Tetanus

Signs and Symptoms

Tetanus often begins with muscle spasms in the jaw (called trismus), and can be accompanied by difficulty swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. These spasms can spread to the muscles of the abdomen, upper arms, and thighs. The symptoms can occur anywhere from days to months after exposure to the bacteria.

Prevention

There are two important ways to prevent tetanus:

1. getting vaccinated against tetanus
2. after an injury that could cause tetanus, receiving a shot (post-exposure tetanus prophylaxis)

For kids, tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. They typically receive a series of four doses of DTaP vaccine before 2 years of age, followed by a booster dose at 4 to 6 years of age. After that, a booster (Tdap) is recommended at 11 to 12 years of age, and then a tetanus and diphtheria booster every 10 years through adulthood. Be sure your kids don't miss their appointments so that the immunizations are given on time.

As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.

Post-exposure tetanus prophylaxis also involves getting tetanus shots, but after an injury occurs. Shots given will depend on the number of years since the patient's last booster, the total number of tetanus vaccinations the patient has received, and the nature of the wound. The doctor may recommend a tetanus booster (Td , DTaP, or Tdap, depending on the patient's age and previous immunizations) and/or an injection of tetanus immune globulin (TIG) to neutralize any toxin released by the bacteria.

Neonatal tetanus can be prevented by making sure that all pregnant women have had their tetanus immunizations, by delivering babies in sanitary conditions, and by proper umbilical cord care. If you are pregnant, discuss your immunization record with your obstetrician well before your due date.

Any skin wound — especially a deep puncture or a wound that may be contaminated with feces, soil, or saliva — should be cleaned and dressed right away. Although it's important to clean all wounds, remember that cleaning is not a substitute for immunization.

Treatment

Doctors play an important role in preventing tetanus by making sure kids' immunizations are up to date and providing post-exposure prophylaxis if a child has a wound that's at risk for tetanus.

A child who does develop tetanus will be treated in a hospital, usually in the intensive care unit (ICU). There, a child typically receives antibiotics to kill bacteria and TIG to neutralize the toxin that the bacteria have already released. The child will also receive medicines to control muscle spasms and may be given treatment to support vital body functions.

When to Call the Doctor

If you're not sure whether your kids have been immunized against tetanus, or if you know they're not fully immunized, call your doctor. If it's been more than 10 years since someone in your family has had a tetanus booster, schedule an office visit to bring immunizations up to date.

If the event of a puncture or other deep wound, clean the wound and call the doctor to discuss whether your child should receive post-exposure tetanus prophylaxis. If your child develops lockjaw or muscle spasms — particularly after sustaining a wound — seek medical attention right away.

Reviewed by: Joel Klein, MD
Date reviewed: July 2010