Tetanus

Tetanus is a serious, potentially fatal illness caused by a toxin produced by the bacterium Clostridium tetani, which typically enters the body through a wound. It causes severe muscle stiffness and spasms and is preventable through vaccination.

• Jaw stiffness and difficulty opening the mouth ("lockjaw"), often the earliest sign
• Muscle stiffness and painful spasms, which can spread to the neck, abdomen, and back
• Spasms may be triggered or worsened by light, noise, or touch
• Difficulty swallowing
• In severe cases, spasms affecting the muscles used for breathing, which can be life-threatening
• In newborns (neonatal tetanus): difficulty feeding, stiffness, and spasms, usually from infection of the umbilical cord stump

• Caused by toxin from Clostridium tetani, bacteria commonly found in soil, dust, and animal faeces.
• Typically enters the body through a wound, particularly deep or dirty puncture wounds, but can also follow burns or minor injuries.
• In newborns, infection often results from unhygienic cutting or care of the umbilical cord.
• Risk is greatly increased by incomplete or absent tetanus vaccination.

• Diagnosed clinically based on the characteristic pattern of muscle stiffness and spasms, together with a history of a recent wound or, in newborns, unhygienic cord care, in a person with incomplete vaccination.
• There is no specific blood test used routinely to confirm the diagnosis; management is guided by clinical suspicion.

Tetanus is a medical emergency managed at hospital level, ideally in a quiet, dimly lit area to reduce spasm-triggering stimulation.

Tetanus immunoglobulin is given as soon as possible to neutralise circulating toxin, alongside thorough cleaning and debridement of the wound.

Metronidazole is given to eliminate the bacteria producing the toxin.

Muscle relaxants (such as diazepam) are used to control spasms, and in severe cases, patients may need airway support and assisted breathing due to spasms affecting the breathing muscles.

A full course of tetanus vaccination is also given, as natural infection does not provide lasting immunity.

• Complete the routine tetanus vaccination schedule for infants and ensure booster doses as recommended.
• Ensure all pregnant women receive tetanus toxoid vaccination to protect against neonatal tetanus.
• Practise clean cord care at birth, including using a sterile instrument to cut the cord and keeping it clean and dry afterward.
• Clean any wound thoroughly and seek medical care for deep, dirty, or puncture wounds, including a booster vaccination if due.
• Seek prompt tetanus vaccination status review and, if needed, vaccination or immunoglobulin after any significant wound.