Clostridium tetani (Tetanus)

tetanusBacteria: Clostridium tetani (C. tetani)

Vaccine: DTaP, Tdap, or TD

Transmission 

The bacteria that causes tetanus, Clostridium tetani,  is often found in the soil. In the United States, tetanus is most often transmitted through a break in the skin, such as a deep puncture, like stepping on a nail. However, injuries that involve dead skin (burns, frostbite, gangrene, crush injuries, etc.) are more likely to cause tetanus. Wounds contaminated with soil, saliva, or feces, and that are not properly cleaned, as well as punctures with non sterile needles are at an increased risk for tetanus.

Symptoms

Once it enters the body, the bacteria starts to release a neurotoxin (poison), which begins to attack the nervous system. Somewhere around three weeks after your child is exposed to the bacteria, you would notice your child might have a headache, become cranky, and have spasms and tightening of the jaw muscle. Sometimes the tightening in jaw, head, and neck is so extreme that the child can’t open their mouth, swallow, or even breathe (why this disease is often called “lockjaw”).

The neurotoxin spreads through the bloodstream and starts to interfere with the normal activity of nerves, leading to muscle spasms that could be strong enough to break your child’s bones and cause paralysis or inability to move parts of his body. Spasms can be so forceful that they tear muscles or even cause spine fractures.  If left untreated, tetanus can lead to death and is very dangerous.

Who is at Risk:

Anyone who has not had a tetanus vaccine or booster within the past ten years, especially those who are unvaccinated and living under unsanitary conditions. 

Possible Complications

Broken bones due to extreme muscle spasms, paralysis or inability to move parts of the body, and torn muscles or spin fractures due to forceful spasms are some of the major complications. Death from tetanus is not a rare event. 

Pregnancy/Unborn Child/Newborn Risk:

Neonatal tetanus is another form of tetanus that can occur in newborns delivered in unsanitary conditions. Often times, this occurs when the bacteria enters the umbilical cord stump if the cord is not cleaned properly. This can be prevented through proper umbilical cord care, as well as through maternal vaccination while pregnant. It is recommended in the US for mothers to get vaccinated against tetanus during every pregnancy so that antibodies can be passed to the unborn child and keep the child protected for some time after birth. Due to vaccination, neonatal tetanus is uncommon in the United States.

Prevention:

The best and only way to really prevent your child from getting tetanus is though vaccination. Vaccination against tetanus should be given every ten years. Should your child get such a wound and you are unsure if he is protected or if you are unsure of when his last booster was, he must be treated immediately!

Currently in the United States, it is recommended that children receive five doses of the DTaP vaccine to avoid getting these three bacterial diseases. The doses are at 2 months old, 4 months old, 6 months old, between 15-18 months old, and between 4-6 years old.

Since immunity wears off to these three bacteria over time, boosters are recommended for everyone over a lifetime.

The DTaP vaccine is given in five doses to children under the ages of 7. Following this series, the tetanus and diphtheria (Td) vaccine is recommended to all individuals every ten years. A tetanus and diphtheria vaccine with a pertussis booster, called the Tdap (not to be confused with DTaP) vaccine (which has a reduced dose of the diphtheria and pertussis vaccine), is recommended to replace one of the Td boosters any time between the ages of 11 and 64. The recommendation for this Tdap booster is between the ages of 11 and 12 years of age.

The Tdap vaccine is especially important for health care professionals, anyone caring for a baby under 12 months, and pregnant women. All pregnant women are also advised to get the Tdap vaccine, preferably between 27 and 36 weeks’ gestation to pass on important antibodies to the tetanus bacteria.

Also, all children and adults who have had a severe cut or burn may need Td or Tdap to protect against tetanus infection, as well as further care. It is recommended that Tdap be given after a severe cut or burn to prevent tetanus infection.

Tetanus in general is rare in the United States due to vaccination. Today there are fewer than 50 cases reported each year.4

Treatment:

Any skin wound, especially a deep puncture wound or one that may be contaminated with feces, soil, or saliva needs to be cleaned and dressed immediately. (It’s important to note that cleaning a wound is no substitute for vaccination.)

Next, seek medical attention immediatelyThe doctor may recommend a tetanus booster, and further treatment. Children who develop tetanus will be treated in the hospital, most likely in the intensive care unit (ICU).

Once in the hospital, your child would receive antibiotics to help kill the bacteria and antibodies [tetanus immunoglobulin (TIG)] to start to neutralize the toxin the bacteria may have started to release. Further, your child will get doses of medication to control muscle spasms, and other treatment to support vital body functions.

Prognosis:

Tetanus kills about 1 out of every 5 people infected with the bacteria.1

 

Resources:

  1. Centers for Disease Control and Prevention (CDC). www.cdc.gov
  2. Medline Plus.US National Library of Medicine. National Institutes of Health. www.nlm.nih.gov
  3. WebMD. www.webmd.com
  4. Kids Health. Nemours. www.kidshealth.org

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