Health Care and Tetanus

One of the most painful medical conditions you can get is tetanus. Also known as lockjaw, tetanus is an infection characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. These spasms usually last a few minutes each time and occur frequently for three to four weeks.

According to the Mayo Clinic, 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. 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.

See your doctor for a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot in five years. If you aren't sure of when your last booster was, get a booster. Or, see your family physician about a tetanus booster for any wound — especially if it might have been contaminated with dirt, animal feces or manure — if you haven't had a booster shot within the past ten years or aren't sure of when you were last vaccinated. Much more detailed info is available at this website: http://www.mayoclinic.org/diseases-conditions/tetanus/home/ovc-20200456.

The Clostridium bacteria live in soil, saliva, dust, and manure. The bacteria can enter the body through a deep cut, like those you might get from stepping on a nail, or through a burn, according to the National Institutes for Health (NIH). In the US, where 50 or fewer cases of tetanus occur each year, deaths are more likely to occur in persons 60 years of age and older and in persons who are diabetic. More material on tetanus is available at these two websites: https://www.nlm.nih.gov/medlineplus/tetanus.html, and http://www.adultvaccination.org/tetanus_vaccine_vaccination_adult_immunizations.htm.

According to Nemours, Once the bacteria are in the body, they produce a neurotoxin (a protein that acts as a poison to the body's nervous system) that causes muscle spasms. The toxin can travel throughout the body via the bloodstream and lymph system. As it circulates more widely, the toxin interferes with the normal activity of nerves throughout the body, leading to generalized muscle spasms. Spasms can be so forceful that they tear muscles or even cause spine fractures. Without treatment, tetanus can be fatal.

In the United States, most cases of tetanus follow a contaminated cut or deep puncture injury, such as a wound caused by stepping on a nail. Sometimes the injury is so small the person never even sees a doctor. Injuries that involve dead skin (such as burns, frostbite, gangrene, or crush injuries) are more likely to cause tetanus. Wounds contaminated with soil, saliva, or feces — especially if not properly cleaned — and skin punctures from non-sterile needles (such as with drug use or self-performed tattooing or body piercing) are also at increased risk.

Another form of tetanus, neonatal tetanus, occurs in newborns who are delivered in unsanitary conditions, especially if the umbilical cord stump becomes contaminated. Prior to immunizations, neonatal tetanus was much more common in the United States. Now, routine immunizations for tetanus produce antibodies that mothers pass to their unborn babies. These maternal antibodies and sanitary cord-care techniques have made newborn tetanus very rare in developed countries. Much more information is available at this site: http://kidshealth.org/en/parents/tetanus.html.

Tetanus leads to death in about 1 in 10 cases. Several vaccines are used to prevent tetanus among children, adolescents, and adults including DTaP, Tdap, DT, and Td, according to the Centers for Disease Control (CDC). The Advisory Committee on Immunization Practices (ACIP) recommends 5 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for infants and children. One dose of DTaP vaccine is recommended at each of the following ages: 2 months, 4 months, 6 months, 15 through 18 months, 4 through 6 years old. DTaP vaccine may be given at the same time as other vaccines.

Some children should not get DTaP vaccine or should wait:

·         Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine.

·         Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.

·         Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose.

According to the CDC, you should talk with your doctor if your child:

·         Had a seizure or collapsed after a dose of DTaP

·         Cried non-stop for 3 hours or more after a dose of DTaP

·         Had a fever over 105 degrees Fahrenheit after a dose of DTaP.

Ask your health care provider for more information. Some of these children should not get another dose of pertussis vaccine, but may get a vaccine without pertussis, called DT. DTaP should not be given to anyone 7 years of age or older. Much more info is available at this website: http://www.cdc.gov/vaccines/vpd-vac/tetanus/.

According to the National Vaccine Information Center, tetanus bacteria do not survive in the presence of oxygen, which is why puncture wounds, which do not bleed very much and are protected by tissue and skin from direct exposure to the air, are a perfect environment for tetanus bacteria to multiply and cause infection. The incubation period for tetanus infection, from time of exposure to appearance of the first symptoms, can be three days to three weeks.

From 1972 to 2001, 52% of all tetanus cases reported in the U.S., and 76% of all deaths from tetanus were in persons over age 65. From 1987 to 2008, persons with diabetes accounted for 13% of all reported tetanus cases and 29% of all tetanus deaths. Intravenous drug abusers accounted for 15% of all cases during that time period. In 2009 there were 19 tetanus cases reported with two related deaths.

Vaccination is not completely foolproof and can cause some serious side effects in certain cases. The good news is that cases of tetanus have been vastly reduced over the last few decades. The bad news is that there have been some serious repercussions in a very small percentage of the overall population:

·         As of September 1, 2015, there had been 5,277 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following vaccination with tetanus or tetanus-containing vaccines combined with diphtheria vaccine, including 842 deaths and 4,344 serious injuries.

·         Using the MedAlerts search engine, as of September 30, 2015 there had been 22,686 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with tetanus and tetanus-containing vaccines combined with diphtheria vaccine since 1990.

·         Over 70%  of those serious tetanus vaccine-related adverse events occurring in children six years old and under. Of these tetanus-vaccine related adverse event reports to VAERS, 2,678 were deaths, with over 90% of the deaths occurring in children under six years of age.

Currently, there are 15 different tetanus-containing vaccines manufactured by various drug companies, which are licensed in the U.S.  More detailed material about tetanus is available at this website: http://www.nvic.org/Vaccines-and-Diseases/Tetanus.aspx.

Tetanus is a serious medical condition and should be treated as a deadly healthcare situation. Do not go without vaccination, but see your pediatrician or family medical practitioner to talk about all the available options and what they recommend as the best course of action for you and your family. Although all vaccinations carry some risk, the risk of going without preventive care is even greater. Talk with your doctor whenever you have any questions about tetanus.

Until next time.