What is Tetanus Prophylaxis?
Tetanus is a disease that largely affects your nervous system. It has been linked with wounds and injuries for many centuries and is widely known to cause ‘lockjaw’, a condition where you can’t open your mouth due to intense, painful muscle spasms. There are four types of tetanus: localized, generalized, cephalic, and neonatal. Localized tetanus creates stiffness in specific muscles while generalized tetanus effects the whole body, causing symptoms like trouble swallowing and body spasms. Cephalic tetanus can lead to issues with the nerves in your head, and neonatal tetanus affects newborn infants, making them irritable and stiff.
In developed countries, tetanus is rare because of flourishing immunization programs. However, it’s essential for everyone to get vaccinated, especially in less developed countries. Some reported cases in the United States happen due to people not getting vaccinated or not having wounds and injuries treated properly. Tetanus was once a common cause of sickness and death before the creation of a substance called ‘tetanus toxoid’ in 1924. This substance was used to make a better vaccine in 1938 and became popular during World War II, significantly reducing tetanus cases. Today, this vaccine is seen as one of the safest and most effective medical treatments.
The tetanus vaccine is usually combined with vaccines for diphtheria and pertussis (whooping cough). There are five of these combination vaccines currently used, each identified by a code: DTaP, DTP, Tdap, Td, and DT. ‘D’ stands for diphtheria, ‘T’ for tetanus, ‘P’ for pertussis, and ‘a’ signifies that the vaccine uses cell-free components. Lowercase ‘d’ and ‘p’ simply mean that the vaccine contains less of the toxoid for diphtheria or pertussis. The DTP vaccine was replaced in 1992 by DTaP and Tdap due to higher than desirable side effects like redness and pain at the injection site.
It’s usually recommended that children receive doses of the DTaP or DT vaccine at 2, 4, and 6 months old, with extra doses given between 15 to 18 months and between 4 and 6 years. This schedule is followed by a Tdap booster at age 11 or 12, then a booster every 10 years afterwards. Adults are also advised to have a Td or Tdap vaccine every 10 years if they’ve been fully immunized earlier. For those who’ve never been vaccinated, they’ll need three doses of the vaccine. The first of these three doses is administered 4 weeks from the first dose, and the last dose 6 to 12 months later. It’s important to have a booster every ten years because immunity to the diseases starts to wear off. Protection from tetanus seems to be lower in older adults, which reinforces the need for regular boosters.
The most important way to prevent tetanus is to get vaccinated, be aware of people at risk, and treat wounds and injuries appropriately. Make sure to understand the guidelines related to tetanus immunization and follow them for your protection.
What Causes Tetanus Prophylaxis?
Tetanus is a disease caused by a specific bacteria called Clostridium tetani, which is found in dirt and the stomachs of animals. This bacteria can’t be removed from the environment and can enter the body through cuts in the skin or openings in the body’s natural barriers like the skin and mucous membranes.
Once it enters the body, the bacteria changes into a different form and travels to the spinal cord and the base of the brain using motor neurons, which are nerve cells that control muscles. Here, it creates a harmful substance called tetanospasmin, which messes with the chemicals in your nervous system that normally help to regulate it.
Another substance the bacteria makes is tetanolysin, which can break down red blood cells and cause damage to cell membranes. However, scientists are still not sure what role this substance plays in the disease.
Risk Factors and Frequency for Tetanus Prophylaxis
Thanks to widespread vaccination programs introduced in the 1940s, cases of tetanus, a serious disease caused by bacterial infection, have greatly decreased. In the United States, the Centers for Disease Control and Prevention reported only 264 cases from 2009 to 2017. Of these, 23% were in individuals over 65 years old and 13% were in individuals under 20 years old. Unfortunately, around 7% of tetanus cases resulted in death, and all of these occurred in people over 55 years old.
Before vaccines were commonplace, around 600 cases of tetanus were reported annually in the United States. However, thanks to vaccinations, this number has fallen by 96%. This has been beneficial not only in reducing tetanus cases but also in eliminating neonatal tetanus, a form of the disease that affects newborn babies. Currently, the incidence of tetanus in the U.S. is only 0.01 per 100,000 people. The people who do get tetanus usually have incomplete tetanus immunizations or did not receive proper wound care.
Unfortunately, tetanus is still a major cause of death in underdeveloped countries. Globally, it is estimated that there are 1 million cases and 200,000 deaths from tetanus each year, particularly in Southeast Asia and Africa. These regions lack the resources for large-scale vaccination programs and adequate wound or injury treatment. Furthermore, the World Health Organization is concerned that the real number of individuals affected by tetanus is likely much higher due to underreporting, especially as many underdeveloped nations do not have adequate disease reporting and surveillance systems.
Signs and Symptoms of Tetanus Prophylaxis
When taking a patient’s medical history, it’s important to gather as much information as possible. This includes their immunization record and any complications they’ve experienced from vaccines. For patients coming from other countries, particularly undeveloped nations, extra care should be taken. Inquire about any symptoms like muscle spasms, stiffness, and pain. If they’ve had any wounds or injuries, find out how they occurred, when they occurred, and any factors that might have made them more likely. A physical exam should also be carried out.
- Check for muscle stiffness, rigidity, and spasms
- Examine any wounds, including their size and depth
- Assess the condition of the tissue around the wound
- Look for foreign bodies
- Check for signs of decreased blood flow
- Ask about and look out for signs of autonomic instability, such as excessive sweating, rapid heart rate, and fluctuating high or low blood pressure.
Testing for Tetanus Prophylaxis
Tetanus is a condition that one might need to consider if there’s been an injury prone to infection and the person hasn’t had their vaccines up to date. Identifying a patient at risk for tetanus involves a detailed look at the patient’s medical history and a physical examination. Tetanus is diagnosed based on its signs and symptoms because there aren’t any specific lab tests for it. Sometimes, other tests might be needed to rule out similar conditions like a dental abscess or meningitis.
The World Health Organization (WHO) outlines different criteria for diagnosing tetanus in adults and newborns. For adults, the WHO guidelines require evidence of a past injury or wound and one of the following symptoms: painful muscle contractions, trismus, or risus sardonicus. Trismus is when there are severe painful spasms in the jaw muscles, making it hard to open the mouth. Risus sardonicus is a forced, grimace-like smile.
For newborns, if an infant seems normal for the first 2 days of life, able to cry and breastfeed, and then loses that ability between days 3 to 28 and develops muscle stiffness or spasms, tetanus is suspected.
One reliable clinical test for tetanus is the “spatula test.” In this test, a healthcare professional touches the back wall of the throat with a dull instrument. If tetanus is present, it will cause a reflex jaw spasm. This test is known to be highly specific and sensitive for diagnosing tetanus.
Treatment Options for Tetanus Prophylaxis
The decision on whether or not to give a tetanus shot is usually based on a person’s previous immunization status and how serious their wound is. Generally, wounds can be classified as high or low risk, and an individual’s immunization status may be classified as either unimmunized (i.e., had less than 3 doses or an unknown immunization status), or immunized (i.e., received 3 or more doses).
For someone who’s unimmunized and has a low-risk wound (e.g., a clean, minor injury), a tetanus vaccine is recommended. However, if they have a serious wound (e.g., a wound that’s contaminated or resulting from a crushing injury, a gunshot, a burn, or from an animal or human bite), both the tetanus vaccine and a medical treatment called the human tetanus immune globulin (HTIG) are usually recommended. HTIG helps in neutralizing the tetanus bacteria in the body.
For individuals who are immunized and have a low-risk wound, they may need another tetanus shot if it has been more than ten years since their last shot. However, if they have a high-risk wound and it’s been more than five years since their last shot, then another shot will be recommended.
Prevention against tetanus should be provided as soon as possible after a person gets a wound, but it can still be provided even if the person has had the wound for some time, this is due to the unpredictable and potentially long incubation period (the time to develop symptoms) of tetanus. In some cases, HTIG can be given up to 21 days later.
Edward Jenner, the developer of the first vaccine, found people were able to develop immunity to smallpox without the details of the biochemical process in the body (who developed the first-ever vaccine), used HTIG to bind to and neutralize the tetanus toxins that had not bound to the body tissue yet. This form of treatment, which is called passive immunization, has proven to be quite effective and is generally accepted as a standard tetanus treatment.
However, in some countries where HTIG isn’t available, another treatment called anti-tetanus horse serum may be used instead, but it’s been known to have serious side effects. When HTIG is used, it should be injected both into the muscle and directly around the wound if the wound is present.
It’s also important to clean and remove the damaged tissue from all wounds as soon as possible, as part of tetanus prevention. In some cases, wounds that are prone to tetanus infections may be left open to prevent conditions where the bacteria can grow.
If a pregnant woman needs a tetanus shot, she should receive it between 27 to 36 weeks of her pregnancy, regardless of when she had her last shot. If she hasn’t been vaccinated before, she’ll be given three doses of the vaccine, each spaced four weeks apart.
For individuals with HIV or AIDS, HTIG is typically recommended regardless of their immunization status or the classification of their wound.
What else can Tetanus Prophylaxis be?
When a doctor is trying to figure out what’s causing certain symptoms, they might consider a number of different conditions. These could include:
- Reactions to certain medications (drug-induced dystonias)
- Poisoning from strychnine (a substance sometimes found in rat poison)
- A serious reaction to certain psychiatric drugs (malignant neuroleptic syndrome)
- A rare condition causing muscle stiffness and spasms (stiff-person syndrome)
- A dental infection causing difficulty opening the mouth (trismus)
- Meningitis (inflammation of the protective layers around the brain and spinal cord)
- Encephalitis (inflammation of the brain)
- A decline in brain function due to severe liver disease (hepatic encephalopathy)
- A severe, ongoing seizure (status epilepticus)
- A life-threatening reaction to certain drugs used during surgery (malignant hyperthermia)
- Poisoning from a black widow spider bite (envenomation)
What to expect with Tetanus Prophylaxis
Tetanus still results in a significant number of deaths in developing countries. Roughly, an estimated 2 out of every 10 people who get sick from tetanus will not survive. Contrary to what some might think, surviving tetanus doesn’t grant immunity to the disease – meaning, one could still get it again. As a result, survivors should get vaccinated to prevent future infections. It’s important to note that cephalic (a type of tetanus that affects the head) and neonatal tetanus (a type of tetanus that affects newborn babies) often have severe consequences.
Complete recovery from tetanus is not instant; it can take several months. This is due to the need for new nerve terminals to grow back, which typically takes around 4 to 6 weeks. Hence, patience and continuous care are essential during this recovery period.
Possible Complications When Diagnosed with Tetanus Prophylaxis
In developed countries, complications from illnesses like tetanus are uncommon. However, they can still occur in people who have not been vaccinated, have skipped their booster shots, or have improperly treated wounds or injuries. Once someone is diagnosed with tetanus, the doctors can only provide supportive care as often it becomes too late. This condition can cause serious health problems and even death.
Complications of Tetanus:
- Health complications due to improper vaccination or missed booster shots
- Complications due to improper treatment of wounds and injuries
- Supportive care being the only treatment once tetanus is diagnosed
- High risk of serious health conditions
- Potential death
Preventing Tetanus Prophylaxis
Educating patients and their parents is very important in preventing diseases that can be prevented by vaccines. A lot of people are not aware about vaccines, hence, they rely on their healthcare providers for information and guidance. This is very important particularly in reducing the difference in vaccination rates among various racial and ethnic groups. According to the Community Preventive Services Task Force and the National Vaccine Advisory Committee, when healthcare providers see their patients, they should talk about why vaccines are necessary and what vaccines are normally recommended. During this discussion, the patients should also be given the chance to get the appropriate vaccines.
