Tetanus is a serious but rare condition caused by bacteria getting into a wound.

The condition can be fatal if left untreated, but the tetanus vaccine and improvements in treatment mean deaths from tetanus are now very rare in the UK. In 2013, there were only seven recorded cases of tetanus in England and Wales, and no deaths.

Most cases occur in people who were never vaccinated against the condition or didn’t complete the entire vaccination schedule. People who inject illegal drugs are also at an increased risk.

How You Get Tetanus

Tetanus is caused by bacteria called Clostridium tetani. These bacteria can survive for a long time outside the body, and are commonly found in soil and the manure of animals such as horses and cows.

If they enter the body through a wound, the bacteria can quickly multiply and release a toxin that affects the nerves, causing symptoms such as muscle stiffness and spasms. The bacteria can cause tetanus if they get into the body through:

  • Cuts and scrapes
  • Tears or splits in the skin
  • Burns
  • Animal bites
  • Body piercings, tattoos and injections
  • Eye injuries
  • Injection of contaminated drugs

Deep wounds containing dirt or foreign objects are most likely to lead to tetanus, but the condition can occur after a minor injury you didn’t notice at the time. Tetanus cannot be spread from person to person.

Signs and symptoms of tetanus

The symptoms of tetanus usually develop within 4 to 21 days after infection. On average, they start after around 10 days.

The main symptoms include:

  • Stiffness in your jaw muscles (lockjaw) – this can make it difficult to open your mouth
  • Painful muscle spasms – these can make swallowing and breathing difficult
  • A high temperature (fever) of 38C (100.4F) or above
  • Sweating
  • A rapid heartbeat (tachycardia)

Left untreated, the symptoms can continue to get worse over the following hours and days. In some cases, life-threatening problems such as suffocation or a cardiac arrest (where the heart stops beating) can occur.

When To Seek Medical Advice

You should contact your GP or visit your nearest minor injuries unit if you’re concerned about a wound, particularly if:

  • The wound is deep
  • The wound contains dirt or a foreign object
  • You haven’t been fully vaccinated against tetanus
  • You’re not sure whether you’ve been fully vaccinated against tetanus

Your GP can assess the wound and decide if you need any treatment or need to go to hospital.

You should immediately go to your nearest accident and emergency (A&E) department or call 999 for an ambulance if you develop severe muscle stiffness or spasms.

How tetanus is treated

If your doctor thinks you could develop tetanus but you haven’t had any symptoms yet, they will clean any wounds you have and give you an injection of tetanus immunoglobulin. They may also give you a dose of the tetanus vaccine if you haven’t been fully vaccinated in the past.

Tetanus immunoglobulin is a medication that contains antibodies that kill the tetanus bacteria. It offers immediate but short-term protection from tetanus.

If you develop symptoms of tetanus, you’ll usually need to be admitted to a hospital intensive care unit (ICU). Treatments you may have include:

  • Tetanus immunoglobulin and antibiotics
  • A procedure to remove any dead tissue or foreign material, such as dirt, from the wound
  • Medication to relieve muscle stiffness and spasms, such as muscle relaxants and sedatives
  • Breathing support using a ventilator (a machine that helps you breathe)
  • Nutrients through a tube connected to the stomach or a drip into a vein

Most people who develop symptoms of tetanus will eventually make a recovery, although this can take several weeks or months. In the UK, around 1 in every 7 to 10 people who develop tetanus will die from the condition.

Tetanus vaccination

A tetanus vaccination is given as part of the NHS childhood vaccination programme. The full course of the vaccination requires five injections, usually given on the following schedule:

  • The first three doses are given as part of the 5-in-1 vaccine for babies at eight, 12 and 16 weeks
  • A booster dose is given as part of the 4-in-1 pre-school booster at three years and four months of age
  • A final booster is given as part of the 3-in-1 teenager booster at 14 years of age

This course of five injections should provide long-lasting protection against tetanus. However, if you or your child has a deep or dirty wound, it’s best to get medical advice.

If you’re not sure whether you’ve had the full vaccination course, contact your GP surgery for advice. It is possible to fully vaccinate older children and adults who weren’t vaccinated when they were younger.

Tetanus Vaccination For Travel

Tetanus is found throughout the world, so you should ideally make sure you’re fully vaccinated before travelling abroad.

Contact your GP surgery for advice if you’re planning on travelling abroad and haven’t been fully vaccinated against tetanus, or you’re going to an area with limited medical facilities and your last vaccine dose was more than 10 years ago.

If you’ve never had a tetanus vaccination before, you may be advised to have as many of the three initial doses of the vaccine as possible before you leave (there should be one-month gaps between each dose) and complete the full course when you return.

If you’ve had the three initial doses of the vaccine but no booster doses, having a booster dose before you travel may be recommended.

If you’ve been fully vaccinated with all five routine doses, an additional dose of the tetanus vaccine is usually still recommended as a precaution if you’re travelling to an area with limited medical facilities and your last dose of the vaccine was more than 10 years ago.