David Perlstein, MD, MBA, FAAP
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Tetanus facts
- What is tetanus?
- Where do tetanus bacteria grow in the body?
- How does the tetanus toxin cause damage to the body?
- What is the incubation period for tetanus?
- What is the course of tetanus? What are tetanus symptoms and signs?
- Is tetanus contagious?
- What is the treatment for tetanus?
- How is tetanus diagnosed, and what is the prognosis of tetanus?
- Is it possible to prevent tetanus?
- What is the schedule for active immunization (tetanus shots)?
- What are the side effects of tetanus immunization?
- What is passive immunization (by way of specialized immunoglobulin)?
How is tetanus diagnosed, and what is the prognosis of tetanus?
The diagnosis of tetanus is made clinically, based on a patient's history of exposure such as stepping on a rusty nail in the backyard, and by the symptoms present, such as "lockjaw," difficulty swallowing, fever, and generalized muscle spasms.
Once diagnosed and treated, the prognosis is generally good if the patient receives appropriate care early in the illness. The toxin does no permanent damage, and patients who receive appropriate supportive care generally recover. Sometimes symptoms develop rapidly, and some people live in remote areas where they are not able to receive appropriate care and are at a higher risk of death from tetanus.
Is it possible to prevent tetanus?
Active immunization ("tetanus vaccine") plays an essential role in preventing tetanus. Preventative measures to protect the skin from being penetrated by the tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).
What is the schedule for active immunization (tetanus shots)?
All children should be immunized against tetanus by receiving a series of five DTaP vaccinations, which generally are started at 2 months of age and completed at approximately 5 years of age. Booster vaccination is recommended at 11 years of age with Tdap.
Follow-up booster vaccination is recommended every 10 years thereafter. While a 10-year period of protection exists after the basic childhood series is completed, should a potentially contaminated wound occur, an "early" booster may be given in selected cases and the 10-year "clock" resets.
What are the side effects of tetanus immunization?
Side effects of tetanus immunization occur in approximately 25% of vaccine recipients. The most frequent side effects are usually quite mild (and familiar) and include soreness, swelling, and/or redness at the site of the injection. More significant reactions are extraordinarily rare. The incidence of this particular reaction increases with decreasing interval between boosters.
What is passive immunization (by way of specialized immunoglobulin)?
In individuals who exhibit the early symptoms of tetanus or in those whose immunization status is unknown or significantly out of date, the tetanus immunoglobulin (TIG) is given into the muscle surrounding the wound with the remainder of the dose given into the buttocks.
American Academy of Pediatrics. "Tetanus (Lockjaw)." In: Pickering, L.K., ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.
Braunwald, Eugene, et al. Harrison's Principles of Internal Medicine, 17th ed. United States: McGraw-Hill, 2008.
Switzerland. World Health Organization. "Diphtheria Reported Cases." July 15, 2015. <http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencediphtheria.html>.
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