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Tetanus is a disease, commonly known as "lockjaw," caused by a bacterium called Clostridium tetani. The incubation period usually ranges from 3 days to 3 weeks. Tetanus occurs when the spores of Clostridium tetani are introduced into a cut or wound. The organisms germinate, then release a toxin that causes severe, painful muscle spasms, first in the jaw, then in the neck, chest, back, arms, and legs. Uninhibited muscle spasms may lead to fractures, swallowing difficulties, aspiration, or asphyxia. Cardiac arrhythmias may occur, as well as wide swings in temperature and blood pressure. Tetanus antitoxin must be promptly administered, in conjunction with an antibiotic, usually metronidazole. Aggressive supportive measures, including mechanical ventilation, play an essential role. Even when medical care is optimal, the death rate ranges from 10-20%.
The elderly are at highest risk for tetanus, because many have never been fully immunized. Tetanus vaccine consists of tetanus toxin that has been inactivated by formaldehyde and adsorbed onto aluminum salts to increase its effectiveness. The vaccine is routinely given, in combination with diphtheria and pertussis vaccines, to all children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years, followed by tetanus-diphtheria vaccine every 10 years thereafter. All adults who completed the recommended childhood immunizations but have not received tetanus-diphtheria vaccine within the past 10 years should be given a booster. Unvaccinated persons more than seven years of age should receive three doses of adult tetanus-diphtheria vaccine. The first two doses should be separated by 4-8 weeks, and the third dose should be given 6-12 months after the second. An accelerated immunization schedule is recommended for partially immunized children who will be traveling to developing countries. Reactions to tetanus-diphtheria vaccine may include fever or discomfort and swelling at the injection site. Severe allergic reactions, which occur rarely, are a contraindication to further doses of the vaccine.
All cuts or wounds should be promptly and thoroughly cleansed.
From the World Health Organization
Tetanus toxoid vaccine
From the Centers for Disease Control (CDC)
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