What is tetanus?
Tetanus is a bacterial infection caused by the bacteria Clostridium Tetani. It commonly lives in dirt, dust and animal waste and the spores are usually introduced into the body via lacerations or puncture wounds. The spores can survive in a wound for as long as 3 months before becoming active. The most common time frame for presentation of tetanus is around 14 days, but it can also be delayed (up to months), after the injury. Unlike other vaccine preventable diseases, tetanus is not transmissible from person to person.
Examples of wounds that are considered tetanus prone-
- Bites, either animal or human
- Deep penetrating wounds
- Wounds with foreign bodies i.e. splinters
- Open fractures
- Cuts or lacerations with outdoor equipment
- Tooth reimplantation post avulsion
- IV drug use sites
Tetanus can occur following trivial or even unnoticed wounds. Tetanus prophylaxis should be strongly considered for all unimmunised or partially immunised persons, regardless of the nature of the wound.
Signs and Symptoms
People infected with tetanus commonly show signs of muscle spasm, mainly around the face and neck, including lock jaw. Spasms can last for significant amounts of time, requiring large amounts of analgesia.
Severe cases can lead to breathing difficulties, respiratory infections and heart attack. 1 in 10 people with tetanus will die despite receiving prompt medical treatment.
Vaccination is the most effective way to prevent tetanus.
As per the National Immunisation Program (NIP), a primary course of tetanus vaccination is given at 6-weeks, 4-months, and 6-months of age (Infanrix hexa®).
Boosters are then scheduled at-
- 18-months (Infanrix®/Tripacel®)
- 4-years (Infanrix-IPV®/Quadracel®)
- Year 7 (high school program)/12 to 13-years of age (Boostrix®)
A further booster dose as dTpa (Boostrix®/Adacel®) is recommended but not funded, for adults aged ≥ 50-years who have not received a dose of tetanus-containing vaccine in the last 10 years.
Regular booster doses every 10-years are no longer recommended. However immunisation advice regarding the management of a tetanus prone wound varies from this [see below].
Tetanus prone wounds
The correct management of a tetanus prone wound is vital in the prevention of tetanus [see resources: RCH Clinical Practice Guideline].
Key messages include:
- Where applicable, wounds should be cleaned, disinfected, and surgically treated if required
- In paediatric patients, a full immunisation history should be taken, ensuring that a primary course of tetanus vaccination has been completed
- If a patient is > 5 years post a tetanus vaccine, then a booster is recommended
- An important age group to consider for a booster are those aged between 9-13 yrs, as they are 5-years post their 4-year old vaccine, and may not have yet received their Year 7 (adolescent) booster
Children or adults who are unimmunised or only partially
Every person will receive an injury at some point in their life. Whether it is tetanus prone, will depend on medical assessment. Even the most superficial wounds could be at risk of tetanus depending on the mechanism of injury.
An unimmunised or partially immunised person is at greatest risk of contracting tetanus. The elderly population are often included in this group due to timing of their last booster, most commonly being exposed whilst gardening.
A partially immunised person is one who has not yet completed a primary course, or has received < 3 doses of a tetanus containing vaccine. These people require not only a tetanus-containing vaccine but also tetanus immunoglobulin (TIG) [refer to resources for specific advice].
If immunisation history is in doubt, TIG and a tetanus-containing vaccine should be administered.
Immunoglobulin provides protection for up to 1 month after administration. Vaccination provides protection against the toxin and not the bacteria. A full course of 3 doses of a tetanus-containing vaccine should be completed to ensure ongoing immunity. If individual advice is required consider a referral to a Specialist Immunisation Clinic.
The use of ADT® in children aged < 10-years is not recommended as it does not contain enough antigen to promote an adequate immune response in the unimmunised, however there are unlikely to be safety issues. Parents requesting this option should be made aware of the increased risk of contracting tetanus.
Management of immunosuppressed patients with a tetanus prone-wound
Immunosuppressive medications are becoming more common place in the management of particular medical conditions. Patients who may be immunosuppressed include:
- Autoimmune conditions ie: IBD, lupus, rheumatologocial conditions
- Solid organ transplant recipients, Haematopoietic stem cell transplant recipients
- All oncology patients
Patients who are immunosuppressed should be considered unimmunised and treated accordingly with immunoglobulin and a vaccine.
- Australian Immunisation Handbook: Tetanus
- The Royal Children’s Hospital Clinical Practice Guideline: Management of tetanus prone wound
Author: Lynne Addlem (Immunisation Nurse, The Royal Children’s Hospital) and Rachael McGuire (Education Nurse Coordinator)
Reviewed by: Lynne Addlem (Immunisation Nurse, The Royal Children’s Hospital)
Date: September 2020
Materials in this section are updated as new information becomes available. The Melbourne Vaccine Education Centre (MVEC) staff regularly review materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.