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Tetanus prone wounds

  • What is Tetanus?

    Tetanus (sometimes called lock-jaw) is a disease caused by bacteria (Clostridium tetani) often found in soil. The bacteria can enter wounds which can occur during activities such as gardening, or after stepping on a soiled sharp object, and produce a toxin that attacks a person's nervous system.

    The disease usually occurs after an incubation period of three to 21 days, but ranges from one day to several months.

    Early symptoms of tetanus include:

    • painful muscle spasms that begin in the jaw (lock jaw);
    • stiff neck, shoulder and back muscles;
    • difficulty swallowing;
    • violent generalised muscle spasms;
    • convulsions; and
    • breathing difficulties.

    A person may have a fever and sometimes develop abnormal heart rhythms. Complications include pneumonia, broken bones (from the muscle spasms), respiratory failure and cardiac arrest.

    How is it spread?

    Tetanus is found the world over in dirt, dust and animal faeces. Infection may occur after:

    • minor injury (sometimes small punctures to the skin that are contaminated with soil, dust or manure, such as cat scratches, rose thorns, glass or other foreign bodies); or
    • major injury (such as open fractures, dirty or deep penetrating wounds, animal bites and burns).

    Who is at risk?

    In Australia, tetanus mostly occurs in older adults who were not adequately immunised, noting multiple vaccine doses are required to be fully protected. In countries or communities with lower childhood immunisation rates, newborns, children and young adults are also at risk. Injecting drug users may have a greater risk of being infected with the bacteria from contaminated injection sites or contaminated drugs.

    How is it prevented?

    Immunisation protects against tetanus toxin.

    In Australia, infants and children are recommended to receive tetanus-containing vaccine in a five-dose schedule given at two, four, six and 18 months and four years of age. A booster dose of tetanus-containing vaccine is scheduled for adolescents between 11 and 13 years and currently recommended every ten years thereafter.

    Kids who have never had a tetanus-containing vaccine are recommended to receive three doses of tetanus-containing vaccine with at least four weeks between doses.

    Kids under 10 years will require booster doses after six and 12 months. Kids over 10 years (and adults) will require booster doses 10 yearly after the primary course.

    Tetanus-prone wound management

    All wounds other than clean, minor cuts are considered ‘tetanus-prone’. Seek medical advice for dirty wounds or wounds where the skin has been penetrated. First aid treatment should always include cleaning the wound.

    Some wounds are even more likely to encourage the growth of tetanus bacteria, such as:

    • compound fractures (where the broken bone pierces the skin);
    • burns;
    • animal bites;
    • any type of penetrating wound, such as from a rusty nail or rose thorns; and
    • wounds contaminated with soil, manure or foreign objects such as wood fragments.

    The need for tetanus-containing vaccine in people with a tetanus-prone wound, with or without tetanus immunoglobulin (TIG), depends on the nature of the wound and the person’s vaccination history.

    The doctor may advise you to have a tetanus booster shot, depending on how long it has been since your last tetanus dose. The medical team can review your vaccine history on the national Immunisation Register if you are uncertain.

    If you have not had any previous vaccinations against tetanus, a full course of at least three doses should be given. A catch-up vaccine calculator can be used to confirm the schedule.

    If you are worried about getting vaccinated, please raise your specific concerns with your doctor, so that we can address your concerns and find a way to minimise the risk of contracting tetanus.

    Further reading


    Developed by The Royal Children's Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed November 2022

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


Disclaimer  

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.