Cause
Tetanus is caused by a toxin released into the nerves and muscles by the bacterium Clostridium tetani, which is found in soil, dust, and the feces of some animals. The disease occurs very rarely in the United States, in part due to the availability and routine use of the tetanus vaccine.
Symptoms
It usually begins with muscle spasms in the jaw, along with headache, restlessness, and irritability, followed by difficulty chewing and swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. The muscles of the face can lock into a characteristic smile with arched eyebrows. There may be a fever and chills. Spasms spread to muscles in the stomach, back, hip, and thigh muscles.
How It Spreads
Most cases in the United States develop from a puncture wound or cut from a dirty object such as a nail, splinter, or fragment of glass. Neonatal tetanus occurs after a baby is delivered in unsanitary conditions, especially if the umbilical cord cut is contaminated with the bacteria and the mother has not been immunized against tetanus.
Incubation Period
The incubation period is typically 2 to 14 days, but it can be as long as months after the injury. Symptoms of neonatal tetanus typically begin 3 to 12 days after birth.
How Long Symptoms Last
Recovery usually takes at least four to six weeks.
When to Call Your Child’s Doctor
Call your child’s doctor if your child gets a wound, especially if it is a puncture wound or an animal bite, and she has not been immunized against tetanus or you are unsure when she got her last tetanus booster; if your child develops any of the symptoms of tetanus; or if you are pregnant and unsure about your tetanus immunization status.
How the Diagnosis Is Made
The diagnosis is usually made based on the history of symptoms and the doctor’s physical examination of the child.
Treatment
Tetanus is treated in the hospital, usually in an intensive care unit. The child receives antibiotics to kill the bacteria and an antitoxin to neutralize the toxin. Medications are given to control muscle spasms and to stop abnormal nerve activity that can cause disturbances in heartbeat, blood pressure, and body temperature.
Prevention
Tetanus can be prevented by receiving the recommended routine immunizations with tetanus vaccine—usually as part of the DTaP (diphtheria-tetanuspertussis) vaccine—at 2, 4, 6, and 15 to 18 months and again at 4 to 6 years. Boosters should be given thereafter at 10-year intervals. Although cleaning a dirt- or soilcontaminated wound is not a substitute for immunization, be sure to clean all wounds.
Contagious Periods
The disease is not a contagious one.
Complications
Death occurs in 5 to 35 percent of cases. With intensive care treatment, fewer than 10 percent of infants with neonatal tetanus will die; without it, more than 75 percent die. In some cases, children, especially infants, will suffer brain injury, resulting in cerebral palsy, mental retardation, or behavioral difficulties.