Australia’s trusted immunisation experts
06 February 2024
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NSW Health recently reported three cases of tetanus and the tragic death of a woman in her 80s – the first tetanus fatality in the state in 30 years.
Tetanus is a rare but potentially fatal disease. Thankfully, it’s preventable – being up to date with tetanus vaccination is your best protection.
The bacteria that causes tetanus is called Clostridium tetani. Spores can enter your body usually following a skin wound, puncture or injury.
Tetanus cannot be transmitted from person to person.
The spores are ubiquitous, found in soil, dust and animal waste. They can persist in the environment for months to years, and are remarkably hardy – they’re even resistant to boiling and a number of disinfectants.
Once in a wound, the bacteria can grow and produce a toxin. It is the toxin that acts on your nervous system to cause muscle rigidity and painful spasms.
One classic symptom of tetanus is “lockjaw”, where the muscles around your mouth go into spasms. This makes it difficult to eat and speak but patients maintain full consciousness or awareness. The muscle contractions and spasms are intensely painful and can be triggered by loud noises, physical contact or even light.
Patents with tetanus are commonly treated in an intensive care unit and require cleaning of the wound, antibiotics and injections of anti-toxin, known as human tetanus immunoglobulin, as well as a vaccine.
In severe cases, spasms of muscles surrounding your airways and lungs, alongside high and low blood pressure and heart rhythm abnormalities can lead to death.
Despite the best treatment, about 2-10% of patients die.
In Australia, tetanus is rare because of high vaccination coverage, with around 14 cases reported to health authorities a year.
Tetanus can occur at any age, but is more common in older adults who have never been vaccinated or were vaccinated more than ten years ago.
The vaccine is very effective in preventing tetanus. Tetanus vaccination stimulates the production of antibodies, also known as antitoxin. This means vaccination doesn’t stop Clostridium tetani growing in contaminated wounds. Rather, it protects against the effects of the toxin.
Tetanus vaccination has been available in Australia since 1925. It’s currently on the National Immunisation Program (NIP) as an initial five-dose schedule for infants and children until five years of age, administered as a combined diphtheria-tetanus-acellular pertussis (DTPa) vaccine.
Most children (97%) in Australia complete this primary immunisation schedule.
The level of antitoxin needed for protection from tetanus is 0.1-0.2 international units (IU) per millilitre (mL). This level is reached following a fifth dose, at age four to six years.
But by middle age, about 20% of Australians have low or undetectable levels of antitoxin. This places them at risk of contracting tetanus after a wound or injury.
A single dose of tetanus vaccine produces protective levels of antitoxin in these people. This is why a booster dose of tetanus vaccine is recommended for the following people if their last dose was more than ten years ago:
If you have a tetanus-prone wound and there is any doubt about your tetanus immunisation status, you should receive tetanus immunoglobulin as soon as possible. You should also receive a tetanus vaccine.
If you’re overseas, it could be hard and expensive to get access to both tetanus immunoglobulin and tetanus vaccine.
If you’re over 14 years of age, you can check your vaccine history:
If it has been more than ten years since your last dose, ask your GP about getting a booster. It could save your life.
Professor Nick Wood - Associate Director, Clinical Research and Services, National Centre for Immunisation Research and Surveillance
Dr Helen Quinn - Acting Associate Director Policy Support & Guideline Development, National Centre for Immunisation Research and Surveillance
This article first appeared in The Conversation. It has been reproduced here under Creative Commons licence.