Tetanus (Lockjaw)

By BILL MCKELL,

Tetanus is a serious bacterial disease which affects one's nervous system. The responsible bacteria are found in soil, dust, saliva or manure, and can remain viable for years if not exposed to sunlight. When these 'bugs' enter the body through a break in the skin (caused by a cut or puncture wound via a contaminated object) they produce a toxin which impairs the nerves that control muscles. This toxin causes muscle stiffness and spasms – the major signs and symptoms of tetanus. The disease occurs worldwide and dates back at least to the fifth century BC. Worldwide, tetanus is estimated to cause up to half a million deaths annually, mostly in neonates and young children. In the U.S. from 2000-2007, an average of 31 cases were reported each year. Contamination of the umbilical cord is the most common source of infection in the newborn infant. Nearly all cases of tetanus occur in people who have never been vaccinated or adults who haven't kept up with their 10-year booster shots. Tetanus has a worldwide mortality of 10-60 percent in untreated adults. Respiratory failure is the most common cause of death.

The incubation period (time from exposure to onset of illness) is usually between three and 21 days (average 10 days). Common signs and symptoms of tetanus include spasms and stiffness of jaw muscles, stiffness of neck muscles, difficulty swallowing, stiffness of abdominal muscles, stiff arms and legs, and painful body spasms lasting for several minutes (typically triggered by minor occurrences such as a draft, loud noise, physical touch, or light), and persist for weeks to months. The spasms may be severe enough that bone fractures occur. One may also see fever, profuse sweating, elevated blood pressure, and a rapid heart rate.

Diagnosis is based on the above-mentioned signs and symptoms, plus the identification of a possible entry site.

Treatment is supportive for there is no cure for tetanus. Meticulous nursing care is imperative. Treatment focuses on managing complications until the effects of the tetanus toxin resolve. Once the toxin has bonded to one's nerve endings it is impossible to remove. Complete recovery requires new nerve endings to grow, which may take months. Management will be determined by your personal physician plus possibly a consulting surgeon and/or an Infectious Disease specialist.

 

Now, here's the meat of this column – you can easily prevent tetanus by being immunized. In children under seven years the tetanus vaccine is administered as a combined vaccine, DPT/DTaP, which is usually begun at around two months of age, a series of three to five injections (one of which is a booster given at the time of entrance to school. This vaccine provides protection against tetanus, diphtheria, and pertussis (whooping cough). In adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap is commonly used. The CDC (Centers for Disease Control and Prevention) recommends that adults receive a booster vaccine every 10 years and standard practice in most places in the United States is to give a booster dose to any patient with a puncture wound who is uncertain of when he or she was last vaccinated. If you're traveling internationally, especially to a developing country where tetanus might be common, make sure your immunity is current.

Incidentally, recovery from tetanus does not confer immunity. Oh joy.

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