The tetanus-causing bacteria typically enter the body through a wound. Spores from the bacteria germinate and produce a toxin that enters the bloodstream and lymphatic system, resulting in tetanus.

Tetanus is fatal in about 10 percent of cases in the U.S. Fortunately, tetanus is preventable through immunization.

Tetanus Facts

Although relatively rare in the U.S. with fewer than 100 cases reported annually, tetanus is of concern in childcare because the bacteria enter the body through wounds. Young children are very active and commonly suffer minor wounds, including punctures, lacerations, or abrasions.

Childcare providers also may experience injuries, such as a cut or scrape while playing outside with children. It is important to be familiar with the cause of tetanus, understand the importance of immunization and regular booster shots, and have current immunization records on file for all children and staff.

Tetanus is infectious, which means it is caused by a living microorganism; in this case, the culprit is C. tetani bacterium that can live in soil. However, tetanus is not contagious, which means it cannot be passed from person to person. According to the Centers for Disease Control and Prevention (CDC), tetanus “is the only vaccine-preventable disease that is infectious but not contagious.”

Tetanus and wounds from rusty nails may be linked in your mind, probably because of warnings you received as a child. In cases where tetanus resulted from a nail-related puncture, it was because the nail was contaminated with C. tetani bacteria, not because the nail was rusty. A shiny nail also can be contaminated.

In order to cause disease, the tetanus bacterium requires an anaerobic (without oxygen) environment, therefore, puncture or deep wounds are at most risk. Animal scratches and bites, insect bites, wounds where flesh is torn or burned, wounds resulting from projectiles, crushing, or frostbite and wounds caused by thorns and splinters are potentially at risk. With some injuries, a tetanus booster shot may be given to adults to protect against the bacterial.

Surgery, dental infections, and self-performed tattoos and piercing also have been linked to tetanus.

Improper cleansing of a wound can make a person more susceptible to tetanus, but even the most thorough cleansing is not a substitute for immunization. In the unimmunized child or under-immunized adult (an adult who has not maintained immunity through booster shots), tetanus can develop from relatively small or minor wounds.

Nearly all reported cases in the U.S. are found in people who have never been immunized for tetanus or have had a lapse in booster vaccinations.

Symptoms of Tetanus

Tetanus is diagnosed by a physician based on observation of physical symptoms along with a history of the wound and immunization records. Symptoms include muscle contractions and spasms that generally begin with “lockjaw,” an extreme jaw stiffness that causes involuntary closing of the mouth.

Muscle stiffness in the neck, abdomen, diaphragm and back follow as contractions move down the body. Muscle spasms may last for several minutes and occur frequently, continuing for up to a month.

Other symptoms of tetanus include difficulty swallowing, irritability, fever, headache, sore throat, sweating, rapid heart rate, and elevated temperature and blood pressure. Complications of tetanus can include fractures of the spine and long bones, pneumonia, ulcers, and secondary infections.

The average time between infection and the onset of symptoms is seven days, although it may vary from as little as five days to as much as 15 weeks.

Treatment for tetanus typically consists of an antitoxin, antibiotics, and a tetanus vaccination. A lengthy stay in an intensive care setting can be required, and the patient may also need medication for sedation and muscle spasms.

Many people completely recover from the disease. However, despite treatment, some patients suffer some lasting effects; it also can be fatal.

Preventing Tetanus

Contracting tetanus does not give immunity from future infection with tetanus. The only effective way to prevent tetanus is through immunization. Children younger than seven years typically receive the DTaP vaccine. This is a combination vaccine that immunizes against diphtheria, tetanus, and pertussis (whooping cough).

The pediatric DT is an alternative immunization that protects against tetanus and diphtheria but does not contain the pertussis component. DTaP is typically administered in four separate doses at 2 months, 4 months, 6 months, and 15-18 months. A booster may be recommended at 4-6 years.
Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years or after an injury with possible exposure to tetanus. Booster shots are important because research indicates that most people have only the minimal protective level of antitoxin left in their systems after 10 years (or sooner, for some individuals).

If an adult has a deep or dirty wound or a puncture wound, and it has been more than five years since the last booster, another booster is recommended. If you plan to travel internationally, make sure your tetanus immunization is current because tetanus is much more prevalent in some other parts of the world.

Side effects of the immunization are mild or nonexistent for most people, but can include pain, redness or a hard lump around the vaccination site, itching, and skin rash.

Immunization and Childcare

It is extremely important that both children and adults maintain appropriate immunizations and that accurate, detailed immunization records are maintained. With appropriate immunization, tetanus is preventable.

Encourage staff to be vigilant in properly treating and reporting all injuries, even if they are minor. Carefully document, in words and photographs, the incident and wound.

Talk with your childcare health consultant or childcare health professional about immunizations, proper wound care, and other preventive measures that can prevent tetanus.

Marna Holland
Parent Educator, Asheville, NC, City Schools Preschool, and Instructor, Western Carolina University

Internet Resources

Medline Plus, www.nlm.nih.gov/medlineplus/tetanus.html

Mayo Clinic, www.mayoclinic.com/health/tetanus/DS00227/DSECTION=6

U.S. Food and Drug Administration, www.fda.gov/Fdac/features/696_tet.html

Tetanus: Questions and Answers, Immunization Action Coalition, www.immunize.org/catg.d/p4220.pdf

Resources

Center for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA 30333;800-CDC-INFO (232-4636); www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm