Tetanus

About tetanus

Tetanus, sometimes called 'lockjaw,' is a serious infectious disease that causes muscle spasms, breathing problems and can result in death.

The bacterium that causes tetanus is Clostridium tetani and is commonly found in the environment. The bacteria enters through broken skin and produces toxins that affect the nervous system.

Tetanus is now uncommon in Australia because of the widespread use of the tetanus vaccine. However, anyone who hasn't been immunised against tetanus is at risk.

Symptoms of tetanus

One of the first signs of tetanus is spasms of the jaw muscles, or 'lockjaw.' This can make it hard to open the mouth. Other symptoms can include:

• muscle spasms that begin in the jaw and neck
• stiffness or pain in the neck, shoulder and back muscles
• trouble swallowing
• breathing difficulties
• painful convulsions (fits)
• rapid heartbeat
• abnormal heart rhythms.

Complications of tetanus

Tetanus is extremely serious and can result in death. Complications of tetanus can include:

• pneumonia
• broken bones (from muscle spasms)
• pulmonary embolism (one or more arteries in the lungs become blocked by a blood clot)
• respiratory failure
• high or low blood pressure
• heart attack.

Spread of tetanus

Tetanus is not passed from person to person.

Tetanus can live in soil, dust and animal faeces (poo). Infection occurs when the bacteria enters the body through a break in the skin.

Symptoms occur between 3 days and 3 weeks after infection. Most cases occur within 10 days. Generally, the infection is severe if symptoms appear very quickly.

People at risk of tetanus

Anyone can get tetanus. But, you are at an increased risk if you:

• have never received a tetanus vaccine
• have missed doses of the vaccine
• are an older adult who has not received a booster dose within the past 10 years.

Other risk factors include:

• having tetanus-prone wounds
• working with soil, animals, or in dusty environments
• injecting drugs
• having diabetes
• having an immunocompromising condition.

Prevention of tetanus

Wound care to prevent tetanus infection

Tetanus can happen from wounds that might seem too minor for medical attention.

Some wounds are more likely to encourage the growth of tetanus bacteria – these are 'tetanus-prone' wounds. Some examples of tetanus-prone wounds are:

• any type of penetrating wound, such as a cut from a rusty nail or rose thorns
• wounds contaminated with soil, manure, or foreign objects like wood fragments
• bite wounds, such as animal bites (including snakebites) or human bites
• open (compound) fractures
• burns
• frostbite.

Immediate and good wound care can help prevent infection. You should:

• apply first aid to even minor, non-infected wounds
• wash hands with soap and water or use an alcohol-based hand rub
• seek medical attention immediately if you have a tetanus-prone wound and are not fully vaccinated, or have not had tetanus booster dose in the last 5 years.

Immunisation against tetanus

Immunisation is a safe and effective way to protect you against serious diseases like tetanus.

Tetanus vaccines provide good protection from infection, but it can fade with time. This means that more doses (boosters) are recommended.

If you sustain a wound, you should seek medical attention as soon as you can, as you may need a tetanus vaccine.

The tetanus vaccine is available in a number ofcombined immunisations – this means it is given along with vaccines against other serious and potentially fatal diseases. The type of combined vaccine used will depend on your age.

The National Immunisation Program Schedule provides free tetanus-containing vaccination for:

• Children at 2 months (from 6 weeks), 4 months, 6 months, 18 months and 4 years.
• Adolescents in Year 7 at secondary school (or age equivalent).
• Pregnant people in each pregnancy, ideally between 20 to 32 weeks, but it may be given up until delivery. The combination diphtheria-tetanus-pertussis vaccine also helps to prevent whooping cough in pregnant people and their newborns.

Free catch-up immunisations are also available for eligible people who have not been fully vaccinated, including:

• people aged up to 20 years
• refugees, asylum seekers and other humanitarian entrants of any age.

If you are not sure if you can get a free tetanus-containing vaccine, ask your GP (doctor) or immunisation provider.

Adult immunisation

A course of tetanus-containing vaccine is recommended for anyone who has never been vaccinated.

Immunity against tetanus decreases with time, so you may need booster vaccines.

If you have been vaccinated before, a tetanus booster dose is recommended if you:

• are 50 years of age and
• have not received a booster dose of tetanus vaccine in the past 10 years.

Immunisation is also recommended every 5 to 10 years if you travel to countries where health care may be difficult to access.

Speak with your GP (doctor) or immunisation provider for more information.

Pregnancy and tetanus immunisation

A single dose of the combination diphtheria-tetanus-pertussis (whooping cough) vaccine is recommended in each pregnancy. This is given ideally between 20 to 32 weeks, but may be given up until delivery.

People who are breastfeeding can also receive this combination vaccine.

Speak with your GP (doctor) or immunisation provider for more information.

Immunisation and HALO

The immunisations you need are decided by your health, age, lifestyle and occupation. Together, these factors are called HALO.

Talk to your immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is needed.

You can check your immunisation HALO using the Immunisation for Life infographic (pdf) infographic.

Diagnosis of tetanus

People with symptoms of tetanus should seek prompt medical care at a hospital.

Call triple zero (000) immediately if you are having difficulty breathing.

A doctor will diagnose tetanus from:

• symptoms
• a physical examination
• by taking a medical history, including information about immunisation.

It is difficult to confirm a diagnosis of tetanus through laboratory tests.

Treatment for tetanus

Tetanus is a life-threatening disease and sometimes death can occur, even with prompt medical attention.

Treatment for tetanus may include:

• tetanus immunoglobulin
• hospitalisation
• anti-convulsive medications
• antibiotics
• surgical treatment of the infected area
• life support – for example, the person may be placed on an artificial respirator if they have severe breathing problems.

People who recover from tetanus disease do not have natural immunity and can be infected again. This is why tetanus vaccination (if indicated) is recommended as soon as possible.

Public health response to tetanus

Doctors must notify tetanus cases to the Department of Health in Victoria. This helps Local Public Health Units to identify the likely source of the disease and to monitor statewide tetanus trends.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Urgent Care Clinics – access to urgent care at home or anywhere else
• Virtual Emergency Care– when immediate healthcare is needed but it’s not life threatening
• Local government immunisation service – Know your council
• Maternal and Child Health Line (24 hours) Tel. 13 22 29
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Immunisation Program, Department of Health, Victorian Government, email immunisation@health.vic.gov.au
• National Immunisation Information Line Tel. 1800 671 811
• Pharmacist
• SAEFVIC Tel. 1300 882 924 (option 1) – to report an unexpected or serious reactions to vaccination.