Tag: tetanus

Tetanus and Tetanus Shots

Tetanus is a vaccine-preventable disease that is caused by the Clostridium tetani bacteria.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Unlike most other infections though, tetanus isn’t contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.

The now “awake” Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.

In the pre-vaccine era, there were about 500 to 600 cases of tetanus in the US each year and about 165 deaths.

Fortunately, tetanus is rare now, as most folks are vaccinated, but we do see some cases in kids who are intentionally not vaccinated or in seniors who haven’t gotten a tetanus booster in a long while.

The unvaccinated child with the toe nail injury?

“A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration… Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection… The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.”

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

He was unvaccinated “based on religious grounds” and had recently injured his toe, resulting “in a small local hematoma and loose toenail.” It also resulted in his getting tetanus and a 30 day stay in the hospital.

What Are the Symptoms of Tetanus?

Unvaccinated children can develop symptoms of tetanus two days to two months (average incubation period is two weeks) after getting a wound that is contaminated by tetanus spores.

“It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked.”

Linda Williams on her unvaccinated 7-year-old son’s bout of tetanus

The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:

  • spasms of the muscles around their mouth, giving the typical “lockjaw” appearance of tetanus
  • spasms of the muscles around the throat, which can make it hard to swallow
  • spasms of the chest muscles, making it difficult to breath
  • spasms of the muscles in the neck, back, arms, legs, and abdomen

Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.

How Do You Diagnose Tetanus?

Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.

It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail – a classic myth about tetanus.

Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.

Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to do.

Neonatal tetanus can occur in newborns if their mother isn’t immunized against tetanus and their umbilical cord stump gets contaminated.

How Do You Treat Tetanus?

The treatments for tetanus can include sedation and mechanical ventilation and:

  • human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
  • antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
  • muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
  • neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis

If you have ever read a story about a child who has needed treatment for tetanus, you will likely opt for a tetanus shot instead.

Do I Need a Tetanus Shot?

Like other vaccine-preventable diseases, keeping up-to-date on your child’s immunizations can help to prevent your child from ever getting tetanus.

One thing that complicates tetanus is that your child may still need a tetanus shot, even if they are fully vaccinated, if it has been five or more years since his last tetanus shot and he has:

  • a wound that is contaminated with dirt, feces, or saliva
  • a puncture wound
  • an avulsion wound, in which part of the wound is pulled away from the other part
  • a wound caused by crush injury, burn, or frostbite

So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).

And yes, a tetanus shot will work in these situations, even if you have already been exposed to the tetanus spores. But no, letting a wound bleed a lot won’t flush out the spores. These are other myths about tetanus and tetanus shots that you might hear.

What to Know About Tetanus and Tetanus Shots

See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.

More About Tetanus and Tetanus Shots

5 Myths About Tetanus and Tetanus Shots

Think you know everything you need to know about tetanus and tetanus shots to make an informed decision about getting vaccinated?

Unfortunately, there is a lot of misinformation out there about tetanus that can scare you away from getting a tetanus shot or make you think that you don’t really need one.

You can only get tetanus from a rusty nail. (False)

Would a rose smell as sweet if you pricked your finger on a thorn and got tetanus?
Would a rose smell as sweet if you pricked your finger on a thorn and got tetanus? Photo by Cherrie Mio Rhodes. (CC BY 2.0)

Tetanus is caused by the Clostridium tetani bacteria.

Unlike most other vaccine-preventive diseases, tetanus is not contagious. Instead, you can get tetanus after being exposed to tetanus spores in dust, soil, and feces, which then grow and make a powerful neurotoxin. Tetanus spores can even be found in the mouth of many animals.

So why does everyone associate tetanus with rusty nails?

We likely think that an old, rusty nail  is more likely to be contaminated with tetanus spores simply because it has been outside for a long time. Especially as compared to a brand new one that you just took out of a box.

But tetanus is not just about nails.

You can get tetanus after a cat or dog bite, a burn, frostbite, a tractor falling on your leg (crush injury), or falling into a rose bush (puncture wounds from thorns), etc. Almost anything that can cause a non-superficial wound can cause tetanus, especially if the wound is contaminated with dirt, feces, or saliva.

A tetanus shot won’t help after you have already been cut, stabbed, or bitten. (False)

The reason we give the shot is because the tetanus spores take time to germinate.

We are not worried about tetanus bacteria on a rusty nail, cat teeth, rose bush, or on ones very dirty hands through which a clean knife went through.

It’s the tetanus spores on those things and everywhere else, because they are in dirt and dust. And then, after the spores germinate inside a wound, the C. tetani bacteria have to start producing the exotoxin that acts as a neurotoxin, which causes the symptoms of tetanus.

The tetanus vaccine is against this exotoxin.

Unfortunately, it only takes a very small amount of tetanus toxin to cause tetanus. That’s why you don’t get natural immunity after being exposed to tetanus, but you do after getting the vaccine. It would only take about 60 nanograms of tetanus toxin to kill a small child.

Once the spores germinate, start producing exotoxin, and the exotoxin finally reaches your nervous system, that’s when you will start having tetanus symptoms.

If a puncture wound bleeds a lot, then you don’t need to get a tetanus shot. (False)

Many puncture wounds do not bleed a lot, but those that do are still at risk for tetanus.
Many puncture wounds do not bleed a lot, but those that do are still at risk for tetanus. Photo by James Heilman, MD

You don’t need to get a tetanus shot if you have a clean, minor wound and:

  • you have completed a primary tetanus series (a minimum of 3 tetanus containing vaccines), and
  • your most recent dose of tetanus vaccine was within the past 10 years

For most other wounds, including dirty wounds, animal bites, and puncture wounds, etc., you likely don’t need a tetanus shot if you have completed a primary tetanus series, and your most recent dose of tetanus vaccine was within the past 5 years.

In addition to a dose of tetanus vaccine, if has been less than 5 years since their last dose or they are unvaccinated or incompletely vaccinated, then they might also need to get tetanus immune globulin (TIG).

How much the wound bleeds has nothing to do with whether or not you need a tetanus shot. After all, a bleeding wound is not going to flush out all of the tetanus spores that might have contaminated your wound, or at least you have no guarantee that it did. What if the bleeding was more superficial and there was a deeper puncture wound that you couldn’t see?

This idea likely comes from the fact that tetanus is an anaerobic bacteria, meaning that it can’t survive around oxygen.

Tetanus is a mild disease. (False)

Tetanus, which people commonly think of as “lockjaw” is hardly a mild disease.

According to the CDC, “Even with modern intensive care, generalized tetanus is associated with death rates of 10% to 20%.”

And tetanus will always be a problem – if you aren’t vaccinated.

Since tetanus isn’t contagious and the tetanus spores are in the dirt and dust around us, you can’t rely on the folks around you to get vaccinated and “hide in the herd” for this vaccine-preventable disease.

Some recent cases highlight this myth:

  • an unvaccinated 7-year-old in Australia who contracted tetanus through an open wound in her foot while playing in her family’s garden. She was in critical condition, remained in the ICU for a few weeks despite quick treatment, and will likely face months, if not years of rehab after being released. (2017)
  • an unvaccinated women who developed obstetric tetanus
  • an unvaccinated 6-year-old in Canada who developed tetanus symptoms 10 days after stepping on a nail (2015)
  • unvaccinated children in parts of the world where vaccines are not longer available, like Ukraine
  • an unvaccinated 7-year-old in New Zealand who developed tetanus after cutting his foot and was hospitalized for almost a month (2013)

Worldwide, there are still about 49,000 deaths a year from neonatal tetanus and 14,500 deaths in children and adults. The incidence of tetanus has dropped tremendously since 1980 though, as more and more people get vaccinated throughout the world.

There are easy, non-toxic ways to prevent tetanus.

This one is actually true, it’s called a tetanus vaccine.

It replaced the previous treatment for tetanus, giving folks tetanus antitoxin, a treatment which began in the late 19th century. The first tetanus vaccine followed soon after, in the early 1920’s. It became more widely used during World War II.

“I myself suffered a fairly severe and deep cut on my ankle from a freak accident a few years ago but the thought of getting a tetanus shot for the injury never even crossed my mind.  I simply soaked my foot and ankle in warm salt water a couple of times a day for about a week to ensure that it stayed clean and contamination free.

The injury healed up nicely and I never exposed myself to the toxins and lingering health problems that can and do result from a tetanus shot.”

The Healthy Home Economist

Of course, when anti-vaccine folks talk about ‘non-toxic’ ways, they mean holistic type treatments without vaccines or other standard medical treatments.

When they tell you to clean the wound and take “extra cod liver oil, natural vitamin C, lacto-fermented foods and plenty of bone broths,” they are basically saying to hope that you are lucky and you don’t get tetanus.

Not only is the tetanus vaccine not toxic, but it helps fight the toxin that tetanus bacteria could produce in a contaminated wound.

What about hydrogen peroxide or colloidal silver? Like simple cleaning, with a deep puncture wound, none of those things will likely get to the ‘bottom’ of the wound. If you have even seen a puncture wound, like when a child steps on a nail, there is not much to clean. The wound typically closes up as the nail or other object exits the skin. Even with other wounds, unless you surgically open and irrigate the wound, you likely won’t clean it well enough to get all of the spores out if they are there.

What to Know About Tetanus and Tetanus Shots

Keeping up-to-date on your tetanus vaccines, which might mean an early shot if you have a dirty wound, is the only way to avoid serious and potentially life-threatening tetanus infections.

More About Tetanus and Tetanus Shots

Obstetric Tetanus Is Still a Thing in the United States

Yes, even though we have had a tetanus vaccine for over 80 years, obstetric tetanus is still a thing in the United States.

Obstetric Tetanus in Kentucky

According to a report from the CDC, in July 2016, an unvaccinated Amish woman in Kentucky developed “facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing” about nine days after “she delivered a child at home, assisted by an unlicensed community childbirth assistant.”

She  was hospitalized for a month, during which time she had seizures and was on a mechanical ventilator to help her breath for a “prolonged” amount of time.

Fortunately, her baby didn’t also develop tetanus, even though the family refused a recommended dose of tetanus immunoglobulin that could prevent neonatal tetanus from developing.

Surprisingly, after this incident, only 12% of community members agreed to be vaccinated with a tetanus vaccine. One pregnant woman even refused to get vaccinated. This is even less than the response to the Ohio measles outbreak in 2014, when up to 28% of unvaccinated Amish members got vaccinated with an MMR vaccine.

Neonatal Tetanus

An 8-day old baby with neonatal tetanus born to an unvaccinated mother.
An 8-day old baby with neonatal tetanus born to an unvaccinated mother. (CC BY 3.0)

In addition to obstetric tetanus, getting tetanus during or right after a pregnancy, neonatal tetanus is a big concern for unvaccinated mothers. Just like if their mothers don’t get a flu or pertussis containing vaccine, without a tetanus vaccine, newborn babies don’t get any passive immunity and protection against tetanus.

In 2015, 34,019 newborns died from neonatal tetanus worldwide. Amazingly, that is down from 787,000 newborns in 1988 “through immunization of children, mothers, other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices.”

It is not all about hygiene though. Tetanus spores are everywhere. For example, in the Kentucky case, the CDC found no evidence of “birth trauma, unsterile conditions, or other complications.”

In Montana, the baby of an unvaccinated mother developed tetanus that was linked to a non-sterile clay that was given to them by a midwife for home umbilical cord care.

Fortunately, these kinds of cases are rare. There have probably been less than 40 cases of neonatal tetanus since the early 1970s, and only two since 1989, but they should still be a reminder of what could happen if we stop getting vaccinated.

Risky Umbilical Cord Practices

Adding to the risk of getting tetanus, the same moms who aren’t getting vaccinated and protected may be following unsafe umbilical cord care practices.

“…tetanus in neonates can result from umbilical cord colonization, particularly in countries with limited resources. This infection results from contamination of the umbilical separation site by Clostridium tetani acquired from a nonsterile device used to separate the umbilical cord during the peripartum period or from application of unhygienic substances to the cord stump.”

AAP – Umbilical Cord Care in the Newborn Infant – 2016

In countries that are still combating neonatal tetanus, we hear of mothers in rural areas  putting herbs, herbal pastes, chalk, powders, clay, oils, and even butter on their baby’s umbilical cord.

These natural substances are certainly not safer than more standard care, as they can be contaminated with something else that is natural – tetanus spores.

What natural things, and risky, things can you see recommended for umbilical cord care in developed countries? How about honey, goldenseal powder, Frankincense and myrrh oil, and Aztec Healing Clay?

You don’t feed honey to infants because of the risk of botulism spores, but you are supposed to put it directly on their umbilical stump?

Some midwifes even recommend ground rosemary or other dried herbs that you are actually supposed to sprinkle directly on your baby’s umbilical stump. The use of dried herbs is especially problematic. It is well known that these products are not sterile.

“Spore forming bacteria (B. cereus, C. perfringens) that are capable of causing foodborne disease when ingested in large numbers are frequently found in spices and herbs, but usually at low levels.”

Food Microbiology. Volume 26, Issue 1, February 2009, Pages 39–43

If dried herbs are also contaminated with tetanus spores (C. tetani), and you place them on an umbilical cord stump of a child whose mother wasn’t vaccinated against tetanus, then you unnecessarily increase the risk for neonatal tetanus.

Not that you would ever hear about this risk from anyone who pushes these practices or tells these moms to avoid getting vaccinated. What happened to informed consent?

And what happens as Andrew Wakefield‘s kids continue to grow up, move beyond getting measles, and begin to have kids? If they still aren’t vaccinated, they and their babies will be at risk for diseases that we thought we had gotten well controlled, like obstetric tetanus, neonatal tetanus, and congenital rubella syndrome.

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