Tetanus is caused by a toxin from the bacterium C. tetani, whose spores are found worldwide in soil, house dust, and feces. Spores can lie dormant for years, then reactivate when introduced into the body via a contaminated wound. A wide range of injuries (cuts, abrasions, burns, animal bites) can be at risk -- even seemingly trivial ones if the blood supply is compromised or the wound is deep. This is because C. tetani is an anaerobe: it lives and reproduces where there is little or no oxygen. When wound conditions are right, it produces a toxin (tetanospasmin) which spreads to the nerves and causes the symptoms we see. Among the first and most frequent is stiffness of the jaw – hence the common name "lockjaw." As tetanus progresses, there is widespread painful muscle rigidity . Agonizing convulsions may occur – strong enough to break bones – and the patient may remain awake and conscious during them. Stiffness of the muscles of breathing or spasms of the throat may cause death by suffocation. Even with prompt and aggressive treatment at the onset of symptoms, up to 20% of patients will die.

Fortunately, widespread immunization has made tetanus rare in the United States – about 50 cases a year. There are two ways to immunize against it. First is "active" immunization: a vaccine is given to induce the body to produce its own protective antibodies. Most Americans receive this form of immunization as children. Currently four tetanus vaccinations are given between ages 2 months and 1 1/2 years, with another dose before entering school, and then again at age 11-12. Because active immunization diminishes with time, a booster every 5-10 years thereafter is best.

The second way to immunize is called "passive," because rather than inducing the body's own defenses, special immunoglobulins with activity against tetanus are given. When injured, those who were never actively immunized or those whose vaccinations were inadequate may need these imminuglobulins. So may those whose immune system may be deficient because of age or disease, those receiving certain cancer treatments, and those on certain drugs. Because tetanus occurs under conditions of low oxygen, people with illnesses that affect circulation (diabetes, vascular disease) or oxygenation (mphysema, sickle cell) may also need passive vaccination.

The other way to reduce tetanus risk is through proper wound management itself. A recent national shortage of active tetanus vaccines has made this even more important. Not all wounds will require stitches, of course, but they should all be evaluated for the risk of tetanus (and other infections) and for proper care during the healing process. Thorough irrigation to flush out bacteria and spores should be done at the time of injury if possible. Often a wound will need to be explored to remove debris or to excise tissue which is dead or compromised and which could become a place for infection to take hold. The doctor will review tetanus immunization status and health history to determine whether a simple booster shot or a combination of active and passive vaccines is needed. While routine primary immunizations and booster shots in the absence of injury can be obtained from the Health Department or a family doctor, acute wounds that break the skin – especially potentially contaminated ones – should be evaluated at the Emergency Department or at an urgent care facility such as Medac, where the physicians and staff are trained in the best way to manage each injury and to reduce the risk of potentially life-threatening infection.