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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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image Tetanus word cloud

Why Do I Need a Tetanus Shot?

I’ve only restarted writing this blog entry about 28 times.

I keep asking myself, “do you really want to go there?” Because it’s about vaccines, and anything written about this topic brings out naysayers who *often* refuse actual scientific data.  But when the #smartmomma crew calls out an issue to be reviewed, then review it we shall.

A request was sent to me asking to discuss the tetanus vaccine in the setting of wound management.  Smart and thoughtful, right?  I mean, who thinks about tetanus anymore?

Well, probably only folks in healthcare give it a passing thought, because THE TETANUS VACCINE WORKS so not a lot of people get it.  And tetanus is indeed preventable only if you are vaccinated.  No herd immunity benefit here. I’m getting ahead of myself, however. What is tetanus, anyway?  I found the  “disease description” on the CDC website so fantastically awesome that I’m feeling compelled to copy and paste it here:
“Tetanus is an acute, potentially fatal disease that is characterized by generalized increased rigidity and convulsive spasms of skeletal muscles. Tetanus is caused by the spore-forming bacterium Clostridium tetaniC. tetani spores (the dormant form of the organism) are found in soil and in animal and human feces. The spores enter the body through breaks in the skin, and germinate under low-oxygen conditions. Puncture wounds and wounds with a significant amount of tissue injury are more likely to promote germination. The organisms produce a potent toxin tetanospasmin which is absorbed into the bloodstream. The toxin then reaches the nervous system, causing painful and often violent muscular contractions. The muscle stiffness usually first involves the jaw (lockjaw) and neck, and later becomes generalized. Tetanus is a noncommunicable disease—it is not transmitted from one person to another.” (cdc.gov)

See in the figure below that tetanus has really declined. Handy.

tetanus cases and deaths per year

 

This topic came to my attention because there are some beliefs circulating that:

  1. Tetanus is pretty rare and tough to get, so therefore “not really a big deal.”
  2. Getting the tetanus vaccine formulation that includes diphtheria and pertussis is “unnecessary” and/or “unhelpful.”

What-the-what?! Let’s start.

  1. I’ll begin by acknowledging some truth here in the first claim. Tetanus IS pretty hard to get, now that we ALL aren’t living on farms and walking in manure and dirt and such. But it’s also hard to get because, DUE TO THE VACCINE most people have immunity against the nasty bacteria Clostridium tetani (25¢), so the bacteria doesn’t get circulated around by humans.
  2. The tetanus vaccine comes in several formulations: by itself, or together with the pertussis and diphtheria vaccines. Why would we give an immunization that contains immune components against other diseases?  This is a trickier one to understand, but I’ll try to explain. First, we know that immunity to pertussis (whooping cough) wanes after a few years, so it just makes sense for overall health to help the body boost immunity against pertussis intermittently.  Second, having these extra antigens around can help the body’s immune system get activated in general and improve the desired acquired immunity to tetanus, pertussis, AND diphtheria.  All 3.  What’s not to like? Neither pertussis nor diphtheria are mild diseases to get.
  1. So tetanus prophylaxis has been discussed here in the setting of open wounds.  For sure, the most important thing to do after sustaining a cut is to wash it out as vigorously and as quickly as possible to irrigate away as many germs as possible.  Deep cuts should always be assessed by a medical professional.The tetanus vaccine is safe and effective, in whatever formulation it’s given. It’s a whole lot better than the alternative (see above description of tetanus, again).  So in fact it IS a big deal, and it might just be a very good thing if unknowingly you DIDN’T transmit pertussis to a newborn baby near you because your weakened immunity got a boost without you even knowing it the last time you cut yourself and needed stitches.  Thankyouverymuch.

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