Tetanus

Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as "lockjaw."

Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and other parts of the developed world. However, the disease remains a threat to those who aren't up to date on their vaccinations, and is more common in developing countries.

There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve.

Symptoms

• Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter the body through a wound, even a scratch.
• The average incubation period is seven to 10 days, but is usually between 3-21 days or longer.
  • In general, shorter incubation periods are seen with more heavily contaminated wounds, more serious disease, and a worse outcome (prognosis).
• Common signs and symptoms of tetanus include:
  • Spasms and stiffness in your jaw muscles (“locking” of the jaw); can cause strange-looking steady smile or grin
  • Difficulty opening the mouth or swallowing
  • Stiffness of the neck muscles
  • Stiffness of the abdominal muscles
  • Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light
  • Painful muscle stiffness all over the body
  • Jerking or staring (seizures)
  • Headache
  • Fever and sweating
  • Changes in blood pressure & a fast heart rate

Causes

• Spores of the bacteria, Clostridium tetani, cause tetanus, and are found everywhere in the environment, particularly in soil, ash, intestinal tracts/feces of animals and humans, and on the surfaces of skin and rusty tools like nails, needles, barbed wire, etc. Being very resistant to heat and most antiseptics, the spores can survive for years.
• When they enter a deep flesh wound, spores grow into bacteria that can produce a powerful toxin, tetanospasmin, which impairs the nerves controlling muscles (motor neurons). The toxin can cause muscle stiffness and spasms — the major signs of tetanus.
• Nearly all cases of tetanus occur in people who have never been vaccinated or adults who haven't kept up with their 10-year booster shots.
• You can't catch tetanus from a person who has it.

Risk factors

• Anyone can get tetanus, but the disease is particularly common and serious in newborn babies and pregnant women who have not been sufficiently immunized with tetanus-toxoid-containing vaccines. Tetanus during pregnancy or within 6 weeks of the end of pregnancy is called “maternal tetanus”, and tetanus within the first 28 days of life is called “neonatal tetanus”.
• The disease remains an important public health problem in many parts of the world, but especially in low-income countries or districts, where immunization coverage is low, and unclean birth practices are common. Neonatal tetanus occurs when nonsterile instruments are used to cut the umbilical cord or when contaminated material is used to cover the umbilical stump. Deliveries carried out by people with unclean hands or on a contaminated surface are also risk factors.
• The following increase the likelihood of getting tetanus:
  • Failure to get vaccinated or to keep up to date with booster shots against tetanus
  • An injury that lets tetanus spores into the wound
  • A foreign body, such as a nail or splinter
• Tetanus cases have developed from the following:
  • Puncture wounds — including from rusty nails/tools, splinters, body piercings, tattoos, injection drugs
  • Gunshot wounds
  • Compound fractures
  • Burns
  • Surgical wounds
  • Injection drug use
  • Animal or insect bites
  • Infected foot ulcers
  • Dental infections
  • Infected umbilical stumps in newborns born of inadequately immunized mothers
  • Crush injuries
  • Injuries with dead tissue

Complications

Once tetanus toxin has bonded to nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires new nerve endings to grow, which can take up to several months.

• Complications of tetanus infection may include:
  • Uncontrolled/involuntary tightening of the vocal cords (laryngospasm)
  • Broken bones. The severity of spasms may cause the spine and other bones to break.
  • Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches.
  • Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing.
    • Respiratory failure is the most common cause of death (1 to 2 in 10 cases are fatal). Lack of oxygen may also induce cardiac arrest and death.
    • Pneumonia develops by breathing in foreign materials (aspiration pneumonia) is another cause of death.

History

• Description of the disease by Hippocrates exists from at least as far back as the 5th century BC.
• The cause of the disease was determined in 1884 by Antonio Carle and Giorgio Rattone at the University of Turin.
• In 1891, C. tetani was isolated from a human victim by Kitasato Shibasaburō, who later showed that the organism could produce disease when injected into animals, and that the toxin could be neutralized by specific antibodies.
• In 1897, Edmond Nocard showed that tetanus antitoxin induced passive immunity in humans, and could be used for prophylaxis and treatment.
• Tetanus toxoid vaccine was developed by P. Descombey in 1924, and was widely used to prevent tetanus induced by battle wounds during World War II.

Statistics & Mortality

• Today, tetanus is uncommon in the United States, with an average of 30 reported cases each year. Nearly all cases of tetanus are among people who have never received a tetanus vaccine, or adults who don’t stay up to date on their 10-year booster shots.
• About ten percent of cases prove fatal.
• Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil contains a lot of organic matter.
• In 2015 there were about 209,000 infections and about 59,000 deaths globally. This is down from 356,000 deaths in 1990.
• Tetanus – in particular, the neonatal form – remains a significant public health problem in non-industrialized countries with 59,000 newborns worldwide dying in 2008 as a result of neonatal tetanus.
• In the United States, from 2000 through 2007 an average of 31 cases were reported per year. Nearly all of the cases in the United States occur in unimmunized individuals or individuals who have allowed their inoculations to lapse.
• In 2015 the highest rates of neonatal tetanus mortality (more than 1,000 deaths per 100,000 population) were observed in Somalia, South Sudan, Afghanistan, and Kenya.
  • The highest rates of mortality from tetanus after the neonatal period (more than 5 deaths per 100,000 population) were observed in Somalia, South Sudan, and Kenya.
• Mortality is substantially higher for people older than 60 years (40%) than for those aged 20-59 years (8%). From 1998 to 2000, 75% of the deaths in the United States were in patients older than 60 years. (Medscape - What is the mortality rate for tetanus (lockjaw)?. By: Patrick B Hinfey, MD; Chief Editor: John L Brusch, MD,FACP. Updated 18 Jan 2019)
• In 2015, about 34,000 newborns died from neonatal tetanus, a 96% reduction since 1988, largely due to scaled-up immunization with TTCV.
• In 2016, 86% of infants worldwide were vaccinated with 3 doses of diphtheria-tetanus-pertussis (DTP) containing vaccine.
• As of April 2018, there are 14 countries that have not achieved Maternal & Neonatal Tetanus Elimination (MNTE).
• It is estimated that tetanus causes 213,000 – 293,000 deaths worldwide each year and that it is responsible for 5–7% of all neonatal deaths and 5% of maternal deaths globally.
• Neonatal tetanus has been eliminated from Europe and the overall number of tetanus cases has declined sharply since the 1950s. Tetanus is today a rare disease in Europe and in 2007 a total of 144 cases of tetanus cases, of which 125 were confirmed, were reported by 25 EU countries.
• The highest tetanus risk in Europe is found in the elderly unvaccinated or partially vaccinated population and among injecting drug users. Induced tetanus immunity wanes with increasing age and this partly explains the higher incidence in higher age groups.

Notables who died of Tetanus

1. Ranker - Famous People Who Died of Tetanus (10 listed)

• Fred Thomson (1890-1928) (aka: Frederick Clifton Thomson) - Silent film cowboy actor; (From: Wikipedia - Fred Thomson) In early December 1928, Thomson stepped on a nail while working in his stables. Contracting tetanus, which his doctors initially misdiagnosed, he died in Los Angeles on Christmas Day 1928.
• George Hogg (1915-1945) - Adventurer; (From: Wikipedia - George Hogg) In July 1945, Hogg stubbed his toe while playing basketball with the boys. It became infected with tetanus and two boys went to Lanzhou by motorcycle, a 500-mile round trip to get medicine.
• John A Roebling (1806-1869) - American civil engineer; (From: Wikipedia - John A Roebling) On June 28, 1869 at Fulton Ferry, while he was standing at the edge of a dock, working on fixing the location where the bridge would be built, his foot was crushed by an arriving ferry. His injured toes were amputated. He refused further medical treatment and wanted to cure his foot by "water therapy" (continuous pouring of water over the wound). His condition deteriorated. He died on July 22, 1869 of tetanus at the home of his son on Hicks Street, in Brooklyn Heights. It was just 24 days after the accident. Roebling is buried in the Riverview Cemetery in Trenton, New Jersey.
• George Crockett Strong (1832-1863) American Civil War (Union); (From: Wikipedia - George Crockett Strong) He was wounded on July 18, 1863, while leading the assault against Fort Wagner on Morris Island, South Carolina, and died of tetanus in New York City.
• Lord Robert Manners (1758-1782) Royal Navy officer; (From: Wikipedia - Lord Robert Manners (Royal Navy officer)) At the Battle of the Saintes (12 April 1782), Resolution was in the centre of the line and saw heavy action. During the battle, one of Manners' arms was broken, and both legs wounded, one so severely as to require amputation. Being of a strong constitution, it was hoped he might survive, and he was sent back to England aboard the frigate Andromache. However, tetanus set in, and he died on 23 April 1782 and was buried at sea.
• George Montagu (1753-1815) English army officer & naturalist; (From: Wikipedia - George Montagu (naturalist)) He died of tetanus after stepping on a nail at Knowle House. He was buried at Kingsbridge Parish Church.
• Joe Hill Louis (1921-1957) American singer, harmonica player & guitarist; (From: Wikipedia - Joe Hill Louis) Louis died on August 5, 1957, in John Gaston Hospital, in Memphis, at the age of 35, of tetanus contracted as a result of an infected cut on his thumb, sustained while he was working as an odd job man.
• Amos Stoddard (1762-1813) US Army officer in American Revolution & War of 1812; (From: Wikipedia - Amos Stoddard) From May 1 to May 9 of 1813, Fort Meigs was attacked by a large British and Indian force from Canada under Major General Henry Procter (see Siege of Fort Meigs). Early on, Stoddard was wounded in the leg by shrapnel. He survived long enough to see the British retreat, but on May 11 he died from tetanus.
• Johann Tserclaes, Count of Tilly (1559-1632) Dutch field marshal of Catholic League’s forces in the Thirty’s War; (From: Wikipedia - Johann Tserclaes, Count of Tilly) He was wounded by a cannonball early in the Battle of Rain and died of tetanus fifteen days later in Ingolstadt at the age of 73 on 30 April 1632. His tomb is in Altötting, Upper Bavaria.

Resources & Additional Reading

• Mayo Clinic - Tetanus
• CDC - Tetanus Vaccination
• CDC - Tetanus
• Wikipedia - Tetanus
• World Health Organization - Tetanus 9 May 2018
• European Centre for Disease Prevention & Control - Disease factsheet about tetanus
• Tetanus-Once a Vaccination Success Story: Now Making a Comeback? By: Dr Carol Lynn Curchoe, 17Mar 2017 (Image)
• Science ABC - Will You Get Tetanus if You Step on a Rusty Nail? (Image)
• PM Pediatrics - Why Do I Need a Tetanus Shot? By: Dr Christina Johns. 8 May 2017