Tetanus and the tetanus vaccine

What is tetanus?

Tetanus is an infection caused by a germ (bacterium) called Clostridium tetani which can attack the muscles and nervous system. It is a serious infection which can even be fatal. Tetanus germs (bacteria) are commonly found in soil, house dust, and animal and human faeces. The tetanus bacteria may get into your body through a cut or a wound in the skin. The bacteria release a poison (toxin) which causes the illness.

Even small wounds such as a prick from a thorn can allow enough bacteria to get into the body to cause tetanus. The illness usually takes around 10 days to develop but can vary from four days to three weeks. Therefore, you may have forgotten about a small cut before the illness starts.

What are the symptoms of tetanus?

Tetanus symptoms include:

• Muscle spasms which are painful and make it difficult to breathe and swallow.

• Jaw stiffness (lockjaw), which can make it hard to open your mouth.

• Neck stiffness.

• They may start with a high temperature and feeling generally unwell.

How common is tetanus?

Tetanus in the UK is extremely uncommon. Most cases occur in people over the age of 65 years who have not been immunised against tetanus, as the immunisation was only routinely introduced in 1961. In 2021 there were eleven cases of tetanus in the UK. Tetanus continues to be a problem in poorer countries, where there is inadequate vaccination and where newborns get tetanus due to unsafe birth practices.

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The tetanus vaccine

Tetanus vaccine is actually given as a combination vaccine with other vaccines. There are three types of combination vaccine:

• For young children the pre-school booster is normally part of the combined diphtheria/tetanus/acellular whooping cough (pertussis)/inactivated polio vaccine (DTaP/IPV or dTaP/IPV).

• For children aged under 10 years the vaccine is usually part of the combined diphtheria/tetanus/acellular whooping cough (pertussis)/inactivated polio vaccine/plus Haemophilus influenzae type b/hepatitis B vaccine (DTaP/IPV/Hib/Hep B). This is called the 6-in-1 vaccine.

• For adults and teenagers who receive tetanus immunisation, a combined tetanus, diphtheria/inactivated polio vaccine (Td/IPV) is normally used.

The tetanus vaccine stimulates your body to make antibodies against the tetanus toxin. These antibodies protect you from illness should you become infected with tetanus.

At what age do you have the tetanus injections?

All children in the UK are offered tetanus immunisation as part of the routine immunisation programme. A full course of tetanus immunisation consists of five doses of vaccine as follows:

For how long will the tetanus vaccine protect me?

The primary course of three injections gives good protection for a number of years. The fourth and fifth doses (boosters) maintain protection. After the fifth dose, immunity remains for life and you do not need any further boosters (apart from some travel situations - see 'I am going abroad', below).

Adults who haven't had the tetanus vaccine

Some adults have not been fully immunised against tetanus because routine immunisation for children was not introduced in the UK until 1961. Men serving in the armed forces from 1938 onwards were offered tetanus immunisation. So, some older people born in the UK may still be at risk, as are other people (eg, those born outside the UK) who did not have their complete vaccinations.

See your practice nurse if you think that you are not fully immunised against tetanus (that is - if you have not had at least five injections in total). The course does not need to be started again if an injection is delayed. A late injection is enough to catch up, even if you have it years after it was due.

When do I need a tetanus jab?

After you have a cut or bite, the decision about whether to get a tetanus jab or other protection against tetanus depends on a combination of your vaccination status and the type of wound you have (whether is it clean, tetanus-prone, or high-risk tetanus-prone). It's not always straightforward, so you should consult a healthcare professional. In general:

If your wound is clean, you are very unlikely to need any immediate tetanus jabs. You might, however, be offered a jab to complete your course if you haven't been fully immunised.

If your wound is tetanus-prone, you will usually only need a tetanus jab immediately afterwards if:

• You did not receive an adequate course of the first three tetanus vaccine doses;

• You are a child aged 5-10 years who received the first three vaccine doses but no preschool booster;OR

• You received the last of your first three vaccine doses more than 10 years ago.

If your wound or injury is considered to be high risk for tetanus (for example, where there has been significant contact with soil or manure) then an injection of human tetanus immunoglobulin is usually given, regardless of whether or not you have been immunised against tetanus. This gives extra protection against tetanus.

Do I need the tetanus vaccine if I'm going abroad?

Usually not if you are up to date with your immunisations. However, if you are to travel to areas where medical attention may not be available and it has been more than 10 years since your last injection, then a dose of vaccine may be advised. This is even if you have had five previous injections. This is a precautionary measure in case you have a very dirty wound and are not able to receive antiserum. Your doctor or practice nurse will advise you further about this.

Are there any side-effects from the tetanus vaccine?

It is common to get a little redness and swelling around the injection site, which should go after a few days. Some people feel slightly unwell for a day or so, with a mild headache, slight aching of the muscles and a mild high temperature (fever). Severe reactions are extremely rare.

Who should not receive the tetanus vaccine?

If you are unwell with an illness causing a high temperature (fever), it is wise to postpone having the vaccine until the illness has gone (except if the dose is needed after a cut or wound). Also, you should not have another injection of vaccine if a previous injection caused a severe (anaphylactic) reaction. The tetanus vaccine is safe if you are pregnant or breastfeeding.