What is Tetanus?

Tetanus is caused by the bacteria Clostridium Tetani. Its spores are present in our day-to-day environments, but most commonly thrive in soils, rusty contaminated tools, as well as human and animal faeces. 

Who is most at risk of developing an infection?

Tetanus infections are a worldwide risk, with those in least developed counties most at risk. This is due to poor standards in hygiene and waste management, as well as limited or lacking access to healthcare. 

Also people who live or work in the countryside or have animals should always make sure they are up-to-date with their vaccinations

How do you contract tetanus?

As with all bacterial infections Clostridium Tetani needs a route into the body and infections usually find their way in through a break in our skin, wounds or burns.

Wounds either caused by a contaminated object, such as a rusty garden fork, or wounds and burns that are existing and open that are exposed to contaminants like soil, are particularly susceptible to developing a tetanus infection. 

Tetanus vaccination programme

Within the United Kingdom, all persons are eligible to receive the tetanus vaccine, as part of the childhood vaccination programme.

Since 1961 the tetanus vaccine has been a part of the childhood vaccination programme, and those who conformed to the programme after this date will have had three tetanus vaccines (priming course) by six months of age, administered within the 6-in-1 vaccine. 

A fourth is given, in the form of a 4-in-1 ‘pre-school’ booster when the child is 3 years old. A fifth is given, in the form of a 3-in-1 booster in the child’s teenage years, often between 13-15 years. 

How many tetanus vaccinations do I need?

A full tetanus vaccination history is defined as five tetanus vaccines.

How often do I need tetanus boosters?

Booster shots are recommended every 10 years. If you are unsure of your vaccination status, review of your records via the NHS App, or discus with your GP.

When may I need an extra tetanus shot?

When you have an injury, such as a wound or burn, you may receive a booster dose of tetanus vaccine if there is a high risk of tetanus infection developing. 

However, if a tetanus infection is suspected then the person may also be administered Human Tetanus Immunoglobulin, a specific medication that introduces tetanus antibodies straight way, so you can a fight tetanus infection straight away without the immune system getting into gear.

What wounds require a tetanus shot?

Medical providers have access to a range of guidelines that indicate when persons should be provided a tetanus vaccination, or Human Tetanus Immunoglobulin.

These guidelines are complex and depend on a variety of factors. Often patients are seriously injured and/or unwell and seek treatment for their injury and/or illness, rather than the specific concern of tetanus.

For those who sustain minor injuries, of which they can manage themselves, but are unsure if they should seek medical assistance due to the concern of tetanus, the below is general guidance.

Clean Wounds:

Superficial wounds, defined as those with minimal damage to the skin, where there has not been deep penetration into the skin or underlying tissue, and have been thoroughly cleaned and covered with a dressing within six hours of injury, have a low likelihood of developing a tetanus infection.

Therefore, tetanus boosters are not indicated, unless the person never received a priming course of tetanus vaccine.

Tetanus Prone:

Wounds that are tetanus prone, and therefore have a risk of developing infection include:

• Puncture wounds, from often, contaminated equipment such as gardening, or industrial tools.
• Foreign bodies within the wound.
• Wounds or burns that go on to develop infections*
• Some animal bites and scratches (see superficial bites and scratches below)

Superficial bites or scratches:

This means those that have caused minimal damage to the skin, are not deep or penetrating, and do not bleed freely, that have been cleaned well, are less likely to develop a tetanus infection.

However superficial bites and scratches from ‘working animals’, such as farm dogs & cats, are at higher risk of developing a tetanus infection, due to their environment, where the animal may be rooting in soil or mixing with various animals and their faeces (manure).

These injuries often require assessment and treatment from a medical provider regardless of tetanus risk.

Assessment will include consideration of tetanus risk, and booster vaccines will be considered. Often if the person injured is vaccinated within the last ten years, then a booster is not required.

Where the last tetanus vaccination was more than ten years ago, or the child is aged five-ten years old and has not received a ‘pre-school booster’ then a tetanus vaccine would be required. Those who have never received a priming course of tetanus vaccine will need a tetanus vaccine and Human Tetanus Immunoglobulin administering.

High Risk Tetanus Prone Wounds:

Wounds requiring booster tetanus vaccinations and Human Tetanus Immunoglobulin are often extensive injuries, where medical attention would be sought due to the extent of the injury primarily. Medical professionals will administer any tetanus booster vaccinations and/or Human Tetanus Immunoglobulin as per national guidelines, in line with person specific risk assessment. Not everyone will require the same treatment. 

Anyone who has sustained an injury where heavy contamination has occurred should always seek medical advice, examples of heavy contaminated wounds, would be significant wounds with direct contact of, or embedded, soils and manure, significant animal attacks with multiple wounds would be another example.

For those who have sustained any large or deep wound or burn, or those where bleeding cannot be controlled should attend an Accident & Emergency Department or call 999. Whereas person has an existing wound or burn and have developed any symptoms of infection, they should attend an Accident & Emergency Department or call 999.

Severely immunosuppressed persons, despite full tetanus immunisation history, should seek medical advice as additional booster vaccines may be required.

Where tetanus vaccines are administered following injury due to no initial priming course, further doses to conform to the United Kingdom immunisation schedule should be arranged with your GP. 

What are the symptoms of tetanus?

Symptoms of tetanus infection include:

• Fits (seizures)
• Fever (high temperature)
• Sweating
• Fast heartbeat
• Problems swallowing
• Breathing difficulties
• Muscle spasms
• Stiff jaw (lockjaw)

When do you need a tetanus to travel?

Check out the NHS’s travel vaccination advice to see if you need to get a tetanus vaccination prior to foreign travel

You should always seek appropriate medical advice for any injury, or illness concerns. Medical advice regarding tetanus can be obtained from NHS 111, Minor Injury Units, Urgent Care Centres, or GP’s. 

Just like humans, animals can develop tetanus too so it is worth making sure they are vaccinated as well and if you suspect they could have it contact your vet straight away.

Tomas Davies, Specialist Paramedic.

Tomas Davies works within both Urgent & Emergency Care settings, responding to 999 calls on behalf of the National Health Service with St John Ambulance, as well as working within a range of Minor Injury & Illness Units, and Urgent Care Centres. 

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