Questions and Answers - Immunization Action …

1 Tetanus: Questions and Answers Information about the disease and vaccines What causes tetanus? Obviously, the high probability of death is a major Tetanus is caused by a toxin (poison) produced by complication. the bacterium Clostridium tetani. The C. tetani bac- teria cannot grow in the presence of oxygen. They How is tetanus diagnosed? produce spores that are very difficult to kill as they The diagnosis of tetanus is based on the clinical are resistant to heat and many chemical agents. signs and symptoms only. Laboratory diagnosis is not useful as the C. tetani bacteria usually cannot How does tetanus spread? be recovered from the wound of an individual who C. tetani spores can be found in the soil and in the has tetanus, and conversely, can be isolated from intestines and feces of many household and farm the skin of an individual who does not have tetanus. animals and humans. The bacteria usually enter the human body through a puncture (in the presence of What kind of injuries might allow tetanus to enter anaerobic [low oxygen] conditions, the spores will the body?)

2 Germinate). Tetanus bacilli live in the soil, so the most dangerous kind of injury involves possible contamination with Tetanus is not spread from person to person. dirt, animal feces, and manure. Although we have How long does it take to show signs of tetanus after traditionally worried about deep puncture wounds, being exposed? in reality many types of injuries can allow tetanus The incubation period varies from 3 21 days, with bacilli to enter the body. In recent years, a higher an average of eight days. The further the injury site proportion of cases had minor wounds than had ma- is from the central nervous system, the longer the jor ones, probably because severe wounds were more incubation period. The shorter the incubation period, likely to be properly managed. People can also get the higher the risk of death. tetanus from splinters, self-piercing, and self-tattoo- ing. Injecting drug users are also at risk for tetanus. What are the symptoms of tetanus?

3 The symptoms of tetanus are caused by the teta- I stepped on a nail in our yard. What should I do? nus toxin acting on the central nervous system. In Any wound that may involve contamination with the most common form of tetanus, the first sign is tetanus bacilli should be attended to as soon as pos- spasm of the jaw muscles, followed by stiffness of sible. Treatment depends on your vaccination status the neck, difficulty in swallowing, and stiffness of and the nature of the wound. In all cases, the wound the abdominal muscles. should be cleaned. Seek treatment immediately and bring your Immunization record with you. Other signs include fever, sweating, elevated blood pressure, and rapid heart rate. Spasms often occur, With wounds that involve the possibility of tetanus which may last for several minutes and continue for contamination, a patient with an unknown or incom- 3 4 weeks. Complete recovery, if it occurs, may take plete history of tetanus vaccination needs a tetanus- months.

4 And diphtheria-containing shot (Td or Tdap) and a dose of tetanus immune globulin (TIG) as soon as How serious is tetanus? possible. Tetanus has a high fatality rate. In recent years, teta- A person with a documented series of three tetanus- nus has been fatal in about 10% of reported cases. and diphtheria-containing shots (Td or Tdap) who has received a booster dose within the last ten years What are possible complications from tetanus? should be protected. However, to ensure adequate Laryngospasm (spasm of the vocal cords) is a compli- protection, a booster dose of vaccine may still be cation that can lead to interference with breathing. given if it has been more than five years since the last Patients can also break their spine or long bones dose and the wound is other than clean and minor. from convulsions. Other possible complications in- clude hypertension, abnormal heart rhythm, and Is there a treatment for tetanus? secondary infections, which are common because There is no "cure" for tetanus once a person develops of prolonged hospital stays.

5 Page 1 of 4. Technical content reviewed by the Centers for Disease Control and Prevention Item #P4220 (7/13). Immunization Action Coalition St. Paul, MN 55104 (651) 647-9009 Page 2 of 4. symptoms, just supportive treatment and manage- 1991, concerns about safety led to the development ment of complications. The best "treatment" is pre- of more purified (acellular) pertussis vaccines that vention through Immunization . are associated with fewer side effects. These acel- lular pertussis vaccines have replaced the whole cell How common is tetanus in the United States? DTP vaccines in the Tetanus first became a reportable disease in the late In 2005, two new vaccine products were licensed for 1940s. At that time, there were 500 600 cases re- use in adolescents and adults that combine the teta- ported per year. After the introduction of the tetanus nus and diphtheria toxoids with acellular pertussis vaccine in the mid-1940s, reported cases of tetanus (Tdap) vaccine.

6 These vaccines are the first acellular dropped steadily. pertussis-containing vaccines that make it possible to From 2000 through 2007 an average of 31 cases vaccinate adolescents and adults against pertussis. were reported per year. Almost all cases of tetanus are in people who have How are vaccines made that prevent diphtheria, tetanus and pertussis? never been vaccinated, or who completed their child- These vaccines are made by chemically treating the hood series, but did not have a booster dose in the diphtheria, tetanus, and pertussis toxins to render preceding 10 years. them nontoxic yet still capable of eliciting an im- What is neonatal tetanus? mune response in the vaccinated person. They are Neonatal tetanus is a form of tetanus that occurs in known as inactivated vaccines because they do newborn infants, most often through the use of an not contain live bacteria and cannot replicate them- unsterile cutting instrument on the unhealed umbili- selves, which is why multiple doses are needed to cal stump.

7 These babies usually have no temporary produce immunity. immunity passed on from their mother because their What's the difference between all the vaccines con- mother usually hasn't been vaccinated and therefore taining diphtheria and tetanus toxoids and pertussis has no immunity. vaccine? Neonatal tetanus is very rare in the United States It's like alphabet soup! Here is a listing of the vari- (only two cases have been reported since 1989), but ous products: is common in some developing countries. It caused DTaP: Diphtheria and tetanus toxoids and acellu- more than 257,000 deaths worldwide each year in lar pertussis vaccine; given to infants and children the years 2000 to 2003. ages 6 weeks through 6 years. In addition, three childhood combination vaccines include DTaP as Can you get tetanus more than once? a component. Yes! Tetanus disease does not result in immunity be- DT: Diphtheria and tetanus toxoids, without the cause so little of the potent toxin is required to cause pertussis component; given to infants and chil- the disease.

8 People recovering from tetanus should dren ages 6 weeks through 6 years who have a begin or complete the vaccination series. contraindication to the pertussis component. When did vaccine first become available for diphthe- Tdap: Tetanus and diphtheria toxoids with acel- ria, tetanus, and pertussis? lular pertussis vaccine; given to adolescents and The first inactivated toxin, or toxoid, against diph- adults, usually as a single dose; the exception is theria was developed around 1921, but it was not pregnant women who should receive Tdap during widely used until the 1930s. In 1924, the first teta- each pregnancy. nus toxoid (inactivated toxin) was produced and was Td: Tetanus and diphtheria toxoids; given to chil- used successfully to prevent tetanus in the armed dren and adults ages 7 years and older. Note the services during World War II. The first pertussis small d which indicates a much smaller quantity vaccine was developed in the 1930s and was in of diphtheria toxoid than in the pediatric DTaP.

9 Widespread use by the mid-1940s, when pertussis formulation. vaccine was combined with diphtheria and tetanus toxoids to make the combination DTP vaccine. A How are these vaccines given? series of 4 doses of whole-cell DTP vaccine was quite The DTaP and DT preparations are all given as an in- (70 90%) effective in preventing serious pertussis jection in the anterolateral thigh muscle (for infants disease; however, up to half of the children who re- and young toddlers) or in the deltoid muscle (for ceived the vaccine developed local reactions such as older children and adults). Tdap and Td are given redness, swelling, and pain at the injection site. In in the deltoid muscle for children and adults age 7. Immunization Action Coalition St. Paul, MN 55104 (651) 647-9009 Page 3 of 4. years and older. protected, receiving more doses than recommended can lead to increased local reactions, such as painful Who should get these vaccines? swelling of the arm. All children, beginning at age 2 months, and adults need protection against these three diseases diph- Who recommends the use of these vaccines?

10 Theria, tetanus, and pertussis (whooping cough). The Centers for Disease Control and Prevention Routine booster doses are also needed throughout (CDC), the American Academy of Pediatrics (AAP), life. the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP) all How many doses of vaccine are needed? recommend this vaccine. The usual schedule for infants is a series of four doses of DTaP given at 2, 4, 6, and 15 18 months of What side effects have been reported with these age. A fifth shot, or booster dose, is recommended vaccines? between age 4 and 6 years, unless the fourth dose Local reactions, such as fever, redness and swelling was given late (after the fourth birthday). at the injection site, and soreness and tenderness where the shot was given, are not uncommon in chil- For people who were never vaccinated or who may dren and adults. These minor local and systemic ad- have started but not completed a series of shots, verse reactions are much less common with acellular a 3-dose series of Td should be given with 1 to DTaP vaccine; however, a determination of more rare 2 months between dose #1 and #2, and 6 to 12.