Tetanus:
Questions and Answers
information about the disease and vaccines
What causes tetanus? break their spine or long bones from convulsions. Other
possible complications include high blood pressure,
Tetanus is caused by a toxin (poison) produced by the
abnormal heart rhythm, and secondary infections, which
bacterium Clostridium tetani. The C. tetani bacteria
are common because of prolonged hospital stays.
cannot grow in the presence of oxygen. They produce
spores that are very difficult to kill as they are resistant Obviously, the high probability of death is a major
to heat and many chemical agents. complication.
How does tetanus spread? How is tetanus diagnosed?
C. tetani spores can be found in the soil and in the The diagnosis of tetanus is based on the clinical signs
intestines and feces of many household and farm and symptoms only. Laboratory diagnosis is not useful
animals and humans. The bacteria usually enter the as the C. tetani bacteria usually cannot be recovered
human body through a puncture. That puncture can from the wound of an individual who has tetanus, and
occur either indoors or outdoors. conversely, can be isolated from the skin of an individual
Tetanus is not spread from person to person. who does not have tetanus.
How long does it take to show signs of tetanus What kind of injuries might allow tetanus to enter
after being exposed? the body?
The incubation period varies from 3–21 days, with an Tetanus bacilli live in the soil, so the most dangerous
average of eight days. The further the injury site is from kind of injury involves possible contamination with dirt,
the central nervous system, the longer the incubation animal feces, and manure. Although we have tradition-
period. The shorter the incubation period, the higher ally worried about deep puncture wounds, in reality
the risk of death. many types of injuries can allow tetanus bacilli to enter
the body. In recent years, a higher proportion of cases
What are the symptoms of tetanus? had minor wounds than had major ones, probably
because severe wounds were more likely to be properly
The symptoms of tetanus are caused by the tetanus
managed. People can also get tetanus from splinters,
toxin acting on the brain and spinal cord. In the most
self-piercing, and self-tattooing. Injecting drug users are
common form of tetanus, the first sign is spasm of the
also at risk for tetanus.
jaw muscles, followed by stiffness of the neck, difficulty
in swallowing, and stiffness of the abdominal muscles. I stepped on a nail in the garage. What should
Other signs include fever, sweating, elevated blood I do?
pressure, and rapid heart rate. Spasms often occur, Any wound that may involve contamination with
which may last for several minutes and continue for 3–4 tetanus bacilli should be attended to as soon as possible.
weeks. Complete recovery, if it occurs, may take months. Treatment depends on your vaccination status and the
nature of the wound. In all cases, the wound should be
How serious is tetanus?
thoroughly cleaned. Seek medical treatment immediately
Tetanus has a high fatality rate. In recent years, tetanus and bring your immunization record with you.
has been fatal in about 10% to 20% of reported cases.
With wounds that involve the possibility of tetanus
What are possible complications from tetanus? contamination, a patient with an unknown or incomplete
history of tetanus vaccination needs a tetanus- and
Laryngospasm (spasm of the vocal cords) is a complica-
diphtheria-containing shot (Td or Tdap) and a dose of
tion that can interfere with breathing. Patients can also
tetanus immune globulin (TIG) as soon as possible.
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A person with a documented series of three tetanus- (inactivated toxin) was produced and was used success-
and diphtheria-containing shots (Td or Tdap) who has fully to prevent tetanus in the armed services during
received a booster dose within the last 10 years should World War II. The first pertussis vaccine was developed
be protected. However, to ensure adequate protection, in the 1930s and was in widespread use by the
a booster dose of vaccine may still be given if it has been mid-1940s, when pertussis vaccine was combined with
more than 5 years since the last dose and the wound is diphtheria and tetanus toxoids to make the combination
other than clean and minor. DTP vaccine. In 1991, concerns about DTP safety and
side effects led to the development of more purified
Is there a treatment for tetanus? (acellular) pertussis vaccines that are associated with
There is no "cure" for tetanus once a person develops fewer side effects. These acellular pertussis vaccines
symptoms, just supportive treatment and manage have replaced the whole cell DTP vaccines in the U.S.
ment of complications. The best "treatment" is In 2005, two vaccine products were licensed adoles-
prevention through immunization. cents and adults that combine the tetanus and diphthe-
ria toxoids with acellular pertussis (Tdap) vaccine.
How common is tetanus in the United States?
Tetanus first became a reportable disease in the late How are vaccines made that prevent diphtheria,
1940s. At that time, there were 500–600 cases reported tetanus and pertussis?
per year. After the introduction of the tetanus vaccine These vaccines are made by chemically treating the
in the mid-1940s, reported cases of tetanus dropped diphtheria, tetanus, and pertussis toxins to render them
steadily. nontoxic yet still able to produce an immune response in
From 2018 through 2020, an average of 22 cases were the vaccinated person. They are known as “inactivated”
reported per year. vaccines because they do not contain live bacteria.
Almost all cases of tetanus are in people who have never
What’s the difference between all the vaccines
been vaccinated, or who completed their childhood
containing diphtheria and tetanus toxoids and
series, but did not have a booster dose in the preceding
pertussis vaccine?
10 years.
It’s like alphabet soup! Here is a listing of the various
What is neonatal tetanus? products:
Neonatal tetanus is a form of tetanus that occurs in • DTaP: Diphtheria and tetanus toxoids and acellular
newborn infants, usually by using an unsterile cutting pertussis vaccine; given to infants and children ages
instrument on the unhealed umbilical stump. These 6 weeks through 6 years. In addition, several child-
babies usually have no temporary immunity that would hood combination vaccines include DTaP as a compo-
have been passed on from their mothers through the nent.
mothers' vaccinations.
• Tdap: Tetanus and diphtheria toxoids with acellular
Neonatal tetanus is very rare in the United States (only pertussis vaccine; given to adolescents and adults.
3 cases were reported from 2001 through 2016), but is Pregnant people should receive Tdap during each
common in some developing countries. pregnancy.
Can you get tetanus more than once? • Td: Tetanus and diphtheria toxoids; licensed for ages
Yes! Tetanus disease does not result in immunity 7 years and older. The small “d” indicates a smaller
because so little of the potent toxin is required to cause quantity of diphtheria toxoid than in the pediatric
the disease. People recovering from tetanus should DTaP formulation. CDC recommends use of Td in
begin or complete the vaccination series. children younger than age 7 years who have devel-
oped a contraindication to pertussis vaccination.
When did vaccine first become available for
diphtheria, tetanus, and pertussis? How are these vaccines given?
The first inactivated toxin, or toxoid, against diphtheria The DTaP preparations (or Td when the pertussis
was developed around 1921, but it was not widely component is contraindicated) are given as an injection
used until the 1930s. In 1924, the first tetanus toxoid in the anterolateral thigh muscle (for infants and young
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Tetanus: Questions and Answers (continued) page 3 of 4
toddlers) or in the deltoid muscle (for older children). Physician Associates, American College of Physicians,
Tdap and Td are given in the deltoid muscle for children National Association of Pediatric Nurse Practitioners,
and adults age 7 years and older. American Pharmacists Association, and the Society for
Healthcare Epidemiology of America.
Who should get these vaccines?
All children, beginning at age 2 months, adolescents, and What side effects have been reported with these
adults need protection against these three diseases— vaccines?
diphtheria, tetanus, and pertussis (whooping cough). Local reactions, such as redness and swelling at the
Routine booster doses are also needed throughout life. injection site, soreness and tenderness where the shot
was given, as well as mild systemic reactions such as
When adolescents and adults are scheduled for fever, are not uncommon in children and adults.
their routine tetanus and diphtheria booster,
Side effects following Td or Tdap in older children and
should they get vaccinated with Td or Tdap?
adults include redness and swelling at the injection site
Immunization experts recommend that a dose of Tdap (following Td) and generalized body aches, and tiredness
be given to all adolescents at age 11–12 years as a (following Tdap). Older children and adults who received
booster during the routine adolescent immunization visit more than the recommended doses of Td/Tdap vaccine
if the adolescent has finished the childhood DTaP can experience increased local reactions, such as painful
schedule and has not already received a dose of Td or swelling of the arm. This is due to high levels of tetanus
Tdap. If a child age 7–9 years did not complete a primary antibody in their blood.
series in childhood, a dose of Tdap should be given as
part of the catch-up schedule, followed by the routine How effective are these vaccines?
adolescent dose at age 11–12 years. If the catch-up After a properly spaced primary series of DTaP or Td/
dose is given at age 10, it can be counted as the Tdap, approximately 95% of people will have protective
adolescent dose. levels of diphtheria antitoxin and 100% will have
All adults should receive a single dose of Tdap as soon protective levels of tetanus antitoxin in their blood.
as feasible. Then, subsequent booster doses of Td or However, antitoxin levels decrease with time so routine
Tdap should be given every ten years. Pregnant people boosters with Td or Tdap are recommended every 10
should receive Tdap during each pregnancy. Adolescents years. Short-term protection from pertussis illness after
and adults who have recently received Td vaccine can be vaccination is about 80–85% but protection begins to
given Tdap without any waiting period. decline after about a year.
If someone experiences a deep or puncture wound, or
Can a pregnant person receive Tdap vaccine?
a wound contaminated with dirt, an additional booster
dose of either Td or Tdap may be given if the last dose Yes. All pregnant people should receive Tdap during
was more than five years ago. If both Td and Tdap are each pregnancy, preferably early in the time period
available and the person has not received a dose of Tdap between 27 and 36 weeks’ gestation. Studies show that
since their 7th birthday, give Tdap. It is important to vaccination during pregnancy reduces a baby's risk of
keep an up-to-date record of all immunizations so that getting pertussis in early infancy by 90 percent. Infants
repeat doses don’t become necessary. Although it is are not adequately protected against pertussis until they
vital to be adequately protected, receiving more doses have received at least 3 doses of DTaP. If a new mother
than recommended can lead to increased local reactions, hasn't ever been vaccinated with Tdap, it should be
such as painful swelling of the arm. administered before hospital discharge.
Who supports the use of these vaccines? Who should not receive these vaccines?
The use of these vaccines is recommended by the Generally, any person who has had a serious allergic
Advisory Committee on Immunization Practices and reaction to a vaccine component or a prior dose of the
approved by the CDC, American Academy of Pediatrics, vaccine should not receive another dose of the same
American Academy of Family Physicians, American vaccine. People who had a serious allergic reaction to
College of Obstetricians and Gynecologists, American a previous dose of DTaP or Tdap vaccine should not
College of Nurse-Midwives, American Academy of receive another dose.
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Tetanus: Questions and Answers (continued) page 4 of 4
A person younger than 7 years who develops Precautions include: Guillain-Barré syndrome (a rare type
encephalopathy (e.g., coma, decreased level of of neurological condition) within 6 weeks after a
consciousness, prolonged seizures) not due to another previous dose of tetanus toxoid; a severe local
identifiable cause within 7 days of administration of reaction (called an Arthus reaction) after a previous dose
a previous dose of DTP or DTaP should not receive of tetanus or diphtheria toxoid-containing
another dose of DTaP. To complete timely tetanus and vaccine (defer vaccination until at least 10 years
diphtheria vaccination of these young children, CDC have elapsed since the last dose of vaccine that caused
recommends off-label use of Td (tetanus-reduced the reaction); and a moderate or severe
diphtheria) vaccine (licensed for age 7 years and older), acute illness with or without fever. A person with a mild
following the same schedule that would be used for illness may be vaccinated.
DTaP in this age group. If the person whose encepha- A person with a recognized, possible, or potential
lopathy followed a previous dose of DTP, DTaP, or neurologic condition should delay receiving DTaP or
Tdap, is currently age 7 or older, they should receive Tdap vaccine until the condition is evaluated, treated,
Td instead of Tdap. and/or stabilized.
Certain conditions are precautions to DTaP and Tdap
vaccines. A precaution means that a person would Can the vaccine cause the disease?
usually not receive the vaccine but there may be occasions No.
when the benefit of immunization outweighs the risk, for
instance during a community-wide outbreak of pertussis.
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