The weather is finally warm again. You are outside, cleaning the barn, getting the lawn mower ready for the summer, planting new plants. Suddenly, you step on an old nail, or cut your hand on the lawn mower blade or scrape your arm with a dirty spade. Is your tetanus shot up to date? What? Tetanus? No one gets tetanus anymore. Actually, they do.

Due to widespread immunization and careful wound care, the documented cases of tetanus have continually declined. Most recent annual statistics for reported cases in the United States were 19 cases of tetanus with two cases resulting in death. In developing countries, tetanus is much more common. Worldwide, the incidence of tetanus is somewhere between 500,000 and 1 million cases resulting in an estimated 290,000 deaths. The majority of these cases are in unvaccinated neonates in Third World countries.

Commonly referred to as “lockjaw,” tetanus infections cause uncontrollable muscle spasms.  Often the muscles controlling the mouth are infected, thus resulting in this nickname.   Tetanus can affect all muscles. Sometimes muscles used to breathe can spasm, causing a lack of oxygen to the brain and other organs that may lead to death.

Tetanus is caused by a bacterial spore commonly found in soil, dust and animal waste.  It is a “hardy” organism and can survive many years in the soil. Two German scientists first identified the tetanus spore in 1899. Fortunately, one of these scientists also discovered the first protective vaccine to prevent the disease.

The low incidence of tetanus infection in the United States is due primarily to required childhood vaccinations. Children ages 6 months to 7 years should have a tetanus vaccine usually administered along with a diptheria vaccine. Adolescents should receive a Tdap (tetanus, diptheria and pertussis) vaccine between 11 and 12 years of age, and one more prior to turning 18. Most U.S. colleges require documentation revealing an individual has received three doses of tetanus toxoid (tetanus vaccine) between the ages of 7 and the time of admission to the school. Adults should receive a booster dose of tetanus every 10 years after the age of 18. An adult tetanus vaccine should be a Tdap. The Tdap is a combination vaccine, which helps prevent tetanus, diptheria and pertussis.

The adult Tdap vaccine is considered to be effective for 10 years. If you receive minor cuts, scrapes and abrasions, you should not require a “booster” within the 10-year time frame.  A tetanus booster should be administered if the wound received is contaminated with soil, waste of any kind, animal feces or body fluids, and the person has not received a tetanus vaccine within the previous five years. Tetanus spores usually enter the body through deep puncture wounds, such as those caused by rusty nails, splinters, deep cuts or burns.

Tetanus is acquired through contact with the environment; it is not transmitted from person to person.

When you receive a deep cut or wound, clean it thoroughly with soap and water. If you do not have a record of your last tetanus vaccine, contact your primary care physician. Urgent care centers and emergency rooms do have tetanus vaccines available.  t is much more convenient to keep a record of your most recent tetanus vaccine. Wear thick-soled shoes that cover the tops of your feet when clearing debris. Wear yard gloves when working in your garden. Do not wear flip-flops when exploring old houses, barns, garages, etc.

Have a safe, injury-free summer.

Billie Whitfield, RN, CIC, is the infection preventionist at Vidant Beaufort Hospital.