NSW Health recently reported three cases of tetanus and the tragic death of a woman in her 80s — the state’s first tetanus fatality in 30 years.
Tetanus is a rare but potentially deadly disease. Fortunately, it is preventable – being up to date with tetanus vaccination is your best protection.
What is tetanus and how do you get it?
The bacteria that causes tetanus is called Clostridium tetani. Spores can enter your body, usually after a skin wound, puncture or injury.
Tetanus cannot be passed from person to person.
The spores are ubiquitous and found in soil, dust and animal waste. They can persevere months to years in the environment and are remarkably hardy – they can even withstand cooking and some disinfectants.
Once in a wound, the bacteria can grow and produce a toxin. It is the poison that acts on your nervous system, causing muscle stiffness and painful spasms.
What are the symptoms?
A classic symptom of tetanus is “jaw clench,” where the muscles around your mouth go into spasm. This makes it difficult to eat and speak, but patients remain fully conscious or conscious. The muscle contractions and spasms are intensely painful and can be triggered by loud noises, physical contact, or even light.
Patents with tetanus are usually treated in an intensive care unit and require cleaning of the wound, antibiotics, and injections of antitoxin known as human tetanus immune globulin, as well as a vaccine.
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In severe cases, spasms of muscles around your airways and lungs, in addition to high and low blood pressure and heart rhythm disturbances, can lead to death.
Despite the best treatment, approx 2–10% of patients die.
How does the vaccine work?
In Australia, tetanus is rare due to high vaccination rates, with approx 14 cases reported to the health authorities per year.
Tetanus can occur at any age, but is more common in older adults who have never been vaccinated or were vaccinated more than a decade ago.
The vaccine is very effective in preventing tetanus. Tetanus vaccination stimulates the production of antibodies, also called antitoxin. This means that vaccination does not stop Clostridium tetani grow in infected wounds. Rather, it protects against the effects of the toxin.
When do we need a tetanus shot?
Since then, tetanus vaccination has been available in Australia 1925. It is currently on the National Immunization Program (NIP) as an initial five-dose schedule for infants and children up to five years of age, administered as a combined diphtheria-tetanus-acellular pertussis (DTPa) vaccine.
Most children (97%) in Australia complete this primary immunization schedule.
The amount of antitoxin needed for protection against tetanus is 0.1-0.2 international units (IU) per milliliter (ml). This level is reaches after a fifth dose, at the age of four to six years.
But in middle age about 20% of Australians have low or undetectable levels of antitoxin. This puts them at risk of contracting tetanus after a wound or injury.
Read more: Health check: are you up to date on your vaccinations?
A single dose of tetanus vaccine produces protective levels of antitoxin in these people. This is why a booster dose of the tetanus vaccine is recommended for the following people if their last dose was more than ten years ago:
adults over 50 years old
adults 65 years or older
travelers, of any age, to countries where it can be difficult to access health services in a timely manner if you sustain a tetanus-prone wound (any wound other than a clean, minor cut).
If you have a tetanus-prone wound and there is any doubt about your tetanus immunization status, get tetanus immune globulin as soon as possible. You should also get a tetanus vaccine.
If you are abroad, it can be difficult and expensive to access both tetanus immunoglobulin and tetanus vaccine.
How do I check my vaccination status?
If you are over 14 years old, you can check your vaccination history:
online, by creating a myGov account and accessing your Medicare online account through the Express Plus Medicare mobile app
by calling the Australian Immunization Registry on 1800 653 809
by asking your doctor or immunization provider print a copy of your vaccination data.
If it’s been more than a decade since your last dose, ask your GP for a booster. It can save your life.