How to avoid tetanus: Key prevention steps everyone should know

Tetanus may sound like a disease from another era, but experts are warning that it remains a serious threat.

Two recent reports from the US Centres for Disease Control and Prevention found hundreds of tetanus cases and dozens of deaths over 15 years, along with four cases in children in 2024 alone.

At the same time, vaccination rates have declined, worrying experts that more people could become vulnerable to this potentially deadly but preventable infection.

To help us understand what tetanus is, why it remains dangerous and how people can protect themselves, I spoke with wellness expert Dr Leana Wen.

Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

What exactly is tetanus?

Tetanus is caused by a bacterium called Clostridium tetani. The bacteria produce spores that are extremely common in the environment.

The spores can be found in soil, dust and animal manure. Tetanus occurs when the spores enter the body through an injury. Once inside, the bacteria can produce a potent toxin that attacks the nervous system.

As for that rusty nail, the rust itself is not the problem. Nails and other objects are a concern because they may be contaminated with these bacterial spores, especially if they have been outdoors.

Many kinds of injuries can lead to tetanus. Puncture wounds are a classic example, but lacerations, fractures that break the skin, burns, crush injuries and even relatively minor cuts can also pose a risk if they are contaminated with dirt or debris.

In a recent CDC case series involving infections in four children, injuries included an ankle fracture sustained while riding an electric scooter, a puncture wound and a foot injury.

When to worry about tetanus?

 People should seek medical attention if they have a deep puncture wound, a wound contaminated with dirt or animal faeces, a crush injury, a burn, a frostbite injury, or a wound containing debris that cannot easily be cleaned.

The clinician will not only clean the wound but also determine whether additional tetanus protection is needed.

It’s essential to seek care right away. Tetanus can often be prevented after an injury through proper wound care, administration of a tetanus-containing vaccine and, in some cases, tetanus immune globulin, which contains antibodies that provide immediate protection.

Symptoms of tetanus

 Symptoms often begin several days to weeks after an injury. Many people have heard the term “lockjaw,” and that’s one of the classic symptoms. Patients may initially experience jaw stiffness, neck pain, back pain or difficulty swallowing.

As the disease progresses, muscles throughout the body can become rigid and go into painful spasms. The disease can quickly become life-threatening.

Muscles involved in breathing may stop functioning properly. Some patients develop spasms of the vocal cords that obstruct the airway.

Others develop dangerous fluctuations in blood pressure and abnormal heart rhythms because the autonomic nervous system becomes affected. Recovery can take weeks or months, and even with excellent medical care, the disease can be fatal.

What vaccines are recommended?

 The American Academy of Pediatrics recommends that children receive five doses of a tetanus-containing vaccine as part of the routine childhood immunisation schedule, beginning at 2 months of age.

Adolescents should then receive a Tdap or tetanus, diphtheria and acellular pertussis booster at age 11 or 12.

Adults should receive a tetanus booster every 10 years thereafter. Those who have sustained a severe burn or dirty wound should follow up with a booster after five years, according to the CDC.

Pregnant individuals should also receive a Tdap vaccine during each pregnancy to help protect newborns.

Who is most at risk today?

The people most at risk are those who are unvaccinated or have not completed their primary vaccination series. A CDC surveillance report found that among people who developed tetanus and whose vaccination history was known, nearly half had never received a tetanus vaccine.

Children whose parents or caregivers decline vaccination are particularly vulnerable. This also includes newborns; receiving a tetanus-containing vaccine during pregnancy helps protect infants against neonatal tetanus.

Older adults are another important group. The highest rates of tetanus cases and tetanus-related deaths occurred among women age 80 and older, according to the CDC report.

The primary series of the tetanus vaccine was first recommended in 1947. It’s possible that some of these older women never received the primary series, and did not receive it as part of military services like men of similar ages did.

Is tetanus contagious?

 No. Tetanus is not contagious. This is important for people to know, first because it helps them understand how tetanus is spread, and second because it highlights why vaccination is so important.

With diseases such as measles, one person’s vaccination helps protect others because it reduces transmission within a community, which we call herd immunity. Tetanus does not work the same way. You cannot rely on others around you being vaccinated to keep you safe.

 First, know your vaccination status. A lot of adults cannot remember when they last received a tetanus booster or whether they ever had their primary vaccine series. This is something that can easily be checked with your healthcare provider.

Second, don’t ignore wounds. Seek prompt medical attention for deep puncture wounds or wounds contaminated by dirt or debris.

Third, recognise that tetanus is still here. It has become rare because vaccines work so well, not because the disease has disappeared.

The bacteria that cause tetanus are everywhere in our environment and cannot be eliminated, which is why staying up to date on vaccination is so important.

This is one of those situations in medicine where we have a safe, highly effective way to prevent a potentially life-threatening disease, and we should take advantage of it.