Commonly, little to no attention is paid to tetanus (lockjaw) because a reliable and effective vaccine against tetanus is available. But hand on heart, do you know your tetanus vaccination status? Many have to answer this question in the negative. Yet tetanus is a serious, often fatal bacterial infection characterized by typical muscle spasms. Even today, up to 25 percent of cases in Germany are fatal. That is why the tetanus vaccination is one of the most important vaccinations of all.
What is tetanus?
Tetanus is an infectious disease, with whose pathogen you can be infected anywhere in the world. Because of consistent vaccination coverage, tetanus has become very rare in Germany. However, if vaccination protection is no longer guaranteed, the danger should not be underestimated. Colloquially, tetanus is sometimes equated with blood poisoning (sepsis). Even though bacteria are the triggers in both cases, they are different diseases.
Bacterial infection with Clostridium tetani.
The causative agent of tetanus is a bacterium, namely Clostridium tetani, which is found in soil, dust, human excretions or animal excretions (especially those of horses). The spores are found everywhere in the soil, can survive in the soil for years, and multiply especially in low-oxygen environments. If, for example, one injures oneself while gardening by a splinter of wood, sharp-edged stones in the garden soil, a rusty nail or thorns, the bacteria can enter the body. Especially small to very small wounds, barely visible “trivial injuries” such as scratches or stings, can become dangerous. In wounds with inadequate oxygen supply, the germs then multiply rapidly. In the process, the bacteria secrete one of the strongest poisons, a so-called toxin. This means that it is not the bacteria themselves, but the toxin they produce that unleashes the harmful effects in the organism.
Tetanus: recognizing symptoms
As the inflammation spreads, the bacteria’s toxin can spread throughout the body. It travels through the bloodstream or along the nerves to the brain. There, it inhibits certain areas of the brain, so the first signs of tetanus may appear after an incubation period of about 3 days to 3 weeks (rarely longer):
- Tingling and numbness in the area of injury.
- Headache and dizziness
- Dullness
- Muscle pain
- Restlessness
Typical symptom are spasms of the muscles. The spasms begin in the face (including the jaw and neck muscles) and then spread to the whole body. Other symptoms of tetanus include:
- High fever
- Chills and sweats
- Confusion
- Accelerated breathing
- Fast heartbeat
- Fluctuations in blood pressure and blood flow.
Course: tetanus can be fatal
Later, the very painful cramp – with fully preserved consciousness – spreads to virtually all muscles of the body, the limbs are usually spared. The so-called lockjaw (trismus) occurs, giving the sufferer a grinning facial expression. Spasms of the swallowing and breathing muscles lead to life-threatening choking attacks and in many cases end fatally. In addition to respiratory distress, heart failure is also a possible cause of death in tetanus. Furthermore, the convulsions can place excessive stress on the spine – fractures of the vertebrae and permanent damage to the spine can result. The effects of the toxin can last from four to twelve weeks. Early therapy improves the prognosis. However, even with intensive medical care, tetanus is fatal in 10 to 25 percent of cases.
Tetanus: how is it diagnosed?
The physician can often make the diagnosis of tetanus based on the characteristic muscle spasms, especially if there is insufficient vaccination protection. Furthermore, a blood sample can be taken and tested for the toxin to make the diagnosis – however, an absence of the toxin in the blood is not certain proof that tetanus is not present.
Treatment of tetanus
There is no specific therapy against the venom of the clostridia. Treatment is mainly aimed at stopping the further spread of the bacterium in the body, neutralizing the toxin, and relieving symptoms.The wound is thoroughly cleaned, sometimes surgically (excising contaminated areas of the wound), and treated as openly as possible to allow oxygen to reach the wound and prevent the spread of bacteria. High-dose antibiotics can also help stop the spread of bacteria in the body. In addition, antiserum (tetanus immunoglobulin) is given to make the toxin ineffective. Tetanus vaccination can also help: Even if there is still vaccine protection, the booster shot can be administered to activate the body’s immune response more quickly. Medications to relax the muscles (muscle relaxants) and sedatives are administered to relieve symptoms. In addition, the affected person is protected from external stimuli such as light and noise, as these can trigger the muscle spasms.
Preventing tetanus
After an injury, it is always necessary to first remove any foreign bodies that may have penetrated, then disinfect the wound with iodine or alcohol without fail. This applies especially to small and very small wounds. Deep wounds must not be closed so that sufficient oxygen can reach the wound area. In the case of large wounds into which dirt has entered, or if there is insufficient vaccination protection, a doctor should be consulted in order to take the preventive measures described above. For larger, dirty wounds, a tetanus vaccination is also given as a preventive booster if vaccination protection still exists but the last vaccination was more than five years ago. This may also be the case if the wound is a bite wound, such as a dog bite or a human bite. In any case, a safe protection against tetanus is provided by the vaccination. This vaccination is well tolerated and the protection rate is almost 100 percent.
Vaccination protects against tetanus
Although there is a reliable vaccine against tetanus, many people no longer have adequate vaccine protection. Risk groups are mainly the elderly, chronically ill or people with skin diseases. If the body has too few antibodies in its blood when infected with the bacteria, it is often no longer able to fight the pathogens. The infection then spreads throughout the entire organism. The family doctor or a well-maintained vaccination record can provide certainty about the current vaccination status.
Tetanus: how often to vaccinate?
Basic tetanus immunization in children consists of four partial vaccinations:
- Initial vaccination in infancy (at 2 months of age).
- 2nd vaccination at 3 months
- 3rd vaccination at 4 months
- 4th vaccination at 11 to 14 months
The first booster is recommended for children aged 5 to 6 years, then again at age 9 to 17 years. For adults who did not receive basic immunization as a child, basic immunization consists of three vaccinations given 4 weeks apart and 6 to 12 months. The protection is valid for ten years in each case and must then be refreshed by a new vaccination.
Combination vaccination possible
The vaccine against tetanus is also available as a combination vaccination, so that the shot can also be given together with the vaccination against diphtheria, pertussis (whooping cough) and/or polio (polio). Anyone traveling abroad or going on a long-distance trip should definitely be vaccinated against tetanus. All vaccinations should be recorded in the vaccination card so that you know your vaccination status at all times.
Side effects of tetanus vaccination
The tetanus vaccine is usually very well tolerated, but you may experience (possibly painful) redness or swelling at the injection site. Also, in rare cases, general symptoms accompanying vaccination may occur during the first few days, such as:
- Fatigue
- Muscle pain
- Gastrointestinal problems
- Increased body temperature and chills
Side effects such as allergic reactions of the skin or respiratory tract are very rare in tetanus vaccination (less than 1 in 1,000 people affected). Sporadically, there were already diseases of the nervous system. Tetanus disease cannot be triggered by the vaccination because the vaccine contains the bacterial toxin that has been rendered harmless.
Sources and further information
- Robert Koch Institute (RKI): tetanus.
- Robert Koch Institute (RKI): Recommendations of the Standing Commission on Vaccination.
