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Tetanus

(Lockjaw)

Definition

Tetanus (also known as lockjaw) is caused by an infection leading to marked prolonged muscle spasms. The infection creates a toxin that affects the nervous system. It can be fatal if left untreated.

Nervous System

CNS and PNS
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Causes    TOP

Tetanus is caused by specific bacteria that is found in soil, dust, or manure. It enters your body through a break in the skin. Once inside the body, the bacteria create a toxin. This toxin causes tetanus.

Risk Factors    TOP

Factors that may increase your chance of tetanus include:

  • Lack of tetanus vaccination, regular booster shots, or not updating tetanus vaccination in timely manner
  • IV drug use
  • Skin sores or wounds
  • Burns
  • Exposure of open wounds to soil or animal feces

Symptoms    TOP

Tetanus may cause:

  • Headache
  • Stiff jaw muscles or neck muscles
  • Drooling or trouble swallowing
  • Muscle spasticity or rigidity
  • Sweating
  • Fever
  • Irritability
  • Pain or tingling at a wound site
  • Seizures
  • Difficulty breathing
  • Heart beat that is too fast or too slow

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis is mainly based on the medical history.

Your doctor may test the wound. A culture will grow the bacteria causing the infection. Culture results are not always accurate for tetanus.

Treatment    TOP

Treatment may include:

  • Hospitalization—to manage complications of the infection
  • Opening and cleaning the wound—entire wounded area may need to be surgically removed
  • Antibiotics to fight the bacteria
  • Tetanus immune globulin—antibodies against tetanus that help neutralize the tetanus toxin
  • A tetanus shot—if your tetanus vaccine is not up to date
  • Medication to treat symptoms—may include antiseizure medication or muscle relaxants

Tetanus can cause severe problems with breathing or swallowing. A breathing tube may be inserted in the throat. This will help keep the airway open until you heal. A surgical procedure called a tracheotomy may be done. This will provide an open airway if your upper airway cannot be accessed.

Prevention    TOP

The best means of prevention is immunization. The immunization schedule for tetanus is as follows:

  • All children, with few exceptions should receive the, DTaP vaccine series. This protects against diphtheria, tetanus, and pertussis.
  • A single dose of Tdap vaccine is recommended for children aged 11 years or older, even if they did not receive the DTaP.
  • Adults should receive a booster dose of the tetanus and diphtheria vaccine (Td) every 10 years. They may also receive this vaccine after an exposure to tetanus. It is not harmful to receive a tetanus vaccination earlier than 10 years.

If you or your child has not been fully vaccinated, talk to the doctor. There are catch-up schedules available.

In addition to the vaccine, you can prevent tetanus by taking proper care of wounds:

  • Promptly clean all wounds.
  • See your doctor for medical care of wounds.

RESOURCES:

National Foundation for Infectious Diseases
http://www.nfid.org
National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca
The College of Family Physicians of Canada
http://www.cfpc.ca

References:

ACOG Committee Opinion No. 566: Update on immunization and pregnancy: Tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol. 2013;121(6):1411-1414. Reaffirmed 2015.
Strikas RA, Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years—United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(4):93-94.
Tetanus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114650/Tetanus. Updated May 17, 2017. Accessed October 2, 2017.
Tetanus (lockjaw) vaccination. Centers for Disease Control and Prevention website. Available at:
...(Click grey area to select URL)
Updated November 22, 2016. Accessed October 2, 2017.
1/24/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114650/Tetanus: Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (tdap) vaccine from the advisory committee on immunization practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-15.
11/4/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114650/Tetanus: Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011;60:1424-1426.
4/1/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114650/Tetanus: Bridges CB, Coyne-Beasley T, et al. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older—United States, 2014. MMWR Morb Mortal Wkly Rep. 2014. 63(7):110-112.
Last reviewed September 2017 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 9/14/2016

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