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http://kidshealth.org/parent/infectio
ns/bacterial_viral/tetanus.html
Tetanus, also known as lockjaw, is a
serious but preventable disease that
affects the body's muscles and nerves. It
typically arises from a skin wound that
becomes contaminated by a bacterium called
Clostridium tetani, which is often found
in soil.
Once the bacteria are in the body, they
produce a neurotoxin (a protein that acts
as a poison to the body's nervous system)
known as tetanospasmin that causes muscle
spasms. The toxin can travel throughout
the body via the bloodstream and lymph
system. As it circulates more widely, the
toxin interferes with the normal activity
of nerves throughout the body, leading to
generalized muscle spasms. Without
treatment, tetanus can be fatal.
In the United States, most cases of
tetanus follow a cut or deep puncture
injury, such as a wound caused by stepping
on a nail. Sometimes the injury is so
small the person never even sees a doctor.
Injuries that involve dead skin (such as
burns, frostbite, gangrene, or crush
injuries) are more likely to cause
tetanus. Wounds contaminated with soil,
saliva, or feces — especially if not
properly cleaned — and skin punctures
from nonsterile needles (such as with drug
use or self-performed tattooing or body
piercing) are also at increased risk.
Another form of tetanus, neonatal tetanus,
occurs in newborns who are delivered in
unsanitary conditions, especially if the
umbilical cord stump becomes contaminated.
Prior to immunizations, neonatal tetanus
was much more common in the United States.
Now, routine immunizations for tetanus
produce antibodies that mothers pass to
their unborn babies. These maternal
antibodies and sanitary cord-care
techniques have made newborn tetanus very
rare in developed countries.
In fact, tetanus in general is rare in the
United States and other nations with
tetanus vaccination programs — fewer
than 50 cases of tetanus are reported each
year in the United States. However, many
developing countries have less effective
prevention and immunization programs
against tetanus, so the disease is much
more common there.
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: getting vaccinated against
tetanus along with other routine
immunizations, or, 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 is the case 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: Larissa Hirsch, MD
