Tetanus and Tetanus Shot for Kids

Vaccine Preventable Disease Basics

Stepping on a rusty nail is one classic way that you can get tetanus.
Stepping on a rusty nail is one classic way that you can get tetanus, but it is important to remember that any dirty wound can get contaminated with tetanus bacteria. Photo © Sándor F. Szabó

Tetanus is a vaccine-preventable disease that is caused by the Clostridium tetani bacteria.

Unlike most other infections, though, tetanus isn't contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.

The now "awake" Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.

Symptoms of Tetanus

Unvaccinated children can develop symptoms of tetanus two days to two months (average is two weeks) after getting a wound that is contaminated by tetanus bacteria.

The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:

  • spasms of the muscles around their mouth, giving the typical "lockjaw" appearance of tetanus
  • spasms of the muscles around the throat, which can make it hard to swallow
  • spasms of the chest muscles, making it difficult to breath
  • spasms of the muscles in the neck, back, arms, legs, and abdomen

Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.

Diagnosis of Tetanus

Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.

It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail. Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections.

Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds become contaminated with dirt or feces.

Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to too.

Treatments for Tetanus

The treatments for tetanus can include sedation and mechanical ventilation and:

  • human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
  • antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
  • muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
  • neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis

And tragically, tetanus is a life-threatening disease. On average, about 3 people still die from tetanus each year in the United States, although this is well below the 200 to 300 deaths we saw in the 1950s and 60s.

When Do Kids Get Tetanus Shots

Most importantly, like other vaccine-preventable diseases, keeping up-to-date on your child's immunizations will help to prevent your child from getting tetanus.

One thing that complicates tetanus is that your child may still need a tetanus shot even if he is up to date on his immunizations if it has been five or more years since his last tetanus shot and he has:

  • a wound that is contaminated with dirt, feces, or saliva
  • a puncture wound
  • an avulsion wound, in which part of the wound is pulled away from the other part
  • a wound caused by crush injury, burn, or frostbite

So for example, if your child had a tetanus shot at age four (kids get their primary series of three doses of DTaP at 2, 4, and 6 months and booster doses at 18 months and 4 years, or just before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).

What You Need To Know About Tetanus

Other things to know about tetanus and tetanus shots include that:

  • Tetanus is rare in the United States, but likely because so many kids get immunized with the DTaP and Tdap vaccines, which provide protection against the tetanus bacteria.
  • Neonatal tetanus can occur in newborns if their mother isn't immunized against tetanus and their umbilical cord stump gets contaminated. Although neonatal tetanus was declared eliminated before 2000 in the United States, at least 49,000 newborns died of neonatal tetanus as late as 2013 worldwide.
  • See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.

Get Educated. Get Vaccinated.

Sources:

CDC. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013

Long: Principles and Practice of Pediatric Infectious Diseases, 2nd ed.

Kliegman: Nelson Textbook of Pediatrics, 18th ed.

Gershon: Krugman's Infectious Diseases of Children, 11th ed.

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