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10 February, 2010

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Tetanus

Tetanus is a serious bacterial disease that causes muscle spasms and breathing problems. The tetanus bacillus is called Clostridium tetani. The bacteria produce toxins that affect the nervous system. Around one in 10 people infected with tetanus will die. Tetanus is uncommon in Australia because of the widespread use of the tetanus vaccine. However, anyone who hasn’t been immunised is at risk.

Symptoms
The signs and symptoms of tetanus may include:

Muscle spasms that begin in the jaw and neck
Inability to open the mouth (lockjaw)
Swallowing problems
Breathing difficulties
Painful convulsions
Abnormal heart rhythms.

Complications
The extremely serious and potentially lethal complications of tetanus can include:

Suffocation
Respiratory failure
Pneumonia
Hypertension (high blood pressure)
Hypotension (low blood pressure)
Heart attack.

How it is spread
Tetanus bacteria live in soil, dust and manure, particularly horse manure. Infection occurs when the bacteria enter the body through a break in the skin. Symptoms occur between three days and three weeks after infection. Usually symptoms occur after about 10 days. Generally speaking, if symptoms appear very quickly, the infection is severe. Tetanus is not transmitted from person to person.

High-risk groups
Tetanus is uncommon in Australia thanks to the tetanus vaccine. However, anyone who has not been immunised against tetanus is at risk, in particular:

People who work with soil or horses or in dusty environments
Intravenous drug users
Australians travelling overseas to parts of Asia, South America or Africa
Newborn babies, if the mother has not been immunised (infection may occur via the umbilical stump)
People who get particular wounds.

High-risk wounds
Some wounds are more likely to harbour germs and encourage the growth of tetanus bacteria. High-risk wounds include:

Compound fracture (the broken bone pierces the skin)
Burn
Animal bite
Any type of penetrating wound
Wound contaminated with soil, horse manure or foreign objects such as wood fragments.

Diagnosis
Tests used to diagnose tetanus may include:

Medical history including immunisation status
Travel history
Physical examination.

Treatment
Tetanus is a life-threatening disease. Sometimes, a person dies despite prompt medical attention. Treatment for tetanus may include:

Hospitalisation, perhaps for months
Anti-convulsive medications
Antibiotics
Antitoxin called tetanus immunoglobulin to neutralise the tetanus toxin
Life support – for example, the person may be placed on an artificial respirator if they have severe breathing problems
A vaccine booster shot, if the adult hasn’t had a booster shot in the previous five years.

Prevention
The best prevention against tetanus is immunisation. Avoid skin injuries to reduce the risk of tetanus; for example, wear gloves while gardening.

Seek medical advice for dirty wounds or wounds where the skin has been penetrated. The doctor may advise a tetanus booster shot depending on how long it is since your last tetanus dose.

If you have not had any previous immunisation against tetanus, a full course of three doses should be given. If the wound is deemed ‘tetanus-prone’, tetanus immunoglobulin should be given as well.

Vaccination is available
In Victoria, the tetanus vaccine is available in a combined vaccine that also contains vaccines against other serious and potentially fatal diseases. Different vaccine combinations are available depending on the person’s age.

A free vaccine that offers protection against tetanus is available for all Victorian children when they are:

Two, four and six months of age – in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and haemophilus influenzae type b (Hib) vaccine
Four years of age – in the form of a diphtheria, tetanus, whooping cough and polio vaccine
In Year 10 at secondary school – adolescents receive a booster dose of diphtheria, tetanus and whooping cough vaccine.
Catch-up immunisations are also available free-of-charge to any school-age child over eight years of age who has not been fully vaccinated against the disease.

Boosters for teenagers and adults
Teenagers and adults receive a different formulation of the vaccine that is combined with diphtheria or diphtheria and whooping cough. A further booster shot is recommended at 50 years of age and provided free-of-charge in Victoria.

See your doctor or your local government immunisation service provider for more information.

Before immunisation
Before immunisation, make sure that you tell your doctor or nurse if you or your child:

Is unwell on the day of immunisation (temperature over 38.5˚C)
Has had a serious reaction to any vaccine
Has had a severe allergy to anything
Is pregnant.

Possible side effects of the vaccine
The vaccine is effective and safe. However, all medicines can have unwanted side effects. Side effects from the tetanus vaccine are uncommon and usually mild but may include:

Fever
Tiredness
Irritability
Headache
Soreness and redness at the injection site.

Treating mild side effects
Side effects usually resolve quickly. However, there are a number of treatment options to reduce the side effects of the vaccination:

Paracetamol to reduce any fever – check the label for the correct dose (especially for children)
A cold, wet cloth held against the injection site
Extra drinks
Appropriate clothing – do not overdress.
If reactions are severe and persistent, or if you are worried, contact your doctor for further information.

Anaphylaxis is an extremely rare side effect
There is a very small risk of a serious allergic reaction to any vaccine. This is why you are advised to wait at the clinic or medical surgery for at least 15 minutes following vaccination in case further treatment is required.

Where to get help

Your doctor
Always call an ambulance in an emergency Tel. 000
Emergency department of your nearest hospital
Your local council immunisation service
Immunisation Program - Department of Health Victoria, Tel. 1300 882 008
Nurse on Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
The Maternal and Child Health Line is available 24 hours a day Tel. 132 229
National Immunisation Infoline Tel. 1800 671 811

Things to remember

Tetanus is a serious bacterial disease that causes muscle spasms and breathing problems.
Tetanus is uncommon in Australia because of the widespread use of the tetanus vaccine.
The best prevention against tetanus is immunisation.

You might also be interested in:
Diphtheria.
Immune system.
Immunisation - childhood.
Immunisation - common misconceptions.
Infections - bacterial and viral.
Vaccines.
Whooping cough.

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