Tetanus:

Questions and Answers

information about the disease and vaccines

What causes tetanus? break their spine or long bones from convulsions. Other
possible complications include high blood pressure,
Tetanus is caused by a toxin (poison) produced by the
abnormal heart rhythm, and secondary infections, which
bacterium Clostridium tetani. The C. tetani bacteria
are common because of prolonged hospital stays.
cannot grow in the presence of oxygen. They produce
spores that are very difficult to kill as they are resistant Obviously, the high probability of death is a major
to heat and many chemical agents. complication.

How does tetanus spread? How is tetanus diagnosed?

C. tetani spores can be found in the soil and in the The diagnosis of tetanus is based on the clinical signs
intestines and feces of many household and farm and symptoms only. Laboratory diagnosis is not useful
animals and humans. The bacteria usually enter the as the C. tetani bacteria usually cannot be recovered
human body through a puncture. That puncture can from the wound of an individual who has tetanus, and
occur either indoors or outdoors. conversely, can be isolated from the skin of an individual
Tetanus is not spread from person to person. who does not have tetanus.

How long does it take to show signs of tetanus What kind of injuries might allow tetanus to enter
after being exposed? the body?

The incubation period varies from 3–21 days, with an Tetanus bacilli live in the soil, so the most dangerous
average of eight days. The further the injury site is from kind of injury involves possible contamination with dirt,
the central nervous system, the longer the incubation animal feces, and manure. Although we have tradition-
period. The shorter the incubation period, the higher ally worried about deep puncture wounds, in reality
the risk of death. many types of injuries can allow tetanus bacilli to enter
the body. In recent years, a higher proportion of cases
What are the symptoms of tetanus? had minor wounds than had major ones, probably
because severe wounds were more likely to be properly
The symptoms of tetanus are caused by the tetanus
managed. People can also get tetanus from splinters,
toxin acting on the brain and spinal cord. In the most
self-piercing, and self-tattooing. Injecting drug users are
common form of tetanus, the first sign is spasm of the
also at risk for tetanus.
jaw muscles, followed by stiffness of the neck, difficulty
in swallowing, and stiffness of the abdominal muscles. I stepped on a nail in the garage. What should
Other signs include fever, sweating, elevated blood I do?
pressure, and rapid heart rate. Spasms often occur, Any wound that may involve contamination with
which may last for several minutes and continue for 3–4 tetanus bacilli should be attended to as soon as possible.
weeks. Complete recovery, if it occurs, may take months. Treatment depends on your vaccination status and the
nature of the wound. In all cases, the wound should be
How serious is tetanus?
thoroughly cleaned. Seek medical treatment immediately
Tetanus has a high fatality rate. In recent years, tetanus and bring your immunization record with you.
has been fatal in about 10% to 20% of reported cases.
With wounds that involve the possibility of tetanus
What are possible complications from tetanus? contamination, a patient with an unknown or incomplete
history of tetanus vaccination needs a tetanus- and
Laryngospasm (spasm of the vocal cords) is a complica-
diphtheria-containing shot (Td or Tdap) and a dose of
tion that can interfere with breathing. Patients can also
tetanus immune globulin (TIG) as soon as possible.

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A person with a documented series of three tetanus- (inactivated toxin) was produced and was used success-
and diphtheria-containing shots (Td or Tdap) who has fully to prevent tetanus in the armed services during
received a booster dose within the last 10 years should World War II. The first pertussis vaccine was developed
be protected. However, to ensure adequate protection, in the 1930s and was in widespread use by the
a booster dose of vaccine may still be given if it has been mid-1940s, when pertussis vaccine was combined with
more than 5 years since the last dose and the wound is diphtheria and tetanus toxoids to make the combination
other than clean and minor. DTP vaccine. A series of 4 doses of whole-cell DTP
vaccine was quite (70–90%) effective in preventing
Is there a treatment for tetanus? serious pertussis disease; however, up to half of the
There is no "cure" for tetanus once a person develops children who received the vaccine developed local
symptoms, just supportive treatment and manage reactions such as redness, swelling, and pain at the
ment of complications. The best "treatment" is injection site. In 1991, concerns about safety led to
prevention through immunization. the development of more purified (acellular) pertussis
vaccines that are associated with fewer side effects.
How common is tetanus in the United States? These acellular pertussis vaccines have replaced the
Tetanus first became a reportable disease in the late whole cell DTP vaccines in the U.S.
1940s. At that time, there were 500–600 cases reported In 2005, two new vaccine products were licensed for
per year. After the introduction of the tetanus vaccine use in adolescents and adults that combine the tetanus
in the mid-1940s, reported cases of tetanus dropped and diphtheria toxoids with acellular pertussis (Tdap)
steadily. vaccine.
From 2018 through 2020, an average of 22 cases were
How are vaccines made that prevent diphtheria,
reported per year.
tetanus and pertussis?
Almost all cases of tetanus are in people who have never
These vaccines are made by chemically treating the
been vaccinated, or who completed their childhood
diphtheria, tetanus, and pertussis toxins to render them
series, but did not have a booster dose in the preceding
nontoxic yet still able to produce an immune response in
10 years.
the vaccinated person. They are known as “inactivated”
What is neonatal tetanus? vaccines because they do not contain live bacteria.
They do not reproduce, which is why multiple doses are
Neonatal tetanus is a form of tetanus that occurs in
needed to produce immunity.
newborn infants, usually by using an unsterile cutting
instrument on the unhealed umbilical stump. These What’s the difference between all the vaccines
babies usually have no temporary immunity that would containing diphtheria and tetanus toxoids and
have been passed on from their mothers through the
pertussis vaccine?
mothers' vaccinations.
It’s like alphabet soup! Here is a listing of the various
Neonatal tetanus is very rare in the United States (only products:
3 cases were reported from 2001 through 2016), but is
common in some developing countries. • DTaP: Diphtheria and tetanus toxoids and acellular
pertussis vaccine; given to infants and children ages
Can you get tetanus more than once? 6 weeks through 6 years. In addition, four childhood
Yes! Tetanus disease does not result in immunity combination vaccines include DTaP as a component.
because so little of the potent toxin is required to cause • DT: Diphtheria and tetanus toxoids, without the
the disease. People recovering from tetanus should pertussis component; given to infants and children
begin or complete the vaccination series. ages 6 weeks through 6 years who have a
contraindication to the pertussis component.
When did vaccine first become available for
diphtheria, tetanus, and pertussis? • Tdap: Tetanus and diphtheria toxoids with acellular
pertussis vaccine; adolescents and adults. Pregnant
The first inactivated toxin, or toxoid, against diphtheria
women should receive Tdap during each pregnancy.
was developed around 1921, but it was not widely used
until the 1930s. In 1924, the first tetanus toxoid • Td: Tetanus and diphtheria toxoids; given to children

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and adults ages 7 years and older. Note the small All adults should receive a single dose of Tdap as soon
“d” which indicates a smaller quantity of diphtheria as feasible. Then, subsequent booster doses of Td or
toxoid than in the pediatric DTaP formulation. Tdap should be given every ten years. Pregnant people
should receive Tdap during each pregnancy. Adolescents
How are these vaccines given? and adults who have recently received Td vaccine can be
The DTaP and DT preparations all given as an injection given Tdap without any waiting period.
in the anterolateral thigh muscle (for infants and young If someone experiences a deep or puncture wound, or
toddlers) or in the deltoid muscle (for older children and a wound contaminated with dirt, an additional booster
adults). Tdap and Td are given in the deltoid muscle for dose of either Td or Tdap may be given if the last dose
children and adults age 7 years and older. was more than five years ago. If both Td and Tdap are
available and the person has not received a dose of Tdap
Who should get these vaccines? since their 7th birthday, give Tdap. It is important to
keep an up-to-date record of all immunizations so that
All children, beginning at age 2 months, adolescents, and
repeat doses don’t become necessary. Although it is
adults need protection against these three diseases—
vital to be adequately protected, receiving more doses
diphtheria, tetanus, and pertussis (whooping cough).
than recommended can lead to increased local reactions,
Routine booster doses are also needed throughout life.
such as painful swelling of the arm.
How many doses of vaccine are needed?
Who recommends the use of these vaccines?
The usual schedule for infants is a series of four doses of
The Centers for Disease Control and Prevention (CDC),
DTaP given at 2, 4, 6, and 15–18 months of age. A fifth
the Advisory Committee on Immunization Practices
shot, or booster dose, is recommended between age 4
(ACIP), the American Academy of Pediatrics (AAP), the
and 6 years, unless the fourth dose was given late (after
American Academy of Family Physicians (AAFP), and the
the fourth birthday).
American College of Physicians (ACP) all recommend
For people who were never vaccinated or who may have this vaccine.
started but not completed a series of shots, a 3-dose
series of tetanus-toxoid containing vaccine should be What side effects have been reported with these
given with 1 to 2 months between dose #1 and #2, and vaccines?
6 to 12 months between dose #2 and #3. At least one Local reactions, such as redness and swelling at the
of the doses, preferably the first, should be Tdap, with injection site, soreness and tenderness where the shot
either Td or Tdap used for doses #2 and #3. was given, as well as mild systemic reactions such as
Because immunity to diphtheria and tetanus wanes with fever, are not uncommon in children and adults.
time, boosters of Td or Tdap are needed every ten years. Side effects following Td or Tdap in older children and
adults include redness and swelling at the injection site
When adolescents and adults are scheduled for
(following Td) and generalized body aches, and tiredness
their routine tetanus and diphtheria booster,
(following Tdap). Older children and adults who received
should they get vaccinated with Td or Tdap?
more than the recommended doses of Td/Tdap vaccine
Immunization experts recommend that a dose of Tdap can experience increased local reactions, such as painful
be given to all adolescents at age 11–12 years as a swelling of the arm. This is due to high levels of tetanus
booster during the routine adolescent immunization antibody in their blood.
visit if the adolescent has finished the childhood DTaP
schedule and has not already received a dose of Td or How effective are these vaccines?
Tdap. If a child age 7–9 years did not complete a primary After a properly spaced primary series of DTaP or Td/
series in childhood, a dose of Tdap should be given as Tdap, approximately 95% of people will have protective
part of the catch-up schedule, followed by the routine levels of diphtheria antitoxin and 100% will have p
adolescent dose at age 11–12 years. If the catch-up rotective levels of tetanus antitoxin in their blood.
dose is given at age 10, it can be counted as the However, antitoxin levels decrease with time so routine
adolescent dose. boosters with Td or Tdap are recommended every

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10 years. Short-term protection from pertussis illness another dose of DTaP. DT should be administered for
after vaccination is about 80–85% but protection begins the remaining doses in the series to ensure protection
to decline after about a year. against diphtheria and tetanus. If the person whose
encephalopathy that followed a previous dose of DTP,
Can a pregnant person receive Tdap vaccine? DTaP, or Tdap, is currently age 7 or older, they should
Yes. All pregnant people should receive Tdap during each receive Td instead of Tdap.
pregnancy, preferably early in the time period between Certain conditions are precautions to DTaP and Tdap
27 and 36 weeks’ gestation. Studies show that vaccina- vaccines. A precaution means that a person would
tion during pregnancy reduces a baby's risk of getting usually not receive the vaccine but there may be
pertussis in early infancy by 90 percent. Because infants occasions when the benefit of immunization outweighs
are not adequately protected against pertussis until they the risk, for instance, during a community-wide
have received at least 3 doses of DTaP, it is also recom- outbreak of pertussis. Precautions include: Guillain-
mended that all contacts (family members, caregivers) of Barré syndrome (a rare type of neurological condition)
infants younger than age 12 months are vaccinated with within 6 weeks after a previous dose of tetanus toxoid;
Tdap if they haven't previously received Tdap. If a new a severe local reaction (called an Arthus reaction) after a
mother hasn’t been vaccinated with Tdap, it should be previous dose of tetanus or diphtheria toxoid-containing
administered before hospital discharge. vaccine (defer vaccination until at least 10 years have
elapsed since the last dose of vaccine that caused the
Who should not receive these vaccines?
reaction); and a moderate or severe acute illness with
Generally, any person who has had a serious allergic or without fever. A person with a mild illness may be
reaction to a vaccine component or a prior dose of the vaccinated.
vaccine should not receive another dose of the same
A person with a recognized, possible, or potential
vaccine. People who had a serious allergic reaction to
neurologic condition should delay receiving DTaP or
a previous dose of DTaP or Tdap vaccine should not
Tdap vaccine until the condition is evaluated, treated,
receive another dose.
and/or stabilized.
A person younger than 7 years who develops
encephalopathy (e.g., coma, decreased level of Can the vaccine cause the disease?
consciousness, prolonged seizures) not due to another No.
identifiable cause within 7 days of administration of
a previous dose of DTP or DTaP should not receive

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