What tetanus is and how people get it
Tetanus is caused by the bacterium Clostridium tetani. Its spores survive for years in soil, dust, manure and on rusty objects, and enter the body through broken skin: cuts, punctures, bites, burns, frostbite, splinters. It does not spread from person to person. Deep wounds contaminated with soil are especially risky because they have little oxygen, which lets the spores grow and release a toxin that attacks the nervous system.
The first signs appear on average 1 to 2 weeks after the injury, though sometimes after 3 days or 3 weeks. By then a person may have forgotten a small wound.
Tetanus symptoms
- tight jaw muscles that make it hard to open the mouth (lockjaw);
- stiffness and pain in the neck, back and facial muscles;
- trouble swallowing;
- painful muscle spasms that even light, noise or touch can set off;
- fever, sweating and a fast heartbeat;
- in newborns, refusal to feed, a weak cry and seizures.
Tetanus does not look like a cold or food poisoning, and it is easy to recognize only when it is advanced. So with any suspicious wound, do not wait for symptoms. Check your vaccination status right away.
Why tetanus is dangerous
The toxin causes prolonged muscle spasms, including in the muscles used for breathing. Possible results include spinal fractures and torn muscles from spasms, breathing arrest, heart rhythm problems and pneumonia. Even with intensive care the illness is severe and can be fatal. Surviving it does not give immunity, so vaccination is still needed afterward.
Diagnosis and treatment
Doctors diagnose tetanus from symptoms and the injury history, as there is no quick test that confirms it. Treatment takes place in a hospital, often in intensive care. Patients receive immune globulin or antitetanus serum, the wound is cleaned, and they get antibiotics and medicines that control spasms, plus a ventilator if needed. Recovery takes weeks. The doctor determines the plan, and nothing can be done at home.
What to do about a wound
- Rinse the wound with clean running water and soap and remove visible dirt. You can clean the edges with an antiseptic.
- Do not seal a deep, dirty wound tightly.
- See a trauma center or polyclinic the same day if the wound is deep, contaminated with soil, a bite, a burn or frostbite, or if you do not remember your last vaccination.
In Georgia, emergency tetanus prevention follows the scheme in Minister's Order No. 01-60/n (Table 3). The decision depends on age, number of doses received and time since the last one. For example, an adult with a complete series whose last dose was less than 5 years ago usually needs no extra dose. If more time has passed, the doctor may offer Td. People who are unvaccinated or have not finished the series may also need tetanus immune globulin or serum. The doctor makes the choice, and after emergency prevention the vaccination series must still be completed per the calendar.
Tetanus vaccine in Georgia
The tetanus component is part of vaccines in Georgia's national preventive vaccination calendar (Minister's Order No. 01-60/n, current version of July 13, 2023):
- at 2, 3 and 4 months: the six-in-one (hexavalent) vaccine, three doses at least 4 weeks apart;
- at 18 months and 5 years: the DTaP/P booster;
- at 14 years: Td, then Td every 10 years up to age 55.
Unvaccinated children aged 2 to 13 receive DTaP/P in three doses. Clinics list Hexaxim, Infanrix hexa, Tetraxim, Adacel, Boostrix, Tetadif, Td and DT. For children under 18, calendar vaccines are free under the state program, and adults can get Td for routine boosters through the state immunization program. Vaccination prices at clinics in Georgia are shown further down this page. WHO recommends 6 doses in a lifetime (3 primary and 3 boosters) for long-term protection. If you cannot remember your last dose, ask a doctor. Most often the series is continued, not restarted. The same combined vaccines also protect against diphtheria and whooping cough.
Pregnant women should check their status: a mother's vaccination protects the newborn from neonatal tetanus. Ask your obstetrician about vaccination in pregnancy.
When to see a doctor urgently
- a deep, dirty wound, bite or burn when you have not been vaccinated for a long time or cannot recall the date;
- jaw tightness, trouble opening the mouth or swallowing, or spasms after an injury;
- seizures, refusal to feed and a weak cry in a newborn.
For spasms or labored breathing, call an ambulance at 112.
