Tetanus

Questions and Answers

Q&A
information about the disease and vaccines
What causes tetanus? plication that can lead to interference with breathing.
Tetanus is caused by a toxin (poison) produced by the Patients can also break their spine or long bones from
bacterium Clostridium tetani. The C. tetani bacteria convulsions. Other possible complications include
cannot grow in the presence of oxygen. They produce hypertension, abnormal heart rhythm, and secondary
spores that are very difficult to kill as they are resistant infections, which are common because of prolonged
to heat and many chemical agents. hospital stays.
Obviously, the high probability of death is a major
How does tetanus spread? complication.
C. tetani spores can be found in the soil and in the
intestines and feces of many household and farm How is tetanus diagnosed?
animals and humans. The bacteria usually enter the The diagnosis of tetanus is based on the clinical signs
human body through a puncture (in the presence of and symptoms only. Laboratory diagnosis is not useful
anaerobic [low oxygen] conditions, the spores will ger- as the C. tetani bacteria usually cannot be recovered
minate). from the wound of an individual who has tetanus, and
Tetanus is not spread from person to person. conversely, can be isolated from the skin of an indi-
vidual who does not have tetanus.
How long does it take to show signs of tetanus
after being exposed? What kind of injuries might allow tetanus to enter
the body?
The incubation period varies from 3–21 days, with an
average of eight days. The further the injury site is from Tetanus bacilli live in the soil, so the most dangerous
the central nervous system, the longer the incubation kind of injury involves possible contamination with
period. The shorter the incubation period, the higher dirt, animal feces, and manure. Although we have tradi-
the risk of death. tionally worried about deep puncture wounds, in reality
many types of injuries can allow tetanus bacilli to enter
What are the symptoms of tetanus? the body. In recent years, a higher proportion of cases
had minor wounds than had major ones, probably
The symptoms of tetanus are caused by the tetanus
because severe wounds were more likely to be properly
toxin acting on the central nervous system. In the most
managed. People can also get tetanus from splinters,
common form of tetanus, the first sign is spasm of the
self-piercing, and self-tattooing. Injecting drug users
jaw muscles, followed by stiffness of the neck, difficulty
are also at risk for tetanus.
in swallowing, and stiffness of the abdominal muscles.
Other signs include fever, sweating, elevated blood I stepped on a nail in our yard. What should I do?
pressure, and rapid heart rate. Spasms often occur, Any wound that may involve contamination with teta-
which may last for several minutes and continue for nus bacilli should be attended to as soon as possible.
3–4 weeks. Complete recovery, if it occurs, may take Treatment depends on your vaccination status and the
months. nature of the wound. In all cases, the wound should be
cleaned. Seek treatment immediately and bring your
How serious is tetanus?
immunization record with you.
Tetanus has a high fatality rate. In recent years, tetanus
With wounds that involve the possibility of tetanus
has been fatal in about 10% to 20% of reported cases.
contamination, a patient with an unknown or incom-
What are possible complications from tetanus? plete history of tetanus vaccination needs a tetanus-
and diphtheria-containing shot (Td or Tdap) and a dose
Laryngospasm (spasm of the vocal cords) is a com- of tetanus immune globulin (TIG) as soon as possible.

continued on the next page ▶

Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org

www.immunize.org/catg.d/p4220.pdf • Item #P4220 (8/18)
Tetanus: Questions and Answers (continued) page 2 of 4

A person with a documented series of three tetanus- When did vaccine first become available for diph-
and diphtheria-containing shots (Td or Tdap) who has theria, tetanus, and pertussis?
received a booster dose within the last ten years should
The first inactivated toxin, or toxoid, against diphtheria
be protected. However, to ensure adequate protection,
was developed around 1921, but it was not widely used
a booster dose of vaccine may still be given if it has
until the 1930s. In 1924, the first tetanus toxoid (inac-
been more than five years since the last dose and the
tivated toxin) was produced and was used successfully
wound is other than clean and minor.
to prevent tetanus in the armed services during World
Is there a treatment for tetanus? War II. The first pertussis vaccine was developed in the
1930s and was in widespread use by the mid-1940s,
There is no "cure" for tetanus once a person develops when pertussis vaccine was combined with diphtheria
symptoms, just supportive treatment and manage- and tetanus toxoids to make the combination DTP vac-
ment of complications. The best "treatment" is preven- cine. A series of 4 doses of whole-cell DTP vaccine was
tion through immunization. quite (70–90%) effective in preventing serious pertus-
sis disease; however, up to half of the children who
How common is tetanus in the United States? received the vaccine developed local reactions such
Tetanus first became a reportable disease in the late as redness, swelling, and pain at the injection site. In
1940s. At that time, there were 500–600 cases reported 1991, concerns about safety led to the development
per year. After the introduction of the tetanus vaccine of more purified (acellular) pertussis vaccines that are
in the mid-1940s, reported cases of tetanus dropped associated with fewer side effects. These acellular per-
steadily. tussis vaccines have replaced the whole cell DTP vac-
cines in the U.S.
From 2001 through 2016 an average of 29 cases were
reported per year. In 2005, two new vaccine products were licensed for
use in adolescents and adults that combine the tetanus
Almost all cases of tetanus are in people who have
and diphtheria toxoids with acellular pertussis (Tdap)
never been vaccinated, or who completed their child-
vaccine. These vaccines are the first acellular pertussis-
hood series, but did not have a booster dose in the
containing vaccines that make it possible to vaccinate
preceding 10 years.
adolescents and adults against pertussis.
What is neonatal tetanus? How are vaccines made that prevent diphtheria,
Neonatal tetanus is a form of tetanus that occurs in tetanus and pertussis?
newborn infants, most often through the use of an
These vaccines are made by chemically treating the
unsterile cutting instrument on the unhealed umbilical
diphtheria, tetanus, and pertussis toxins to render
stump. These babies usually have no temporary immu-
them nontoxic yet still capable of eliciting an immune
nity passed on from their mother because their mother
response in the vaccinated person. They are known as
usually hasn't been vaccinated and therefore has no
“inactivated” vaccines because they do not contain live
immunity.
bacteria and cannot replicate themselves, which is why
Neonatal tetanus is very rare in the United States (only multiple doses are needed to produce immunity.
3 cases were reported from 2001 through 2016), but
is common in some developing countries. It caused What’s the difference between all the vaccines
more than 257,000 deaths worldwide each year in the containing diphtheria and tetanus toxoids and
years 2000 to 2003. pertussis vaccine?
Can you get tetanus more than once? It’s like alphabet soup! Here is a listing of the various
products:
Yes! Tetanus disease does not result in immunity
because so little of the potent toxin is required to cause • DTaP: Diphtheria and tetanus toxoids and acellular
the disease. People recovering from tetanus should pertussis vaccine; given to infants and children ages
begin or complete the vaccination series. 6 weeks through 6 years. In addition, four childhood
combination vaccines include DTaP as a compo-
nent.

continued on the next page ▶

Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p4220.pdf • Item #P4220(8/18)
Tetanus: Questions and Answers (continued) page 3 of 4

• DT: Diphtheria and tetanus toxoids, without the be given to all adolescents at age 11–12 years as a
pertussis component; given to infants and children booster during the routine adolescent immunization
ages 6 weeks through 6 years who have a contraindi- visit if the adolescent has finished the childhood DTaP
cation to the pertussis component. schedule and has not already received a dose of Td or
Tdap. If a child age 7–10 years did not complete a pri-
• Tdap: Tetanus and diphtheria toxoids with acellular
mary series in childhood, a dose of Tdap may be given
pertussis vaccine; given to adolescents and adults,
earlier as part of the catch-up vaccinations.
usually as a single dose; the exception is pregnant
women who should receive Tdap during each preg- All adults should receive a single dose of Tdap as soon
nancy. as feasible. Then, subsequent booster doses of Td
should be given every ten years. Pregnant teens and
• Td: Tetanus and diphtheria toxoids; given to children women should receive Tdap during each pregnancy.
and adults ages 7 years and older. Note the small Adolescents and adults who have recently received Td
“d” which indicates a much smaller quantity of vaccine can be given Tdap without any waiting period.
diphtheria toxoid than in the pediatric DTaP formu-
lation. If someone experiences a deep or puncture wound, or
a wound contaminated with dirt, an additional booster
How are these vaccines given? dose may be given if the last dose was more than five
years ago. This could be a dose of Td or Tdap, depend-
The DTaP and DT preparations are all given as an injec- ing on the person’s vaccination history. It is important
tion in the anterolateral thigh muscle (for infants and to keep an up-to-date record of all immunizations so
young toddlers) or in the deltoid muscle (for older chil- that repeat doses don’t become necessary. Although
dren and adults). Tdap and Td are given in the deltoid it is vital to be adequately protected, receiving more
muscle for children and adults age 7 years and older. doses than recommended can lead to increased local
Who should get these vaccines? reactions, such as painful swelling of the arm.

All children, beginning at age 2 months, and adults Who recommends the use of these vaccines?
need protection against these three diseases—diphthe- The Centers for Disease Control and Prevention (CDC),
ria, tetanus, and pertussis (whooping cough). Routine the American Academy of Pediatrics (AAP), the Ameri-
booster doses are also needed throughout life. can Academy of Family Physicians (AAFP), and the
American College of Physicians (ACP) all recommend
How many doses of vaccine are needed?
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 age. A What side effects have been reported with these
fifth shot, or booster dose, is recommended between vaccines?
age 4 and 6 years, unless the fourth dose was given Local reactions, such as fever, redness and swelling at
late (after the fourth birthday). the injection site, and soreness and tenderness where
For people who were never vaccinated or who may the shot was given, are not uncommon in children
have started but not completed a series of shots, a and adults. These minor local and systemic adverse
3-dose series of Td should be given with 1 to 2 months reactions are much less common with acellular DTaP
between dose #1 and #2, and 6 to 12 months between vaccine; however, a determination of more rare adverse
dose #2 and #3. One of the doses, preferably the first, effects can only be made when additional data are
should also contain the pertussis component in the available following extended use of DTaP.
form of Tdap. Side effects following Td or Tdap in older children and
Because immunity to diphtheria and tetanus wanes adults include redness and swelling at the injection site
with time, boosters of Td are needed every ten years. (following Td) and generalized body aches, and tired-
ness (following Tdap). Older children and adults who
When adolescents and adults are scheduled for received more than the recommended doses of Td/
their routine tetanus and diphtheria booster, Tdap vaccine can experience increased local reactions,
should they get vaccinated with Td or Tdap? such as painful swelling of the arm. This is due to the
Immunization experts recommend that a dose of Tdap high levels of tetanus antibody in their blood.

continued on the next page ▶

Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p4220.pdf • Item #P4220 (8/18)
Tetanus: Questions and Answers (continued) page 4 of 4

How effective are these vaccines? A person who develops a coma, decreased level of con-
After a properly spaced primary series of DTaP or Td/ sciousness or prolonged seizures not due to another
Tdap, approximately 95% of people will have protective identifiable cause within 7 days of administration of
levels of diphtheria antitoxin and 100% will have protec- a previous dose of DTP or DTaP should not receive
tive levels of tetanus antitoxin in their blood. However, another dose of DTaP. DT should be administered for
antitoxin levels decrease with time so routine boosters the remaining doses in the series to ensure protection
with tetanus and diphtheria toxoids are recommended against diphtheria and tetanus.
every 10 years. Estimates of acellular pertussis vac- Certain conditions are precautions to DTaP and Tdap
cine efficacy range from 80% to 85%, but protection vaccines. A precaution means that a person would usu-
declines as the time since the dose increases. ally not receive the vaccine but there may be occasions
when the benefit of immunization outweighs the risk,
Can a pregnant woman receive Tdap vaccine? for instance during a community-wide outbreak of per-
Yes. All pregnant women should receive Tdap during tussis. Precautions include: Guillain-Barre syndrome
each pregnancy, preferably early in the time period (a rare type of neurological condition) within 6 weeks
between 27 and 36 weeks’ gestation. Because infants after a previous dose of tetanus toxoid; a severe local
are not adequately protected against pertussis until reaction (called an Arthus reaction) after a previous
they have received at least 3 doses of DTaP, it is espe- dose of tetanus or diphtheria toxoid-containing vaccine
cially important that all contacts (family members, (defer vaccination until at least 10 years have elapsed
caregivers) of infants younger than age 12 months are since the last dose of vaccine that caused the reaction);
vaccinated with Tdap. If a new mother hasn’t been vac- and a moderate or severe acute illness with or without
cinated with Tdap, she should receive it before hospital fever. A person with a mild illness may be vaccinated.
discharge, even if she is breastfeeding. A person with a recognized, possible, or potential neu-
rologic condition should delay receiving DTaP or Tdap
Who should not receive these vaccines? vaccine until the condition is evaluated, treated, and/or
Generally, any person who has had a serious allergic stabilized. Although DTaP vaccine does not cause neu-
reaction to a vaccine component or a prior dose of the rological disorders, receiving the vaccine can cause an
vaccine should not receive another dose of the same already-present underlying condition to show itself.
vaccine. People who had a serious allergic reaction to
a previous dose of DTaP or Tdap vaccine should not Can the vaccine cause the disease?
receive another dose. No.

Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p4220.pdf • Item #P4220 (8/18)