General · 2nd May 2014
Pat Peterson NP
Tetanus is a nervous system disorder caused by an anaerobic (without oxygen) bacteria called clostridium tetani. It was first described around 3000 BC. Historically it was named lockjaw after the characteristic symptom of the disease, namely painful contractions of the jaw muscles.
The clostridium tetani bacterium is found on or in soil, manure, dust, clothing and in some mammal/human gastrointestinal tracts. The bacterium cannot grow in healthy human tissue; it requires an area of tissue damage to thrive. The usual source of entry is from a wound. 65% of tetanus causing wounds is ones that are minor, such as from a cut, puncture, splinter or thorn. The other major source is from a slowly healing deep wound or abscess.
Clostridium tetani produces a toxin that seeks out and irreversibly binds to nerve cells, causing destruction of the cell. When enough nerve cells are affected, regulation of muscle movement and automatic functioning of the nervous system is affected. On average, symptoms appear 8 days following infection. The range however, is from 3 days to 3 weeks. There are four clinical types of tetanus: local, generalized, cephalic and neonatal. Of these, generalized tetanus tends to predominate. If the wound is located far from the spine (the finger, for example), local symptoms may appear first and can be confined to that area. The closer the wound is to the spine or head, the greater the risk of generalized or cephalic tetanus. Neonatal tetanus is often prevalent in third world populations where the umbilical cord is cared for in unsanitary conditions.
Symptoms of generalized tetanus include headache, a stiff neck and pain with swallowing, followed by painful contraction of the jaw muscles (trismus). This is followed by muscle rigidity and then spasms that occur in a descending pattern. Touch, movement, light or noise can trigger muscle spasms. They can last seconds to minutes. They can be so severe that they cause fractures, dislocations, muscle breakdown, and/or asphyxia due to spasm of the throat. Seizures can occur. The body may not be able to regulate temperature, heart rate or blood pressure.
Once the tetanus toxin binds to nerve cells, it destroys the cell. Therefore, there is no cure for tetanus. Care is deemed supportive, by attempting to remove unbound circulating toxin (with tetanus immunoglobulin), as well as prevention of injury and respiratory failure through the use of muscle relaxants. Most individuals are admitted to an intensive care unit for monitoring. It can take up to two months for nerve regeneration to occur though many individuals have difficulties for longer periods of time. Mortality from tetanus is approximately 45%.
Tetanus can only be prevented through immunization. Immunization begins with the first vaccines given to babies at two, four and six months of age, then throughout childhood as part of the vaccination series ending at age 15-16. Boosters need to be administered every ten years following.
Diphtheria vaccine is almost always given together with tetanus. It is a rare disease with primarily respiratory symptoms. Both tetanus and diphtheria rarely occur in North America due to availability of vaccines. Statistics from 1980-2004 in Canada demonstrate between one to ten deaths per year due to tetanus. Interestingly, statistics show that 49% of those with tetanus are over the age of 60, with 57% of those being male. Of those who die from tetanus, 40% are over the age of 60. Also of interest, tetanus can infect those with only partial immunity. Infection severity increases among those without immunization. The tetanus vaccine is very safe with few side effects.
Only those who have reacted negatively to the vaccine are deemed ineligible for vaccination.
With a booster given every ten years, it is important for individuals to maintain a record of their last vaccination. Ask your health professional to update your tetanus status when you are in for your physical exam. We are only too happy to provide this service!