Stepping on a nail isn’t the only way to get a tetanus infection.
The bacterial spores that cause the illness, also known as lockjaw, can also be present in soil, animal waste and dust and can enter the body through breaks in the skin, including puncture wounds, burns, crush injuries and wounds contaminated with dirt, feces or saliva.
An activity as innocuous as gardening can put you at risk if you have an open wound on your hand. Even though it’s rare to contract tetanus, the infection can cause serious complications and is fatal in 10 to 20 percent of cases.
“We forget how horrible a disease it can be if you get it,” says Dr. Jo-anne Klein, a fellowship-trained infectious disease specialist at Tidelands Health Infectious Disease Specialists. “If you don’t have immunity against it and get a wound that’s at risk for contamination, you’re much better off if you’ve been vaccinated and boosted.”

Because there’s no cure for tetanus, taking measures to prevent the condition is crucial. Most people receive a tetanus vaccine as part of their childhood immunizations and may later repeat the shot to lower the risk of infection. Boosters are recommended by the Centers for Disease Control and Prevention every 10 years because vaccine protection can wane over time. The illness does not spread from person to person.

Not sure when you last had a booster? If you don’t remember or are unable to confirm through your immunization records, there’s no harm in having a booster repeated. It’s likely you’re due for one if you don’t remember when you last had it.
“If you don’t have immunity against it and you do get a wound that’s at risk of contamination by the organism, you’ll be playing catch-up with a tetanus shot,” Dr. Klein says. “It would be much better if you already had the immunity the tetanus shot provides.”

Although you’re more at risk of infection if you suffer a deep puncture wound like an animal bite or step on a nail, that’s not the only way the bacteria can enter the body. A scrape or even a splinter can open a pathway for the organism to invade and release toxin.
“It loves to grow in favorable conditions in a wound that’s very deep and not exposed to air,” Dr. Klein says. “But any wound would be at risk if it comes into contact with the organism.”

Once the organism enters the body through a break in the skin, spores from the bacteria transform, begin multiplying and produce a nerve toxin that ultimately reaches the bloodstream. Once in circulation, the illness begins affecting the nervous system. One of the most common signs of the infection is tightening of the jaw muscles, but the illness can also cause:

• Stiff neck
• Difficulty swallowing
• Muscle spasms
• Headache
• Fever
• Seizures
• Changes in blood pressure and heart rate

“Once it begins, it affects every bodily system,” Dr. Klein explains. “It can cause respiratory failure, pneumonia, potential bone fractures from spasms and dehydration because you’re not able to eat or drink due to the muscle spasms. Mortality is high and even higher in patients who are immunocompromised, frail or have co-morbidities.”

Tetanus is considered a medical emergency that requires hospitalization, aggressive wound treatment, medications to control spasms, tetanus vaccination and treatment with a medicine known as human tetanus immune globulin, which provides immediate protection from the tetanus toxin but is not long lasting.

In addition to vaccination, proper wound care after an injury is also important to prevent potential tetanus infection. To reduce your risk of contracting tetanus, follow these CDC recommendations:

• Get a booster every 10 years.
• Wear gloves while gardening.
• Apply first aid to any minor wounds, scrapes or breaks in the skin.
• Wash hands often with soap and water or use an alcohol-based hand sanitizer.
• Talk to your doctor if you’re concerned about a wound or your risk.

“Tetanus vaccination is recommended from the birth until adulthood,” Dr. Klein says. “It’s something we almost never think about because of how good the vaccine has been in preventing this disease. I encourage adults to make sure you are up to date on your booster.”