Tetanus

Tetanus, commonly called lockjaw, is a bacterial disease that affects the nervous system. Due to widespread immunization, tetanus is now a rare disease.

Tetanus is contracted through a wound which becomes contaminated with the organism. It is not transmitted from person to person.

The tetanus germ is present throughout the environment and is commonly found in soil contaminated with manure.

• A common first sign of tetanus is muscular stiffness in the jaw (lockjaw), followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating and fever.

The incubation period is usually eight days but may range from three days to three weeks. Shorter incubation periods are associated with more heavily contaminated wounds.

Recovery from tetanus may not result in immunity. Second attacks can occur and immunization is indicated after recovery.

Wounds should be thoroughly cleaned, and dead or devitalized tissue removed. If the patient has not had a tetanus toxoid booster in the previous 10 years, a single booster injection should be administered on the day of injury. For severe wounds, a booster may be given if more than five years have elapsed since the last dose. Tetanus immune globulin (TIG), antitoxin or antibiotics may be given if the patient has not been previously immunized with a series of at least three doses of toxoid.

Complications include spasm of the vocal cords and/or spasms of the respiratory muscles causing interference with breathing. Other complications include fractures of the spine or long bones, hypertension, abnormal heartbeats, coma, generalized infection, clotting in the blood vessels of the lung, pneumonia and death.

An effective vaccine called tetanus toxoid has been available for many years. Tetanus toxoid in combination with diphtheria toxoid and pertussis vaccine (DTP) is given at two, four, six and 15 months of age, and between four and six years of age. Children who are seven years of age or older should receive Td (tetanus and diphtheria) toxoid. A tetanus booster shot is recommended every 10 years.

The single most important preventive measure is to maintain a high level of immunization in the community.