Tetanus

About tetanus

Tetanus is a condition caused by infection of a type of bacterium called Clostridium tetani, which usually enters your body through a wound. The bacteria produce a toxin that affects your nervous system. This toxin causes your muscles to repeatedly contract and go into spasm.

In the UK, there is a national immunisation programme to protect you against tetanus. Because of this, tetanus is rare in the UK – less than 10 people get it each year.

Symptoms of tetanus

Tetanus infection may result in several different patterns of illness.

Generalised tetanus

This is the most common type of tetanus and can be life-threatening. You may be infected with the tetanus bacteria for between three and 21 days before having symptoms. The symptoms (once they appear) may include:

  • jaw muscle spasms or stiffness (lockjaw)
  • muscle stiffness or pain, which usually starts in your neck, shoulders and back
  • spasms or convulsions of your body (that can last for up to two weeks), which may be painful and can affect your breathing or digestion
  • fever
  • sweating
  • difficulty swallowing and breathing
  • headache

With intensive medical support, eight to nine out of 10 people survive.

Localised tetanus

If you have localised tetanus, bacteria only affect the muscles near the wound where they entered your body. This causes your muscles to go hard and you may have painful spasms. Localised tetanus is rare. It can be treated and isn't usually life-threatening.

Cephalic tetanus

This is another rare form of tetanus. It’s most common in children and affects people who have had a head injury or an ear infection. Cephalic tetanus affects the nerves that run from your brain to other parts of your body and may cause paralysis of parts of your face. Cephalic tetanus may develop into generalised tetanus and can be life-threatening.

Neonatal tetanus

This affects newborn babies in less developed countries, particularly in Asia and Africa, and is often fatal. The symptoms are similar to generalised tetanus and occur within two weeks of birth. Babies with neonatal tetanus may:

  • not feed well and not put on weight
  • appear stiff or rigid
  • have spasms

Complications of tetanus

Without treatment tetanus is usually fatal, but people can survive with intensive medical therapy. The spasms or convulsions may be violent and you can stop breathing or have a heart attack. Other complications of tetanus include:

  • pneumonia and other infections
  • fractures – broken bones caused by spasms or convulsions
  • abnormal heart rhythm
  • coma

Causes of tetanus

Tetanus is caused by a toxin produced by a bacterium called C. tetani, which is found in soil and animal faeces. It can cause a tetanus infection if it enters your body through a wound or a cut. You’re most likely to develop an infection if you have a wound that was caused by something dirty, such as a knife or nail, or an animal bite. Babies can get neonatal tetanus via a healing umbilical stump that hasn't been cleaned properly or that has been cut with an instrument that isn't sterile.

Most people who get tetanus haven't been immunised, or haven't had their tetanus booster. If you haven't been immunised or you haven't had your booster, you can get tetanus if:

  • you have a wound and it becomes infected – this may be minor such as a scratch or cut, or you may have had a piercing
  • you inject drugs or medicines using a needle that isn't sterile and has tetanus bacteria on it

Tetanus can’t be passed from person to person.

Diagnosis of tetanus

If you have had a wound as described above, you should seek urgent medical attention. If you have a recent wound and muscle stiffness or spasms, starting near the wound and progressing elsewhere, this could indicate the initial symptoms of tetanus and you will need immediate medical attention.

The diagnosis of tetanus is usually based on the characteristic symptoms and signs. It may be confirmed by taking a blood test that looks for traces of the toxin in your blood.

Treatment of tetanus

Your doctor will clean your wound thoroughly, and any dead tissue will be removed to help prevent further infection. You will be given an injection, which will work against the toxins produced by the bacteria that cause tetanus. You will also be given intravenous antibiotics to treat the infection and medicines called muscle relaxants, such as diazepam or lorazepam, if you're having muscle spasms.

You will usually need to stay in an intensive care unit (ICU) in hospital and will be linked to a heart monitor and may need to be put on a ventilator to give you help with breathing. If you're having trouble swallowing, you may need to be fed through a tube that will be put through your nose and into your stomach, or you may be given liquid nutrition through a drip.

Prevention of tetanus

In the UK, there is an immunisation programme in place to prevent tetanus. You need five separate injections to be fully protected. In the UK, the first three doses are usually given to babies when they are two, three and four months old. The tetanus vaccine is combined with the diphtheria, whooping cough (pertussis) and polio vaccines. Children then have a booster when they are between three and five, and another one around 10 years later.

If you weren't immunised as a child, you can start the course of injections at any age. And if you are a woman, you can have the vaccine while you're pregnant.

If you have a wound with any dirt in it, seek medical advice. If you have a cut or weeping wound, such as a burn, you may need a booster dose of tetanus vaccine as a precaution. You may also be given a dose of tetanus immunoglobulin which is a protein (antibody) to help your body fight any tetanus infection you might develop. Ask your doctor for more advice.

Animation - How bacterial vaccines work

I think I may have missed my tetanus booster injection. What should I do?

Answer

If you have missed your booster for tetanus, you should book an appointment with the nurse at your GP practice as soon as you can to get it.

Explanation

You should have five tetanus vaccines in total to provide you with complete protection. By ensuring you have all your booster injections, you can stop yourself getting tetanus. If you're unsure, your GP practice may have a record of your last injection. It's useful to keep a note of the injections you have so you're aware of when you need a booster.

Will I have a reaction to the tetanus vaccine?

Answer

Some people may have a reaction to the tetanus vaccine.

Explanation

You may have pain, swelling or redness in the area where you have had the injection. Sometimes there may be a small lump that goes hard, but this isn't painful.

Occasionally, some people have a fever, convulsions, develop pale or bluish skin, go limp or have an allergic reaction to the vaccine. Ask your GP to explain these risks to you.

Very rarely some people may have an anaphylactic reaction to the vaccine. This is when your body has a severe allergic reaction to the vaccine. It means you have problems breathing and your blood pressure drops. If you're concerned or have had a reaction to a vaccine before, ask your GP for advice.

I am travelling to an area where there is tetanus. Do I need to have the injection if I have had my regular boosters?

Answer

If you have already had all five doses of the vaccine, you usually won't need any more. However, if you're travelling somewhere where you may not have access to medical treatment, you may need to have a booster.

Explanation

If you have had five doses of the tetanus vaccine, you should be protected against tetanus for life. However, depending on where you're travelling to, you may need to have a booster vaccine even if you have already had the five doses. If you're travelling somewhere where medical attention may not be accessible, and haven't had a booster for the past 10 years, you may need to have one before you go. This is in case you get a wound that could become infected with tetanus, but medical treatment isn't available.

Contact your GP to find out whether you will need a booster before you travel.