In 2019, a child in Oregon who wasn’t immunized spent two months hospitalized with severe tetanus. After leaving the hospital, the child still faced extensive rehabilitation. Despite that, the child still isn’t immune to tetanus happening again.
Tetanus is a serious disease caused by a toxin made by the bacterium Clostridium tetani. The bacteria usually enter the body through cuts or wounds, especially those contaminated with dirt, soil, or feces. Tetanus can cause painful muscle stiffness and spasm, and it can be life-threatening if not prevented or treated. The stiffness and spasm can get so severe that the patient is unable to breathe effectively due to effects on the chest muscles.
Prior to the development of a vaccine in the 1940s, there were more than a million cases of tetanus a year, with 200,000 deaths a year, globally. The disease is now rare because of effective vaccination programs, but it still occurs in people who are not up to date with their vaccines or do not receive proper care after injuries.
Prevention of tetanus relies entirely on vaccination, as natural infection does not provide immunity. The Advisory Committee on Immunization Practices (ACIP) recommends a series of tetanus toxoid–containing vaccines for all children and adults. For children under 7 years, the DTaP vaccine (diphtheria, tetanus, and acellular pertussis) is given in five doses at ages 2, 4, 6, 15–18 months, and 4–6 years. At age 11–12, a single dose of Tdap (tetanus, diphtheria, and acellular pertussis) is recommended. Adults should receive a booster dose of either Td (tetanus and diphtheria) or Tdap every 10 years. If an adult has never received Tdap, it should be given as the next booster.
Treatment is available for those affected by tetanus. Aggressive wound care and an antibiotic called metronidazole can prevent further production of the toxin, and Tetanus Immune Globulin (TIG) can neutralize some of the toxin that’s already been released into the bloodstream by the bacteria.
Treatment is expensive! The TIG generally costs $10,000-$30,000, not counting however many days the patient is hospitalized and the aggressive wound care. The hospital stay for the child mentioned above totaled $811,929, not counting the extensive rehabilitation required. Without any treatment, the symptoms last at least 2 weeks, but have been known to last months. It’s clearly in our best interest to get vaccinated and stay up to date.
Special recommendations exist for wound management. The ACIP states that if a person has a wound and it has been more than five years since their last tetanus vaccine, a booster dose should be given. For clean, minor wounds, a booster is only needed if it has been more than 10 years since the last dose. Tdap is preferred for those who have never received it before, especially in adolescents and adults.
Pregnant individuals should receive a dose of Tdap during each pregnancy, ideally between 27 and 36 weeks, to protect both the mother and the newborn from tetanus and pertussis.
Tetanus vaccines are safe, with the most common side effects being mild, such as soreness at the injection site or mild fever. Severe allergic reactions are rare but are a contraindication to further doses.
In summary, the best way to prevent tetanus is to stay up to date with tetanus vaccines throughout life and to receive a booster after certain injuries if needed. It’s a common infection without immunizations, expensive to treat, and catching it doesn’t protect you from getting it again.
– Dr. Greg Kostur is a pediatrician at Health West Pediatrics. He champions a holistic approach to children’s healthcare and is an advocate for Health West’s integrated behavioral health model. Dr. Kostur earned his MD from the Uniformed Services University of Health Sciences in Bethesda, Maryland in 1999.
