which contains tetanus toxoid and lower levels of diphtheria antigen.
Neonatal tetanus can be prevented by immunizing women of reproductive age with tetanus toxoid, either during or before pregnancy.
Clean delivery procedures are needed even when the mother has been immunized.
Clean umbilical cord care for the newborn is equally important.
People who recover from tetanus do not have natural immunity and can be infected again.
WHO recommends completion of a six-dose schedule.