Tetanus Frequently Asked Questions

What is tetanus?
Tetanus is an acute, often fatal disease caused by a toxin produced by a spore forming bacterium, Clostridium tetani. The spores can remain viable for years and are common in soil, and animal and human faeces.

How do people get tetanus?
Infection with tetanus occurs when the spores are introduced into the body, often through a puncture wound but also through trivial, unnoticed wounds, through injecting drug use, and occasionally through abdominal surgery.

Anyone who is not fully protected against tetanus by immunisation is at risk from the disease. Individuals with impaired immunity may be at risk, regardless of their immunisation status.

Tetanus is not contagious, person to person spread does not occur.

The incubation period is 3 to 21 days (average of about 10 days) although it may range from one day to several months, depending on the character, extent and localisation of the wound.

Early symptoms in adults often include abdominal rigidity and stiffening of the jaw until it is locked in position (hence the name lock-jaw). This is followed by painful muscle spasms, with difficulty swallowing and breathing. Death may occur in between 10%-25% of cases, mortality is highest in young, the elderly, drug abusers and unvaccinated.

Early recognition and treatment with wound debridement (cleaning), appropriate antibiotics, and tetanus immunoglobulin can be life saving.

Tetanus diagnosis
The diagnosis of tetanus is usually made on clinical grounds as Clostridium tetani is not often isolated from the wound and can be isolated from patients who do not have tetanus.

Protecting against tetanus
Tetanus can be prevented with a vaccine. The vaccine is made of inactivated toxins from the bacteria, this is called a toxoid preparation. Vaccination stimulates the body to produce serum anti-toxin. 

A total of five doses of tetanus toxoid containing vaccine at the appropriate intervals are considered to give lifelong immunity. Recovery from tetanus may not result in immunity, and vaccination following tetanus is indicated. 

Tetanus vaccine in children
Tetanus vaccine is given as part of the routine childhood immunisation programme, together with diphtheria, whooping cough (pertussis), Hib, hepatitis B and inactivated polio (IPV) vaccines (referred to as the “6-in-1” vaccine). Vaccination is given at 2, 4 and 6 months of age. Booster vaccine doses are given at 4-5 years of age (referred to as the "4-in-1" vaccine) and again between 11-14 years of age.

Tetanus vaccination in older children and adults
Adults or children older than 10 years of age who have not been immunised, or only partially immunised, should receive tetanus vaccination according to the recommended schedule, using a vaccine which is appropriate for this age group.

For people unsure of their vaccination status they should seek advice from their GP.

Tetanus vaccination after an injury
Individuals who have wound injuries are medically assessed to determine what treatment is needed to prevent tetanus. The treatment recommended by the doctor will depend on history of tetanus vaccination, type of wound and whether it is considered to be a ‘tetanus prone wound’ (such as wounds contaminated with dirt, faeces, soil and saliva; puncture wounds, avulsions, wounds resulting from crushing, burns, frostbite, missiles). Tetanus immune globulin (TIG) may be recommended for tetanus prone wounds and can be life saving. (See guide to tetanus prophylaxis guidelines in Immunisation Guidelines for Ireland for more details).

Tetanus in Ireland
Tetanus in Ireland is now uncommon because of routine immunisation programmes - however sporadic cases still occur.

Further information
See tetanus chapter of the Immunisation Guidelines for Ireland for more detailed information on tetanus vaccination.

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Last updated: 12 November 2015