Know when You Need a Tetanus Shot

Many people are familiar with the tetanus shot, but do you know when you should get the vaccine? Cases of tetanus in the U. S. and the rest of the developed world are rare due to high rates of vaccination. Vaccination is important, since there is no cure for tetanus, a disease caused by a bacterial toxin found in the soil, dirt, and animal feces. This toxic bacteria forms spores that are very difficult to kill since they are resistant to heat and many drugs and chemicals. Tetanus affects the nervous system and causes painful muscle contractions, particularly of the jaw and neck muscles. It can also hinder breathing, making it potentially deadly. For these reasons, it's important to understand when you should be vaccinated.

Steps

Knowing When to Get a Tetanus Shot

  1. Get a tetanus booster shot after certain injuries. Usually, the bacterial toxins enter the body through a break in the skin caused by an object contaminated with tetanus. If you have one or more of the following injuries or wounds that are prone to tetanus, you should get a tetanus booster shot. These include:
    • Any wound visibly contaminated with soil, dust, or horse manure.
    • Puncture wounds. Objects that can cause these types of wounds include wood splinters, nails, needles, glass, and human or animal bites.[1]
    • Skin burns. Second degree (partial-thickness or with blisters) and third degree (full-thickness) burns are at higher risk for infection than first degree (superficial) burns.[2]
    • Crush injuries that damage tissue by squeezing it between two heavy objects. They can also happen when heavy objects are dropped onto parts of the body.[3][4]
    • Wounds involving necrotic, or dead, tissue. This kind of tissue has no blood supply, increasing its risk for infection (along with severely compromised tissue). For example, areas of gangrene (dead body tissue) are at increased risk for infection.[1]
    • Wounds with foreign objects in them. Wounds that have foreign bodies, such as splinters, glass shards, gravel, or other objects in them are at higher risk for infection.[5]
  2. Know if it's time to get your tetanus shot. If you never received the first series of tetanus shots (primary vaccination series) or you're not sure when you had your last tetanus shot, you should go get a tetanus shot. If you've been injured, you may be wondering whether you need to get a tetanus booster shot. You will need a tetanus booster shot if:[6]
    • Your wound was caused by a “clean” object, but your last tetanus shot was over 10 years ago.
    • Your wound was caused by a “dirty” object and your last tetanus shot more than 5 years ago.
    • You're not sure if the wound was caused by a “clean” or “dirty” object and your last tetanus shot was over 5 years ago.
  3. Get the shot while pregnant. In order to help transfer tetanus antibodies to your baby, you should get a tetanus vaccine when you are between 27-36 weeks pregnant.[7]
    • Your doctor will likely recommend the inactivated Tdap (Tetanus, Diptheria and Pertussis) vaccine during the third trimester of your pregnancy.[8]
    • If you have not had the Tdap vaccine before and don't have it during pregnancy, you should get vaccinated immediately after giving birth.[9]
    • If you get a dirty cut or wound while pregnant, you will likely need to get a tetanus booster shot.
  4. Become immunized. The best way to "treat" tetanus is to prevent it in the first place. Most people don't experience serious reactions to the vaccine, but there are a few common mild reactions. These include localized swelling, tenderness, and redness at the injection site, but these often clear up in 1-2 days.[10] Don't worry about getting an extra tetanus booster. There's usually no problem if you don't wait the 10 years in between shots before getting the shot. There are several vaccines that protect against tetanus. They are:[11]
    • DTaP. The diphtheria, tetanus, and pertussis (whooping cough) vaccine (DTaP) are usually given to babies at ages 2, 4, and 6 months, and again at 15 to 18 months old. DTap is a very effective vaccine for small children. Kids will need another booster between ages 4 and 6.
    • Tdap. Over time, protection from tetanus decreases, so older children need to get a booster shot. It has a full dose of tetanus and lower amounts of diphtheria and pertussis. All people between the ages of 11 and 18 are advised to get the booster, preferably around 11 or 12 years old.
    • Td. If you're an adult, get a Td (tetanus and diphtheria) booster shot every 10 years to stay protected. Since some people may lose the protective antibody levels after 5 years, a booster vaccination is recommended if you get a deep, contaminated wound and haven't had a vaccination in more than 5 years.[10]

Learning About and Recognizing Tetanus

  1. Learn who is likely to get tetanus and how it's spread. Nearly all cases of tetanus occur in people who have never gotten the tetanus vaccine, or adults who don’t stay up to date with their 10-year boosters.[1] The disease is not spread from person to person though, which makes it very different from other vaccine-preventable diseases.[12] Instead, it's spread by bacterial spores that usually enter the body through a puncture. These make a powerful neurotoxin that causes muscle spasms and stiffness.
    • Complications from tetanus are highest among people who have not been immunized or in older adults with inadequate immunization in industrialized countries.[13]
    • You may also be at increased risk of tetanus after a natural disaster, especially if you live in a developing country.[14]
  2. Reduce your risk for tetanus. As soon as you get an injury or wound, clean and disinfect it. If you delay disinfecting the new wounds by more than 4 hours, you increase the chances of tetanus infection.[15] This is even more important if the wound was caused by an object that punctured the skin, which can force bacteria and debris deep into the wound, making it an ideal environment for the growth of bacteria.
    • Pay attention to whether the object that caused your wound is clean or dirty to decide whether you need a tetanus booster. A dirty, or contaminated, object has dirt/soil, saliva, or feces/manure on it, while a clean object does not. Remember that you can't necessarily know if an object has bacteria on it.
  3. Be aware of developing symptoms. The incubation period for tetanus varies from 3 to 21 days, with an average of 8 days. Tetanus severity is determined by a graded scale from I through IV. The longer it takes symptoms to appear, the more mild the disease is likely to be.[16] Common symptoms of tetanus (in order of appearance) include:[12]
    • Spasm of jaw muscles (commonly referred to as “lockjaw”)
    • Stiffness of the neck
    • Difficulty swallowing (dysphagia)
    • Board-like rigidity of the abdominal muscles
  4. Recognize other symptoms of tetanus. The diagnosis of tetanus relies solely on recognizing its symptoms. There are no blood tests that can diagnosis tetanus, so it's important to pay attention to any symptoms. You may also notice fever, sweating, elevated blood pressure, or rapid heart rate (tachycardia).[13] Understand possible complications, including:[12][1]
    • Laryngospasm, or spasm of the vocal cords, which can make breathing difficult
    • Bone fractures
    • Seizures/convulsions
    • Abnormal heart rhythms
    • Secondary infections, such as pneumonia, as a result of prolonged hospitalization
    • Pulmonary embolism, or blood clots in the lungs
    • Death (10% of reported cases are fatal)

Treating Tetanus

  1. Get medical attention. If you think or even suspect you have tetanus, seek medical treatment immediately. It's a medical emergency and you'll need to be hospitalized, because tetanus has a high mortality, or death, rate (10%). In the hospital, you'll be given a tetanus antitoxin, like tetanus immune globulin. This will neutralize any toxin that hasn't already bound to your nervous tissue. The wound will be thoroughly cleaned and you'll get a tetanus vaccine to prevent future infections.[12][13][1]
    • Being infected with tetanus does not give you immunity from future infection. Instead, you'll need to get the tetanus vaccine to keep from getting it again.
  2. Have a doctor determine your course of treatment. There are no blood tests that can diagnosis tetanus. So, lab testing is not useful in the evaluation for disease. Because of this, most doctors do not take a wait and see approach, but instead opt for aggressive treatment if infection is suspected.
    • Doctors will base their diagnosis mainly on the symptoms and clinical signs that are present. The more severe the symptoms, the more rapid the course of action.
  3. Treat the symptoms of tetanus. Since there is no cure for tetanus, treatments are directed at symptoms and emerging complications. You'll be given antibiotics intravenously, by injection, or orally and you'll also get drugs to control muscle spasms.
    • Some of the drugs to control muscle spasms include sedatives from the benzodiazepine group (like diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), and midazolam (Versed). [12][13][1]
    • Antibiotics are not generally effective against tetanus, but they may be prescribed to keep the Clostridium tetani bacteria from reproducing. This can help slow the production of toxins.[17]

Tips

  • There are tetanus vaccines that can also protect against Diphtheria and Pertussis (Tdap) or only Diphtheria (Td). Both vaccines last 10 years.
  • The date of your last tetanus booster should be found in your immunization records at your doctor's office. Some people carry a personalized card verifying their dates of immunization, which you can get from your doctor.
  • If you're at risk for infection, make sure you understand the signs and resulting complications of tetanus. Spasms can become so severe that they may interfere with normal breathing. Convulsions that become so severe that they lead to breakage of the spine or long bones.
  • Better safe than sorry—if you're particularly worried about being infected with tetanus, just get the vaccination.
  • A couple of rare diseases can cause similar symptoms to tetanus. Malignant hyperthermia is an inherited disease that causes a rapid onset of fever and severe muscle contractions when you have general anesthesia.[18] Stiff Person Syndrome is an extremely rare disease of the nervous system that causes periodic muscle spasms. Symptoms usually begin in your mid-40s.[19]

Warnings

  • Seek medical attention for any serious wounds or injuries. If you suspect that you have been infected with the tetanus bacteria, do not wait for symptoms to become present before getting proper treatment. There is no cure for tetanus, only treatment of symptoms until they resolve.


Related Articles

Sources and Citations

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 http://www.cdc.gov/tetanus/about/index.html
  2. ↑ http://www.ncbi.nlm.nih.gov/books/NBK6970/
  3. ↑ http://www.emsworld.com/article/10331311/soft-tissue-injuries-crush-injury-and-compartment-syndrome
  4. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/000024.htm
  5. ↑ http://www.aafp.org/afp/2007/0901/p683.html
  6. ↑ http://www.emedicinehealth.com/preventing_tetanus_infections-health/article_em.htm
  7. ↑ http://www.cdc.gov/vaccines/pubs/preg-guide.htm
  8. ↑ http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html
  9. ↑ CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR 2013; 62 (07):131-5.
  10. ↑ 10.0 10.1 http://www.medicinenet.com/script/main/art.asp?articlekey=47225&page=2
  11. ↑ http://www.cdc.gov/features/tetanus/
  12. ↑ 12.0 12.1 12.2 12.3 12.4 http://www.immunize.org/catg.d/p4220.pdf
  13. ↑ 13.0 13.1 13.2 13.3 http://www.mayoclinic.org/diseases-conditions/tetanus/basics/definition/con-20021956
  14. ↑ http://www.ncbi.nlm.nih.gov/pubmed/21357910
  15. ↑ http://www.rch.org.au/clinicalguide/guideline_index/Management_of_tetanusprone_wounds/
  16. ↑ http://www.scielo.br/pdf/bjmbr/v39n10/6200.pdf
  17. ↑ http://emedicine.medscape.com/article/229594-medication
  18. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/001315.htm
  19. ↑ http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/neuroimmunology_and_neurological_infections/conditions/stiff_person_syndrome.html
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