Tetanus

Overview

Tetanus is a serious bacterial infection that affects the nervous system. It causes painful muscle stiffness and spasms, especially in the jaw and neck, which is why it is sometimes called lockjaw.

Tetanus is rare in countries with routine vaccination, but it still affects people in many parts of the world, especially where vaccination coverage is low.

Tetanus can affect anyone who is not fully vaccinated. Older adults, people with diabetes, and people who inject drugs are at higher risk. People with deep or dirty wounds are also at risk.

Symptoms

Common symptoms

• Stiff jaw and trouble opening the mouth
• Muscle spasms in the neck, back, or belly
• Painful muscle stiffness
• Trouble swallowing
• Fever and sweating
• Fast heartbeat

Symptoms in children

• Crying with painful muscle spasms
• Trouble sucking or feeding
• A stiff neck and difficulty opening the mouth

Symptoms in older adults

• Muscle stiffness that makes falling more likely
• Difficulty swallowing, which can lead to choking
• Feeling weak or less active because of painful spasms

Causes

Main causes

• Tetanus bacteria live in soil, dust, and manure.
• They enter the body through breaks in the skin, such as cuts, puncture wounds, burns, or animal bites.
• Once inside, they release a toxin that attacks the nerves controlling muscles.

Risk factors

• Not being up to date with tetanus vaccinations
• A deep or dirty wound, especially a puncture wound from a nail
• A wound contaminated with soil or animal waste
• Diabetes or a weakened immune system
• Injecting drugs with unsterile needles

When to see a doctor

See a doctor urgently if:

• If you have a wound that might be dirty and you cannot remember when you last had a tetanus shot
• If you have a deep puncture wound, animal bite, or burn
• If you develop muscle stiffness or spasms, especially in the jaw or neck, call your local emergency number immediately

Book a routine appointment if:

• At routine check-ups, ask your healthcare provider if you are due for a tetanus booster
• Before travel or surgery, check your vaccination status

Diagnosis

A doctor usually diagnoses tetanus by asking about your symptoms, your vaccination history, and the wound itself. They will also do a physical examination.

Tests that may be done

• Review of your vaccination history
• Physical examination to check muscle stiffness and spasms
• A wound sample sent to a lab to look for the bacteria, if needed

What to expect at your appointment

If a doctor suspects tetanus, they will usually arrange hospital care right away. In hospital, the team will assess your breathing, muscle control, and the wound, and start treatment to manage symptoms.

Treatment

Tetanus is a medical emergency and is treated in hospital. The main goals are to clean the wound, stop the toxin from doing more harm, control muscle spasms, and support breathing and nutrition until the body recovers.

Self-care at home

• If you have a wound, wash it well with clean running water and mild soap.
• Keep the wound clean and covered until you see a healthcare provider.
• Do not poke or pick at a wound with unclean tools.
• If you are not sure about your tetanus vaccine, ask a healthcare provider.
• Follow the hospital or doctor's advice for wound care after treatment.

Medical treatments

Treatment may include a thorough cleaning of the wound, medicines that help neutralise the tetanus toxin (immunoglobulins), antibiotics to fight infection, and medicines to relax muscles and control spasms. Some people need help with breathing, fluids, or nutrition while in hospital. Exact treatments depend on your situation, so your care team will explain what is happening and why.

When is surgery considered?

A doctor may need to remove dead or contaminated tissue from the wound to help it heal and to clear the bacteria. This is called debridement.

Living with this condition

Recovering from tetanus can take weeks or even months. While in hospital, you will be cared for by a team of doctors, nurses, and therapists. After you leave, you may need physiotherapy to regain strength and movement.

Lifestyle tips

• Rest as much as your care team advises.
• Do gentle exercises or stretches recommended by your physiotherapist.
• Avoid alcohol and smoking, as they can slow healing and weaken the immune system.
• Ask for help with daily tasks while you regain strength.

Diet and exercise

Eat a balanced diet with plenty of protein, fruits, and vegetables to help your body repair itself. If swallowing is difficult, the hospital team will offer softer foods or a feeding tube until it is safe to eat normally. Build activity back slowly with guidance from your physiotherapist.

Mental health and emotional wellbeing

Being in hospital with tetanus, especially if you have had trouble breathing, can be frightening. It is normal to feel anxious or low afterwards. Tell your care team about your feelings; they can offer support and, if needed, help you see a counsellor or psychologist.

Prevention

Yes. The best way to prevent tetanus is to be fully vaccinated and to keep up with booster doses. Also clean wounds quickly and see a healthcare provider if a wound is deep or dirty.

Vaccines

Tetanus vaccine is usually given as part of a combined vaccine in childhood, with booster doses later in life. If you are not sure about your vaccination history, ask your healthcare provider or local health service about a catch-up dose.

Screening programmes

There is no routine screening test for tetanus. Instead, healthcare providers review your vaccination record and give boosters when needed.

Complications

If left untreated

• Breathing difficulties, which can be life-threatening
• Fractures or broken bones caused by severe muscle spasms
• Pneumonia
• Damage to the brain from lack of oxygen
• Blood clots or bleeding problems

Long-term outlook

Tetanus is serious and can be fatal, but with hospital care most people recover. The outlook is better for people who have been vaccinated and for those who get treatment early. Full recovery can take weeks or months, but most people who receive care improve over time.

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