FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

TETANUS IS STILL A DEADLY DISEASE WITHOUT PROPER IMMUNIZATION

Question: I was walking through my yard and felt something in my shoe. It was a rusty nail that went through my shoe and into my foot. Since I hadn't had a tetanus shot for awhile, I went to my family doctor and got a booster. How often do you need to get a booster for tetanus? How severe is tetanus if you actually get it?

Answer: I'm glad that you took the proper steps to make sure you were properly immunized against tetanus. As is almost always true, prevention of this terrible disease is much easier than the cure. Tetanus is relatively rare in industrialized countries precisely because of the widespread immunization against it. There are about 100 cases reported in the United States each year. These unfortunate individuals have not had adequate immunization, and 70 percent of these folks are 50 or older. Tetanus in non-industrialized countries is still a major problem, however. There are more than one million deaths worldwide each year due to tetanus.

Tetanus, or "lockjaw" as it's commonly known, is caused by infection with the bacterium Clostridium tetani. One of the reasons that this organism is so prevalent in earth's soil is its ability to form spores. In this phase of its life cycle, the bacterium becomes dormant and its spores are highly resistant to extremes of weather and other environmental conditions. In addition to being common inhabitants of normal soil, tetanus spores are also found in the digestive tracts of many domestic animals.

Getting a spore inside the body through a wound in the skin is all that is necessary to contract tetanus. This often happens from a very inconsequential injury such as the minor scratches one gets while gardening. The classic example, however, is stepping on the rusty nail outdoors, just like you did. It is also possible to get it from dog bites, burns, and other injuries that break the skin.

The spore of C. tetani emerges from its dormant stage and seemingly "comes alive" once it is inside the body. It reproduces and begins production of a chemical that interferes with the way our human nervous system works. This chemical, called a toxin, can be produced as soon as one or two days after the initial injury, or it may take over a month. The toxin causes restlessness and sore muscles, usually starting with muscles of the neck, back or extremities. Over the subsequent next three days, severe spasm of the jaw muscles -- lockjaw -- develops in 60 percent of individuals. As the illness progresses, more muscles become involved in the acute spasm, including those necessary for eating and breathing. And to make the condition more insufferable, the person is often still fully alert.

Modern medicine can save some individuals that develop generalized tetanus, but it is always a "touch-and-go" situation for weeks. Typical hospitalization is one to two months. Clearly, prevention is better than treatment. Most adults in the U.S. have had immunizations for tetanus as a child. It is necessary to have a tetanus shot every 10 years to maintain protection from this dreaded illness. An adult that isn't sure if he or she ever had tetanus immunization requires a shot now, a second in one month, and the third in one year. Thereafter, a booster is needed once every ten years.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.