“Forget Me Not Tetanus” by Mark Erik Meijer, MD
First published in Aynor Journal, vol. 11, #43 (July 29, 1999) Aynor, South Carolina, USA
There was a day when tetanus (lockjaw) was common in the U.S.A. In countries without effective immunization programs, tetanus is still common. The failure of other countries to eradicate this disease does not pose a threat to this country. Instead, we are our worst enemy to any increased risk to this disease.
In the Civil War, wounded soldiers died of infection. Surgeons rarely washed their hands. In World War I, sterile techniques were used. These measures brought a dramatic reduction in wound infection. Tetanus became the dreaded complication from battle wounds (especially with abdominal wounds).
The leading cause of death for wounded soldiers in World War I was tetanus. Tetanus vaccines eliminated this problem by World War II.
A bacterium named Clostridium tetani causes tetanus. It’s not a spreading bacterial infection that kills patients. Patients die from the tetanus toxin produced by Clostridium tetani. It is produced when the bacteria are inappropriately living and growing in the victim’s body.
Clostridium tetani likes to grow where there is little oxygen (to each its own). The bacteria’s food supply is decomposing protein (meat or flesh) and carbohydrates (plant or sugar). When conditions are bad for survival, these bacteria can hibernate by forming spores (i.e. a cocoon). The spores can survive dormant for years. These spores exist throughout the world’s soil. When conditions improve, the spores can transform back into toxin-producing bacteria.
A close relative to tetanus is botulism, a more talked-about problem in the U.S. A different species of clostridia bacteria produces the botulism toxin. Unlike tetanus toxin, this poison can survive the digestive tract. Botulism shows up where this is little oxygen (hence spoiled canned food).
Again, it’s not the bacteria themselves that kill. It’s the toxin. There is no bacterial infection associated with most cases of botulism. Neither is there an effective vaccine, so watch what you eat.
Clostridium tetani also exists in the large intestines (your colon). Fortunately, the tetanus toxin cannot enter the body through an intact digestive tract.
Deep, ragged wounds with destroyed tissue (protein) that are contaminated with soil or feces provide ideal conditions for Clostridium tetani spores to transform and grow. An example of this is a gun shot wound in the belly (through the colon).
Less dramatic, small, dirty, and deep puncture wounds can also cause tetanus (e.g., step on a rusty nail). In these cases, the number of bacteria grows slowly enough not to cause swelling or pain in the wound. Therefore, the Clostridium tetani infection can grow unnoticed. This allows sufficient time for bacteria to produce enough poison (tetanus toxin) to cause death 10 to 14 days later (abdominal wounds become fatal sooner).
The poison short-circuits the nerves that go to muscles. The brain itself is surrounded by material that prevents the poison from attacking it. Therefore, only the nerves are affected. The short-circuited nerves over-stimulate the muscles they are attached to. This causes these muscles to go into severe spasm.
Short nerves (those whose nerve-endings are closest to the brain) are affected before long nerves. Therefore, muscles closest to the brain go into spasm first. Hence, the expression: “lockjaw.” The effects of tetanus toxin spread rapidly and soon all muscles throughout the body are affected.
Our immune system can protect us from tetanus toxin. When our immune system can identify the presence of this toxin, it can make the antidote (called antibodies) needed. Patients never exposed to tetanus toxin cannot produce enough antibodies to prevent death. It only takes a very small amount of tetanus toxin to kill.
A vaccination consists of a harmless form of tetanus toxin. This safe “toxin” is injected so that it can introduce itself to the immune system. Once the body learns how to make effective antibodies, the blueprints are stored nearby. Once immunized, the immune system can recall the necessary information to make antibodies faster and in larger numbers than ever before (practice makes perfect).
Babies, when first born, do not have a mature immune system. It can’t make antibodies. Babies’ immunity is dependent on the antibodies given to them (prior to birth) by their mothers. They can receive additional antibodies through breast milk the first three months after birth. (This added immunity makes breastfeeding superior to formula.)
Un-immunized mothers (no antibodies) leave newborn babies vulnerable to the effects of tetanus toxin. Countries without effective immunization programs have a lot of babies die from tetanus. This occurs when the open umbilicus (the cut cord) becomes contaminated with dirt.
Since the baby’s immature immune system cannot make antibodies for several months after birth, vaccination cannot begin until the baby is at least 2 months old. Either the mother protects the baby from tetanus or she doesn’t. Women in their reproductive years need to be careful to stay up-to-date with their ownvaccinations.
Just as medicine can find and inject harmless toxin to vaccinate people, doctors can also inject antibodies that can neutralize the tetanus toxin. Tetanus immune globulin gives the patient temporary antibodies against tetanus (just as Mom can for baby). Therefore, un-immunized patients with tetanus-prone wounds can be given immediate protection from tetanus. This shot can also be used for inadequately immunized patients who are beginning to develop tetanus.
Tetanus immune globulin does not confer long-term immunity. Patients receiving tetanus immune globulin are also going to need the tetanus vaccine.
As time passes, we start to forget things. The immune system’s memory can fade as well. The ability to find the “blueprint” and vigorously produce antibodies for tetanus toxin diminishes with time. After many years, we can become as vulnerable to tetanus as an unprotected newborn baby.
With repeated reminders, the immune system won’t forget tetanus toxin. This is why tetanus vaccine boosters are recommended every 10 years.
Since repeated vaccinations make immunity (antibody production) more effective and more reliable, patients previously vaccinated that suffer a severe tetanus-prone wound (e.g., shot in the belly) are given a tetanus vaccine booster sooner than every 10 years.
It’s not hard to figure out why soldiers are required to be immunized against tetanus. Tetanus boosters are given to soldiers every 5 years (instead of the usual 10) as an added precaution against tetanus.
So how deadly is tetanus? Any WW I veteran would remember.
Victims of tetanus usually die from respiratory failure. Death is caused by severe spasms of the muscles we use for breathing. (Spasms of heart muscles are usually less problematic.) To treat severe muscle spasms, muscle relaxers or muscle paralyzing agents are needed. With complete paralysis, a respirator is needed.
An expensive and arduous journey in the Intensive Care Unit (ICU) allows U.S. patients to survive tetanus. Prior to this, most patients died. Many countries cannot provide the sophisticated care needed to treat tetanus.
“Lockjaw” has become rare and almost forgotten in the U.S. It’s obvious that tetanus immunization is much simpler than a case of tetanus. Tetanus vaccination is fantastically effective and safe.
The potential threat of tetanus is as widespread as the bacteria are. We even carry our own supply in our colons. The real threat of tetanus depends on your immunity status.
For normal wear and tear, you need a tetanus vaccine booster every 10 years. You would need a booster sooner (every 5 years) if you receive a severe tetanus-prone wound (e.g., shot in the belly). When immunization has been neglected, patients with tetanus-prone wounds will also need tetanus immune globulin.
America, forget me not tetanus. When did you get your last tetanus booster?©