Updated January 05, 2015.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

She smiled. Her face locked in a smile. Her eyes were not smiling.

I wish I could un-see that. This was a "sardonic smile". It happens when when muscles spasm in Tetanus. Those affected become slowly paralyzed. They do not struggle to breathe; their breaths become shallower and shallower. Awake, they can't control their body to scream out.

I wish I had never seen this.

She had cut her leg. Clostridium tetani bacteria from the soil had gotten into her cut.

 

Tetanus is a vaccine preventable disease. She had not had the vaccine. 

Once someone is sick all we can do is support them. It may take weeks to get better but even in the US 1 in 5 die. Patients develop stiffness and spasms in jaws, neck muscles. They have difficulty swallowing, slowed breathing, painful body spasms, and a hardened abdomen. They may have a fever and rapid heart rate.

We put a tube to their lungs for breathing, a tube to their stomach for feeding. We give them antitoxin, antibiotics (and maybe magnesium, muscle relaxants). 

We keep patients alive - where we can. Those not vaccinated often live where medical resources are limited. Rates rise after natural disasters, especially earthquakes, when resources may be stretched. 

Over 1 million people have tetanus annually worldwide. Only a few cases occur annually in the US. From 2001-8, 233 cases and 26 deaths were reported in the US. This is a success of vaccination. The bacteria that causes tetanus remains in the soil. It is prevented by vaccination.

 Those who develop tetanus rarely have full vaccination; only 16% in US have 3 doses (which is less than the total needed).

It is not communicable between people. C. tetani spores (dormant bacteria) are in the soil and animal (or even human) stool. It can infect us if it enters a cut in our skin - a dirty wound.

The disease is clinically apparent and diagnosed by exam.

How many Tetanus Shots are needed?

We need multiple Tetanus shots forimmunity. Children are given a vaccine called DTaP at months 2,4,6, and 15-18, as well as at 4-6 years. 

Usually Tetanus vaccine is given with Diphtheria (D or d) and Pertussis (aP or ap for acellular Pertussis - whooping cough).

Another tetanus-containing vaccine Tdap should be given once at age 11-12, or at least by age 18, though it can be given up to age 64. Every 10 years after that, the plain tetanus vaccine, Td, should be given. If someone has had Td, but not Tdap, which is newer and many have not yet had, they can have Tdap regardless of when last Td dose was. If someone has a dirty wound, vaccination should be given again if it hasn't been given in the last 5 years.

The vaccine can hurt a bit; see CDC for side-effects.

Can pregnant women have this vaccine?

Yes, women should have Tdap once during each pregnancy (27-36 weeks).  Worldwide neonatal tetanus is worrisome; bacteria enter through the umbilical cord stump, especially if cut without something sterile. In 2000, 14% of newborn deaths worldwide were due to neonatal tetanus (215,000); this has now dropped to 59,000. Mothers can also be infected during birth (or miscarriage).

The Tdap vaccine provides maternal pertussis antibodies to the baby and prevents the mother from passing on pertussis. 

The vaccine contains nothing "alive" - no live bacteria or anything infectious.

There are multiple types of Tetanus Vaccines, right?

Yes, DTaP and Tdap differ by dosage. Children are given DTaP under the age of 7 for a strong immune response. The Tetanus vaccine can also be give separately. 

TIG (Tetanus Immunoglobulin) is made of ready-made antibodies injected when there isn't enough time for a vaccine to lead to antibody production. TIG is used to treat Tetanus too. 

What happens if I have a wound?

Clean all wounds. If the wound is not mild and clean, you should have a tetanus vaccine if you haven't had one in 5 years or haven't had 3 doses. If you haven't had 3 tetanus vaccines, you should have TIG.

Who is most at risk?

Besides infants, elders are at most risk. The risk of dying of tetanus is 5x higher in those over 65 (30% of deaths). IV drug users are at risk. Diabetics are also at risk - 3x as many cases. Non-acute wounds (chronic ulcers, abscesses, gangrene) cause 1 in 6 cases in the US. In 1 in 12 cases, there is no obvious injury.