Paging Dr. Frischer: Tetanus
A young woman recently saw me for a physical. While reviewing her immunizations, I asked her when her last tetanus vaccination was. She answered with a blank stare. This lack of awareness is due to the incredible success of vaccination efforts in the United States. The incidence of tetanus has been reduced dramatically, although it is far more common in other countries.
Tetanus is a life-threatening but preventable disease caused by the toxin of Clostridium tetani. This common bacterium is found in soil, dust, and animal feces. Tetanus has been documented at least as far back as the fifth century. In 1889, the tetanus toxin was first isolated from a human. The first vaccine was finally developed in 1924, and was used during World War II.
In the United States, reported tetanus cases since 1947 have declined by 95%, and deaths by 99%. From 2001 through 2008 there were only 233 cases of tetanus, in total! Overall, tetanus has about a 13% fatality rate. Those with diabetes, or those who abuse IV drugs are at a higher risk.
What does the disease look like? Often referred to as lockjaw, it causes a painful tightening of the muscles and stiffness of the jaw, neck and abdomen. It can lead to the jaw “locking” (trismus) so that it’s difficult to open the mouth or to swallow. There may be body spasms that last for several minutes, seizures, fevers, sweating, elevated blood pressure, and a rapid heart rate. Doctors diagnose tetanus by examining the patient and looking for its signs and symptoms. There are no hospital lab tests to diagnose it. Symptoms can appear anytime from a few days to several weeks after the bacteria enter the body.
How do we get tetanus? We’ve all heard that stepping on a rusty nail can cause it. But it is also caused when the bacteria penetrate through any open wound, including a puncture, gunshot, compound fracture, burn, surgery, injection drug use, animal or insect bite, body piercing, infected foot ulcer, dental infection, or any other break in the skin.
Who should get a tetanus booster? Babies receive the TDaP (tetanus, diphtheria and pertussis) vaccine in a series of five doses between the ages of two months and four-six years. At around 11 or 12, a child should get a booster. After that, a Td (tetanus and diphtheria) booster is recommended every 10 years. If you are an adult and were not vaccinated as a child, you will likely start with a three-vaccine series of Td (or TDaP if needed).
If you have never been vaccinated and you suffer a wound, you would want to have the tetanus vaccine administered within 48 hours. Adults who will be spending time with infants under the age of one may need the TDaP vaccine as a one-time booster. This is for the benefit of the younger, more at-risk population. If you plan to travel internationally, particularly to a developing country where tetanus might be common, you should ensure that your immunity is current.
Who should *not* get the vaccine? Those who have had a life-threatening or allergic reaction to it, or are moderately or severely ill should not get the tetanus vaccine. Those with a neurologic disease like epilepsy, who have had Guillain-Barre Syndrome, or are pregnant, should consult with their doctor first.
The number of tetanus cases reported each year continues to decline, but tetanus remains a very rare but life-threatening disease in the United States. Be sure to stay up to date with your Td vaccination; especially if you are 65 or older, or suffer from a chronic disease.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.