Tag: wounds

Can You Treat Tetanus Without a Tetanus Shot?

Why would anyone want to try and treat tetanus without a tetanus shot?

That’s a good question…

Misinformation about tetanus from the PIC.

Why would a doctor tell others that tetanus could be treated without a tetanus shot?

That might be a question for a state medical board…

Can You Treat Tetanus Without a Tetanus Shot?

As most people will notice, even looking at the ironically named Physicians for Informed Consent’s own post, you don’t treat tetanus without a tetanus shot.

“Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG), agents to control muscle spasm, aggressive wound care, antibiotics, and a tetanus toxoid booster. If tetanus immune globulin is unavailable, Immune Globulin Intravenous (IGIV) can be used.”

CDC on Tetanus for Clinicians

Even in the study that they used as a reference clearly used both tetanus immune globulin and a tetanus shot.

What might be confusing to some folks, is that tetanus toxoid, is synonymous (has the same meaning) as:

  • tetanus vaccine
  • tetanus shot
  • Td (tetanus toxoid + diphtheria toxoid)

So like most people with tetanus, this patient received both tetanus immune globulin and a tetanus vaccine, a fact I tried to point out so that visitors to Physicians for Informed Consent could get true informed consent about their vaccine choices.

The comment that got me banned from posting on Phyicians for Informed Consent.
As often happens on anti-vaccine sites, my comment was quickly deleted and I was banned from posting further messages.

And fortunately, the patient, who’s previous immunization history was unknown, got better!

Treating Tetanus With a Tetanus Shot

Why did he have tetanus?

The case they are talking about occurred in Japan, and again, it isn’t known if the patient had ever received a tetanus vaccine.

“In Japan, tetanus toxoid was introduced in 1968, so elderly adults who were born before 1968 have high risk of tetanus.”

Tomoda et al. on Tetanus without apparent history of trauma

He was born in 1950 and although he had no history of recent trauma, “he grew vegetables in a field as his hobby.”

As most people know, gardening is a risk factor for getting tetanus.

And with such a long incubation period, it is very likely that he had a minor wound or injury while gardening, was exposed to tetanus spores, and later developed tetanus symptoms.

Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.
Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.

The long incubation period is also the reason that giving a tetanus vaccine works to prevent you from getting tetanus even after you have been exposed. Tetanus spores have to germinate, the bacteria have to grow and then produce exotoxins. And then the exotoxins have to travel to different sites in your nervous system, where they act as neurotoxins.

Hopefully, before they do, the dose of tetanus vaccine you got when you pricked your finger on a thorn, stepped on a nail, or cut your leg, etc., will have already induced you to start making antibodies against the exotoxins – antitoxin. Just in case they don’t, in a high risk case, you also would have gotten a dose of tetanus immune globulin for an immediate dose of antitoxin – antibodies against the exotoxins.

The same thing happens if you have already developed tetanus symptoms. A dose of tetanus immune globulin helps to neutralize neurotoxins that haven’t already started doing damage, and you get supportive care until you recover. Plus antibiotics to kill the bacteria so they won’t make more exotoxins and a tetanus shot.

Why not just give tetanus immune globulin, as the post from Physicians for Informed Consent implied you can do?

It is mostly because a tetanus infection doesn’t stimulate any natural immunity and the immunity you get from tetanus immune globulin is temporary, so won’t prevent a relapsing or recurrent case.

Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.
Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.

And because no one would substitute a treatment that is known to work well, a tetanus vaccine with tetanus immune globulin, and switch it out for one that might be riskier and have no extra benefits.

Using immune globulin alone was once the recommended treatment. That was before the tetanus vaccine was developed though. Back then, in the late 19th century and early 20th century, folks with suspected tetanus got treated with anti-tetanic serum that was made in horses. The main problem with this tetanus antitoxin was that it could sometimes trigger serum sickness.

Fortunately, a tetanus vaccine was soon developed and it’s use with tetanus immune globulin helped make deaths from tetanus very rare.

Of course, tetanus is still around. Although it is a vaccine-preventable disease, it will never be eradicated, like smallpox.

“This case had no apparent portal of entry; there was no history of trauma, and no site was found on physical examination. However, this is not uncommon; no obvious entry site was reported in approximately 26% of cases in Japan.”

Tomoda et al. on Tetanus without apparent history of trauma

And not specific to Japan, that you can get tetanus without a history of trauma should be what really concerns folks in this article that the Physicians for Informed Consent has decided to spotlight.

It is a great reminder that vaccines are necessary.

More on Treating Tetanus Without a Tetanus Shot

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