Tetanus

Also called Lockjaw

Almost eliminated by vaccination, and still fatal when it occurs. The question after any dirty wound is when the last booster was.

What it is

A serious infection caused by a toxin from Clostridium tetani, bacteria found in soil, dust and manure, entering through a wound.

The toxin causes severe, painful muscle spasms, starting typically in the jaw, hence lockjaw, and spreading. Spasms of the breathing muscles cause death.

It is very rare in the UK, with only a handful of cases a year, entirely because of childhood vaccination. The people who get it are those never fully vaccinated, older people whose immunity has waned, and people who inject drugs, where contaminated heroin has caused clusters.

It is not spread person to person, and having had it does not confer immunity, so vaccination is needed even after recovery.

**The practical content of this entry is wound management.** After any wound, particularly a dirty, deep or puncture wound, one contaminated with soil or manure, an animal bite, or a burn, the question is whether the person has had a full course of five tetanus vaccinations and when the last was. Where that is uncertain or incomplete, a booster and sometimes immunoglobulin is given.

Thorough wound cleaning is itself an important part of prevention.

Signs you might notice

Stiffness of the jaw muscles, making it hard to open the mouth.

A fixed grimace, from facial muscle spasm.

Stiffness of the neck, back and abdomen.

Painful muscle spasms, which can be triggered by noise, light or touch.

Difficulty swallowing.

Sweating, fever, rapid heart rate.

Later: spasms of the breathing muscles, and arching of the back.

Symptoms typically begin four to 21 days after the wound.

**999 immediately** for jaw stiffness or muscle spasms after any wound.

At the time of injury: clean the wound thoroughly and seek advice about tetanus cover for any dirty, deep or puncture wound, animal bite, or wound contaminated with soil.

How it can affect day-to-day life

The practical issue in the UK is not treatment but knowing vaccination status. Most adults do not know when their last tetanus booster was, and GP records are the place to check.

The UK schedule gives five doses through childhood and adolescence, which is considered to give lifelong protection for most people, with boosters given after certain injuries rather than routinely.

People who grew up outside the UK, or who missed vaccinations, may have no protection at all, and it is worth asking rather than assuming.

For people who inject drugs, tetanus is a real and recurring risk, and vaccination should be offered at every opportunity through drug services.

Gardeners, farmers and anybody working with soil or animals should know their status.

Wound care is the other half: thorough cleaning, removing dirt and dead tissue, and not closing a heavily contaminated wound tightly. See wound care and animal and human bites.

Supporting someone well

Know the vaccination status. Ask the GP practice to check the record.

Complete the childhood schedule, and catch up if doses were missed or if vaccinated abroad.

After any dirty, deep or puncture wound, animal bite or burn, ask specifically about tetanus cover.

Clean wounds thoroughly with running water, and remove visible dirt.

Seek help for wounds contaminated with soil or manure, and for puncture wounds, which are the classic risk.

Offer vaccination through drug and homelessness services; this is the group most at risk.

Treat jaw stiffness or spasms after a wound as an emergency.

Do not assume immunity after having had tetanus; vaccination is still needed.

Where to get help

999 for jaw stiffness or muscle spasms.

A GP practice, urgent care or minor injuries unit for wound assessment and tetanus cover.

A pharmacist or practice nurse to check and update vaccination status.

UKHSA vaccination guidance for the schedule.