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Tetanus is a potentially fatal nervous system disease caused by the bacterium Clostridium tetani entering through an open wound or break in the skin. Thanks to an effective vaccine that is given as part of the childhood vaccination program in Hong Kong, tetanus has become rare, with no reported cases in 2020. Read on to learn more about the causes, symptoms, treatment and prevention of tetanus.
Tetanus is a serious infection caused by a common soil bacteria named Clostridium tetani. It can enter the body through a small cut or scrape, producing toxins (tetanospasmin exotoxin) that can damage the nervous system, causing muscle stiffness and spasms. Tetanus can be a fatal disease, particularly when it affects the breathing muscles resulting in respiratory failure. The condition most commonly affects people who injure themselves and have not been vaccinated against tetanus. As the bacterium causing tetanus is a ubiquitous soil organism, it cannot be eradicated and prevention by vaccination is of paramount importance. Most children growing up in Hong Kong receive this vaccine as part of the childhood vaccination program. However, the protection offered by the vaccination declines with time. Therefore, adults (especially those with an open wound) should get booster shots regularly to prevent tetanus.
Tetanus is caused by the bacterium called Clostridium tetani. The spores of tetanus bacteria are found everywhere in the environment, especially in soil and dust, remaining in a dormant state until they find a place to thrive.
When the spores of tetanus bacteria enter through a wound or small break in the skin, the bacteria are activated and begin to grow and divide, releasing a toxin (tetanospasmin). The toxin attacks the nervous system, leading to symptoms including muscle stiffness and spasms.
Tetanus does not spread from one person to another. Tetanus bacteria gain access to the body through:
Tetanus has an incubation period of 3 to 21 days, with most cases developing symptoms within 14 days of infection.
Signs and symptoms of tetanus include:
Tetanus is diagnosed clinically by doctors performing physical examinations and asking for relevant medical history and vaccination history. There are no diagnostic tests that can confirm tetanus. A laboratory test may only be used to eliminate other conditions causing the signs and symptoms.
Tetanus is a medical emergency that requires urgent hospitalization. Treatment for tetanus includes:
Tetanus vaccine is given as part of the Hong Kong Childhood Immunisation Programme. Tetanus immunisation is administered by injecting tetanus toxoid, usually in conjunction with diphtheria, pertussis and polio vaccines (DTaP-IPV Vaccine). The Department of Health of Hong Kong provides a free comprehensive childhood immunisation program to Hongkongers in all the Maternal & Child Health Centres. The DTaP-IPV Vaccine is given at 2, 4 and 6 months of age, with booster shots at the age of 18 months, Primary One and Six in School. A complete series of tetanus vaccines according to the immunisation schedule provides effective protection for at least 10 years. Adults should update their tetanus vaccine every ten years, or sooner (five years) if they have a high-risk wound.
Most people have no serious reactions after receiving the DTaP-IPV vaccine. Minor reactions such as a sore arm, mild fever or swelling around the injection site are common. Parents can use anti-fever medication (e.g. paracetamol) to help relieve the symptoms. If the child develops breathing difficulty or coma (which is extremely rare) after the vaccination, it is important to go to the Accident & Emergency Department immediately for urgent medical management.
Tetanus, if left untreated, can lead to serious complications including:
Tetanus bacteria (Clostridium tetani) gets into the body through a break in the skin, it can gain entry through tears or splits in the skin, cuts and grazes, burns, animal bites, body piercing, tattoos and injections.
If the wound from the cut is deep, contains dirt or a foreign object and you have not had a tetanus booster in the past 10 years or your tetanus vaccinations aren’t up-to-date, you should seek medical help. You may be recommended to get a tetanus vaccine as soon as possible. If you develop severe muscle stiffness or spasms, you should immediately go to your nearest A&E department or call 999 for an ambulance.
When tetanus does occur, it is a serious bacterial infection that can take months to fully recover with adequate care. If left untreated, tetanus can lead to serious complications including uncontrolled/ involuntary tightening of the vocal cords, bone fractures, pulmonary embolism, lung infection and breathing difficulties, possibly leading to death.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
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