Tetanus is a serious, acute (severe but short-lived) condition that is caused by infection with a bacterium known as Clostridium tetani.
As the Clostridium tetani bacterium is commonly found in the environment, tetanus can never be completely eradicated. In particular, the bacteria are often found in:
The tetanus bacteria usually enter the body through a wound, or cut, in the skin. Once inside, the bacteria multiply and release a neurotoxin (poison) called tetanospasmin, which causes the symptoms of tetanus to develop.
Tetanospasmin can spread through the bloodstream, blocking the nerve signals from the spinal cord to the muscles. This causes muscle spasms (involuntary contractions) and rigidity (stiffness) throughout the body, particularly in the neck, face, and jaw (lockjaw).
For a tetanus infection, the incubation period (the time between getting the infection and the onset of symptoms) is between 4-21 days. The average incubation time is 10 days.
A tetanus infection must be treated quickly because, left untreated, the condition can be fatal. Tetanus cannot be passed from person to person.
Tetanus is a notifiable condition
Due to its potential seriousness, tetanus is a notifiable condition. This means that when the condition is diagnosed, the doctor making the diagnosis must inform the local authority under the Public Health (Infectious Diseases) Regulations (1988).
How common is tetanus?
In the UK, since 1961, babies and young children have been routinely immunised against tetanus as part of the national childhood immunisation programme. Therefore, in the UK, tetanus infections are a rare, with most cases affecting people who are over 65 years of age and who have not been immunised.
For example, from 1984 to 2004, there were 198 cases of tetanus in England and Wales. Out of these:
- 74% occurred in people who were 45 years of age, or over, and
- 16% occurred in people who were between 25-44 years of age.
The highest number of tetanus cases during this period was in adults who were over 65 years of age. This is because people in this age category were not routinely immunised against tetanus as children. There were no reported cases in children under five years of age.
Since 1991, the number of tetanus cases has been consistently low, with an average of six cases occurring each year.
Neonatal tetanus
In the UK, there have been no cases of neonatal tetanus (tetanus in newborn babies) for over 30 years. However, in many developing countries, neonatal tetanus is still a public health problem. It is usually caused by the umbilical stump becoming infected when the umbilical cord is cut using unsterilised equipment.
One of the World Health Organisation’s (WHO) aims was to eliminate neonatal tetanus worldwide by 1995. Unfortunately, the condition has not yet been totally eradicated, but the number of countries reporting cases is steadily decreasing.
Tetanus vaccination
All young children are offered the tetanus vaccine as part of the routine NHS childhood immunisation programme.
The tetanus vaccine works by encouraging the body to create antibodies (infection-fighting cells) which provide a defence against tetanospasmin (the tetanus toxin), providing a person with protection from the illness should they become infected with tetanus bacteria.
The full course of the tetanus vaccine consists of five doses. The primary course consists of three injections which provide protection against the infection for a number of years. The fourth and fifth doses are booster doses which help to maintain protection.
After the fifth dose, immunity remains for life and further boosters are not usually required, unless there is doubt about a person’s immunisation history, or you are travelling to a remote area of the world where treatment for a tetanus infection may not be readily available.
See the ‘prevention’ section for more information and advice about the tetanus vaccination.
