What is tetanus?

Tetanus is a serious bacterial infection that affects the nerves in the brain and spinal cord. This leads to painful muscle spasms throughout the body. It is often fatal.

Tetanus is uncommon in Australia because of vaccination. Everybody should be vaccinated and receive booster doses at the correct times throughout life.

Tetanus is sometimes called 'lockjaw', because it typically causes spasms of the jaw, making it close firmly (lock).

What are the symptoms of tetanus?

Tetanus symptoms can vary but often involve painful muscle spasms. Common symptoms include:

• painful muscle spasms (especially in the face or neck), which can last for several minutes and may continue for a few weeks
• seizures
• stiffness in the shoulders, back and other muscles
• locked jaw (unable to open the mouth), making it hard to talk or swallow
• difficulty breathing
• abnormal heart rhythms and high blood pressure
• fever

Symptoms usually appear within 3 to 21 days after exposure to bacteria causing tetanus. Symptoms may sometimes show up after 1 day. The bacteria may stay in the wound for months after tetanus infection. Symptoms may still appear during this time.

For people who do not have immunity against tetanus, tetanus can be fatal.

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When should I see my doctor?

See your doctor if you have a wound that could be infected by tetanus. These wounds may include:

• deep or puncture wounds (such as a wound from a rose thorn or from a rusty nail)
• animal bites
• wounds contaminated with dirt

Also see your doctor if you are unsure whether your tetanus vaccination is up to date. If you never received the tetanus vaccine as part of your routine vaccinations, speak to your doctor about getting the vaccine.

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What causes tetanus?

Tetanus is caused by infection with the spores from the bacterium clostridium tetani (c. tetani). C. tetani produces a toxin (poison) which attacks the nervous system. This leads to muscle spasms.

C. tetani bacteria live mainly in soil, dust and manure. However, they can be found anywhere. The spores are cells that can survive in soil for many years. Infection happens when the bacteria enter the bloodstream through an open wound, such as:

• a wound or cut that is not clean
• a bite from an animal or human
• a wound that pierces the skin, such as a scratch from a rusty nail

Even something as minor as a prick from a rose thorn can lead to tetanus infection. Certain wounds are more likely to become infected, for example if:

• they are deep
• they contain a foreign body, such as a splinter
• they happen in an unhygienic setting
• the wound is over a broken bone (compound fracture)
• the wound has pus or damage to the tissues (such as from a burn)
• the wound has been contaminated with soil, dust or manure

Tetanus is not contagious. You cannot catch c. tetani bacteria or tetanus from other people.

How is tetanus diagnosed?

Laboratory testing is not used to diagnose tetanus as it does not provide enough information to confirm the condition. Instead, your doctor may:

• examine recent wounds that have been in contact with soil
• check for symptoms like a stiff neck and jaw
• ask you when you last had a tetanus booster vaccine

Tetanus is a notifiable disease. This means your doctor will notify your local public health unit.

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How is tetanus treated?

Treatment for tetanus varies depending on the severity of symptoms and your tetanus immunity status.

To prevent further infection, people with mild symptoms will be given:

• a tetanus immunoglobulin (antitoxin)
• antibiotics
• wound care

The antitoxin provides immediate protection for about one month. You may be given the antitoxin if you have a tetanus-prone wound and:

• have not received all doses of the recommended tetanus vaccine
• are unsure if you have been vaccinated against tetanus
• are immunocompromised

People with severe symptoms will be admitted to hospital to treat breathing and muscle paralysis.

If you have a wound that is at risk of tetanus, apply first aid including immediately by cleaning the wound and applying an antiseptic. This can help prevent tetanus from entering the bloodstream.

What are the complications of tetanus?

Tetanus can cause serious complications and in severe situations it may lead to death.

Complications of tetanus may include:

• pneumonia
• fractures caused by muscle spasms or seizures
• respiratory failure
• cardiac arrest

Can tetanus be prevented?

Tetanus can be prevented with vaccination (known as a ‘tetanus shot’). Immunity lessens over time, so booster doses are needed to ensure you are protected.

The tetanus vaccine is part of routine childhood immunisation under the National Immunisation Program. It is usually combined with diphtheria and pertussis (whooping cough). It is given in multiple doses and free of charge at:

• 6 weeks to 2 months old
• 4 months old
• 6 months old

Booster doses are recommended at 18 months old and 4 years old. Older children are usually given an additional booster vaccination between 11 and 13 years old. You may also need a booster if you are travelling or if you have an injury.

After the complete course of tetanus vaccinations, another booster is usually recommended. These boosters are given at age 50 and age 65 if more than 10 years have passed since the last dose.

Recover from a tetanus infection does not provide long-term immunity. You will still need to be vaccinated to for future immunity.

Tetanus vaccine

Vaccination is your best protection against tetanus. This table explains how the vaccine is given, who should get it and its accessibly.

What age is it recommended?	Children at 6 weeks (or up to 2 months), 4 months, 6 months, 18 months, 4 years and between 11 and 13 years. Pregnant women in the third trimester. At 50 years old if you haven’t had a tetanus vaccine in the last 10 years. At 65 years old if you haven’t had a tetanus vaccine in the last 10 years. If you are travelling overseas and haven’t had a tetanus vaccine in the last 10 years. If you have an open or deep wound and haven’t had a tetanus vaccine in the last 5 years.
How many doses are required?	6 doses as indicated above, then boosters as required. Keep a record of your booster doses to remind you of your vaccination status.
How is it administered?	Intra-muscular injection.
Is it free?	Free for children. Free for people under 20 years old. Free for refugees and humanitarian entrants of any age. For everyone else, there is a cost for this vaccine. Check the Department of Health website and the National Immunisation Program Schedule for routine vaccines. Ask your doctor if you are eligible for additional free vaccines based on your situation or location.
Common side effects	The vaccine is safe. Side effects may include redness, swelling or hardness where the needle went in. Less common side effects may include headache, fever or tiredness.

Resources and support

The Department of Health and Aged Care:

• offers information about getting vaccinated
• details The National Immunisation Program (NIP) Schedule
• explains how to access your immunisation records

NSW Health has a fact sheet about Tetanus.

You can call the healthdirect helpline with any questions or concerns about tetanus on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

Health Translations offers resources on tetanus vaccines in languages other than English.

Aboriginal and/or Torres Strait Islander peoples

Vaccination and Immunisation Matters provides information on vaccinations for Aboriginal and/or Torres Strait Islander people.