Tetanus (Lockjaw): Overview, Symptoms, Causes, and Prevention
Overview
Tetanus is a serious and potentially life-threatening disease that affects the nervous system. It is caused by toxin-producing bacteria and leads to painful muscle contractions, especially in the jaw and neck muscles. For this reason, tetanus is commonly known as lockjaw.
Severe tetanus complications can be fatal. Currently, there is no definitive cure for tetanus; however, medical treatment focuses on controlling symptoms and preventing complications until the effects of the toxin subside.
Due to widespread vaccination, tetanus has become rare in the United States and other developed countries. Nevertheless, it still poses a significant risk to individuals who do not receive booster vaccinations. The disease remains more common in developing countries.
Symptoms
The average incubation period for tetanus is 10 days, but it can range from 3 to 21 days.
Generalized Tetanus
The most common form of tetanus is generalized tetanus. Symptoms usually begin gradually and worsen over approximately two weeks, starting in the jaw and spreading downward to the rest of the body.
Common signs and symptoms include:
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Painful muscle stiffness and spasms in the jaw
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Tightening of facial muscles, sometimes causing a persistent forced smile
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Painful neck muscle stiffness
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Difficulty swallowing
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Abdominal muscle rigidity
As the disease progresses, severe seizure-like muscle spasms may occur and last for several minutes. These spasms can cause:
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Arching of the back
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Stiff neck and legs
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Arms pulled close to the body
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Clenched fists
Stiffness of the neck and abdominal muscles can interfere with breathing.
Even minor stimuli such as loud noises, physical touch, airflow, or bright light may trigger severe spasms.
Additional symptoms may include:
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High or low blood pressure
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Rapid heart rate
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Fever
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Excessive sweating
Localized Tetanus
This less common form causes muscle spasms near the site of the injury. Although usually milder, it can progress to generalized tetanus.
Cephalic Tetanus
Cephalic tetanus is a rare form associated with head injuries. It can cause weakness in facial muscles and spasms of the jaw, and may also progress to generalized tetanus.
When to See a Doctor
Tetanus is a medical emergency. Seek immediate medical care if you experience symptoms of tetanus.
You may manage a clean, minor wound at home only if you received a tetanus vaccine within the last 10 years.
Seek medical attention if:
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You have not had a tetanus shot in the past 10 years
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You are unsure when you last received a tetanus vaccine
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You have a deep wound, puncture wound, animal bite, or foreign object in the wound
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The wound is contaminated with dirt, soil, feces, rust, or saliva
If a wound is contaminated and more than five years have passed since your last booster, a booster dose is required.
Causes
Tetanus is caused by the bacterium Clostridium tetani, which lives in soil and animal feces. The bacteria can remain dormant until they enter a wound that provides an environment suitable for growth.
Once active, the bacteria produce a toxin called tetanospasmin, which interferes with the nerves controlling muscle movement.
Risk Factors
The greatest risk factor for tetanus infection is:
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Not being vaccinated or failing to receive booster doses every 10 years
Other risk factors include:
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Wounds contaminated with soil or manure
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Puncture wounds from nails or splinters
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Weakened immune system
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Poorly controlled diabetes with infected skin wounds
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Umbilical cord contamination in newborns when mothers are not fully vaccinated
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Sharing needles or using unsterilized needles during illicit drug use
Complications
Tetanus complications can include:
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Breathing problems: Life-threatening airway obstruction due to muscle stiffness
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Pulmonary embolism: A blood clot blocking a lung artery
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Pneumonia: Often caused by aspiration during severe spasms
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Bone fractures: Resulting from intense muscle contractions
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Death: Usually caused by airway blockage or damage to nerves controlling breathing and heart function
Prevention
Tetanus is easily preventable through vaccination.
Childhood Vaccination
Children receive tetanus protection as part of the DTaP vaccine, which protects against diphtheria, tetanus, and pertussis (whooping cough).
The DTaP vaccine is given in five doses at:
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2 months
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4 months
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6 months
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15–18 months
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4–6 years
Children who cannot tolerate the pertussis vaccine may receive the DT vaccine instead.
Vaccination for Ages 7–18
A booster dose is recommended at 11–12 years of age, known as Tdap, which protects against tetanus, diphtheria, and pertussis.
Adult Vaccination (Age 19 and Older)
Adults should receive a booster dose every 10 years, either Tdap or Td. Adults who were not vaccinated as children or are unsure of their vaccination history should consult their doctor about receiving Tdap.
Vaccination During Pregnancy
A booster dose is recommended during the third trimester of each pregnancy, regardless of previous vaccination history.
Additional Recommendations
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Review your vaccination status regularly with your doctor
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Ensure vaccinations are up to date before international travel
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Learn about the history of infectious disease outbreaks and the critical role vaccines play in prevention
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