Tetanus Follow-up

  • Author: Patrick B Hinfey, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 28, 2011
 

Further Inpatient Care

Administer a second dose (usually the first is upon discharge from the hospital) of tetanus-diphtheria vaccine or diphtheria-pertussis-tetanus vaccine, and administer a third dose 4 weeks after the second dose.

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Transfer

Patients should be admitted to an intensive care unit. If the facility does not have an intensive care unit, the patient should be transferred by critical care ambulance.

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Deterrence/Prevention

  • An effective vaccine termed tetanus toxoid has been available for many years. Administer tetanus toxoid in combination with diphtheria toxoid and pertussis vaccine (DTP) to children at ages 2 months, 4 months, 6 months, 12-15 months, and between 4-6 years[26] . Administer tetanus and diphtheria (TD) toxoid to children aged 7 years or older. Recommend a tetanus booster shot every 10 years.[12, 13]
  • Administer tetanus and diphtheria (TD) toxoid to children aged 7 years or older. Recommend a tetanus booster shot every 10 years.
  • The tetanus vaccine and the combination TD vaccine are very safe and effective[19] ; however, infrequent adverse effects include a slight fever and soreness, redness, or swelling at the injection site.
  • Patients cannot contract tetanus from the vaccine.
  • Candidates for TD vaccine include all adults who have not had a booster shot in the last 10 years, adults who have recovered from tetanus (ie, lockjaw) disease, and adults who have never received immunization against tetanus.
  • Physicians must thoroughly clean wounds and remove dead or devitalized tissue. If the patient has not had a tetanus toxoid booster in the previous 10 years, administer a single booster injection on the day of injury. For severe wounds, consider administering a booster if more than 5 years have elapsed since the last dose.
  • Consider administering TIG, antitoxin, or antibiotics if the patient has not been previously immunized with a series of at least 3 doses of toxoid.
  • Given the risk of tetanus after bites of all kinds, administer TIG and tetanus toxoid to patients who have had 2 or fewer primary immunizations. Physicians may administer tetanus toxoid alone to patients who have completed a primary immunization series but who have not received a booster in more than 5 years.
  • Almost 70% of a random sample of US residents aged 6 years or older have protective levels of tetanus antibodies. By age 60-69 years, the prevalence of protective antibodies is less than 50%, and by age 70 years, the prevalence is approximately 30%.
  • Tetanus toxoid is a very effective immunogen that stimulates a protective response in virtually all immunocompetent subjects. Studies of former military personnel show that up to 88% have protective antibody levels 15 years after vaccination.
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Complications

  • Complications include spasm of the vocal cords and/or spasms of the respiratory muscles that cause interference with breathing. Other complications include fractures of the spine or long bones, hypertension, abnormal heartbeats, coma, generalized infection, clotting in the blood vessels of the lung, pneumonia, and death.
  • Patients experience severe pain during each spasm. During the spasm, the upper airway can be obstructed, or the diaphragm may participate in the general muscular contraction.
  • Sympathetic overactivity is the major cause of tetanus-related death in the intensive care unit. Sympathetic hyperactivity usually is treated with labetalol at 0.25-1 mg per minute as needed for blood pressure control or with morphine at 0.5-1 mg/kg per hour by continuous infusion.
  • Neonatal tetanus follows infection of the umbilical stump, most commonly resulting from a failed aseptic technique in a mother who is inadequately immunized. The mortality rate of neonatal tetanus exceeds 90%, and developmental delays are common among survivors.
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Prognosis

  • Current statistics indicate that the mortality rate in mild and moderate tetanus is approximately 6%; for severe tetanus, the mortality rate may be as high as 60%.
  • CDC reports from 1982-90 show that the overall case-fatality rate in the United States is 21-31%.
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Patient Education

  • For excellent patient education resources, visit eMedicine's Infections Center. Also, see eMedicine's patient education article Tetanus.
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Contributor Information and Disclosures
Author

Patrick B Hinfey, MD  Research Director and Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jill Ripper, MD, MS  Residency Director, Newark Beth Israel Medical Center

Jill Ripper, MD, MS is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Christian August Engell, MD  Attending Physician, Department of Infectious Diseases, Newark Beth Israel Medical Center

Christian August Engell, MD is a member of the following medical societies: Infectious Diseases Society of America and Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Keith N Chappell, MD  Administrative Chief Resident, Junior Attending Resident, Department of Emergency Medicine, Newark Beth Israel Medical Center

Disclosure: Newark Beth Israel Medical Center Salary Employment

Specialty Editor Board

Gregory William Rutecki  MD, Professor of Medicine, University of South Alabama Medical School

Gregory William Rutecki is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, to the development and writing of this article.

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