(Lockjaw Vaccine; DTaP Vaccine-Tetanus; Tdap-Tetanus)
What Is Tetanus?
]]>Tetanus]]> is a bacterial infection that attacks the nervous system. Tetanus may result in severe muscle spasms, and this can lead to a condition known as lockjaw, which prevents the mouth from opening and closing. Tetanus can be fatal.
Tetanus is caused when the bacterium, Clostridium tetani, enters the body through a break in the skin. The bacterium can come from soil, dust, or manure. It produces a toxin that causes the illness.
This infection is most common in people aged 50 years and older. Also, people who have not been immunized for tetanus, who do not update their tetanus shot regularly, who use intravenous (IV) drugs, who have skin sores or wounds, or who have had ]]>burns]]> or open wounds exposed to soil or animal feces are at increased risk of developing tetanus.
In the United States and other countries with tetanus vaccination programs, the condition is rare. In fact, there have been fewer than 50 cases of tetanus reported each year in the United States since 1995.
- Stiff jaw or neck muscles
- Drooling or trouble swallowing
- Muscle spasticity or rigidity
- Pain or tingling at the wound site
- ]]>High]]> or low blood pressure
- Difficulty breathing
- Irregular heartbeat
- ]]>Cardiac arrest]]>
Symptoms usually begin seven days after the bacteria enter the body, but can begin anywhere from three days to three weeks after infection occurs.
Treatment for tetanus may include:
- Hospitalization to manage complications of the infection
- Opening and cleaning of the wound
- ]]>Surgical removal]]> of the entire wound
- Tetanus immune globulin (antibodies against tetanus that help neutralize the tetanus toxin)
- A tetanus shot, if tetanus vaccines are not up-to-date
- A breathing tube or ]]>tracheotomy]]> in cases of troubled breathing or swallowing
What Is the Tetanus Vaccine?
The tetanus vaccine is an inactivated toxoid (a substance that can create an antitoxin). It is made by growing the tetanus bacteria and purifying and inactivating the toxin it produces. Although the tetanus vaccine is available as a single vaccine; it is most commonly given in combination with ]]>diphtheria vaccine]]> (referred to as DT and Td). Other combinations, referred to as DTaP and Tdap, contain tetanus, diphtheria, and ]]>pertussis vaccines]]>. These vaccines, which must be stored in a refrigerator before given, are injected into the muscle, usually in the arm or thigh.
Who Should Get Vaccinated and When?
The DTaP vaccine is generally required before starting school. The regular immunization schedule (for children and adults) is as follows:
- DTaP vaccines at 2, 4, and 6 months, 15-18 months, and 4-6 years of age
- Booster dose of Tdap given at 11 or 12 years old for children who have not already had the Td booster—Those aged 13-18 years who missed the above booster dose or received Td only can get one dose of Tdap five years after the last dose.
- Booster of Tdap (one time dose for ages 19-64 years) or Td (every 10 years) to provide continued protection
For children aged 4 months to 6 years who have not yet received the vaccination, the Centers for Disease Control and Prevention (CDC) recommend the following catch-up schedule:
|Doses||Minimum Interval Between Doses|
|First and second dose||4 weeks|
|Second and third dose||4 weeks|
|Third and fourth dose||6 months|
|Fourth and fifth dose||
Children seven years and older and adults who have not been vaccinated should also be vaccinated. The choice and timing of vaccination varies depending on age and prior vaccine exposure.
People who meet the following criteria should also get the vaccine:
- Adults who expect to have close contact with an infant younger than 12 months should get a dose of Tdap (with a waiting time of two years since the last dose of Td)
- Healthcare workers who have direct patient contact within hospitals or clinics should get a dose of Tdap (with a waiting time of two years since the last dose of Td)
- If the last dose of Td was 10 years ago or longer, they should get a dose of Td.
- If the last dose of Td was less than 10 years ago, they should get a dose of Tdap after giving birth.
The vaccines are also given if someone has a severe cut or burn.
What Are the Risks Associated With the Tetanus Vaccine?
Most people tolerate the tetanus-containing vaccines without any trouble. The most common side effects are pain, redness, or swelling at the injection site, mild fever, headache, tiredness, nausea, vomiting, ]]>diarrhea]]>, or stomachache.
Rarely, a fever of more than 102ºF, severe gastrointestinal problems, or severe headache may occur. Nervous system problems and severe allergic reactions are extremely rare. Localized allergic reactions (redness and swelling) at the injection site may occur, while ]]>anaphylaxis]]> (life-threatening, widespread allergic reaction) is extremely rare.
]]>Acetaminophen]]> (eg, Tylenol) is sometimes given to reduce pain and fever that may occur after getting a vaccine. In infants, the medicine may weaken the vaccine's effectiveness. Discuss the risks and benefits of taking acetaminophen with the doctor.
Who Should Not Get Vaccinated?
The vast majority of people should receive their tetanus-containing vaccinations on schedule. However, individuals in whom the risks of vaccination outweigh the benefits include those who:
- Have had a life-threatening allergic reaction to DTP, DTap, DT, Tdap, or Td vaccine
- Have had a severe allergy to any component of the vaccine to be given
- Have gone into a ]]>coma]]> or long seizure within seven days after a dose of DTP or DTaP
Talk with your doctor before getting the vaccine if you have:
- Allergy to latex
- ]]>Epilepsy]]> or other nervous system problem
- Severe swelling or severe pain after a previous dose of any component of the vaccination to be given
- ]]>Guillain-Barre syndrome]]>
Wait until you recover to get the vaccine if you have moderate or severe illness on the day your shot is scheduled.
What Other Ways Can Tetanus Be Prevented Besides Vaccination?
Caring properly for wounds, including promptly cleaning them and seeing a doctor for medical care, can prevent a tetanus infection.
WHERE CAN I GET MORE INFORMATION?
American Academy of Pediatrics
National Immunization Program
Centers for Disease Control and Prevention
Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med. 2009;150:40-44.
CDC National Immunization Program website. Available at: http://www.cdc.gov/nip/. Accessed February 5, 2007.
Immunization Action Coalition website. Available at: http://www.immunize.org/. Accessed February 5, 2007.
National Foundation for Infectious Diseases website. Available at: http://www.nfid.org/. Accessed February 5, 2007.
Nemours Foundation website. Available at: http://www.nemours.org/index.html. Accessed February 5, 2007.
1/31/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm. Updated January 10, 2008. Accessed January 28, 2008.
10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Prymula R, Siegrist C, Chlibek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet. 2009;374(9698):1339.
Last reviewed November 2009 by ]]>David L. Horn, MD, FACP]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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