etanus. All of us have a vague idea about what it is. But do we really know all we need to know about it?

Here's an attempt to answer some commonly asked questions about tetanus.

About tetanus

Tetanus (lockjaw) is caused by the toxin of a bacterium called Clostridium tetani.

These bacteria can enter the body even through a tiny prick or scratch. They generally prefer deep puncture wounds, cuts, burns, ulcers, bites, surgery sites, injection sites and umbilical cord stumps.

Tetanus bacteria are commonly found in soil, dust, and manure.

The symptoms

The symptoms may vary on an individual basis.

Only a doctor can provide an adequate diagnosis of symptoms after conducting some investigations.

In general, tetanus causes:

i. Muscle stiffness, twitching and spasms in various regions of the body.

ii. Jaw stiffness and difficulty in swallowing.

iii. Restlessness, fever, headache.

iv. In severe cases, seizures and paralysis.

Is tetanus fatal?

Localised tetanus can be mild but it can progress to generalised tetanus, which can be fatal.

Death usually occurs because of the paralysis of the diaphragm and resulting asphyxia.

Many antibiotics are effective against tetanus, but the symptoms need to be treated separately, usually via intensive care.

Are some people at higher risk of acquiring the disease?

Surgical wounds, diabetic ulcers, animal bites and burns can put you at higher risk of contracting the disease.

Uterine infection can occur after delivery if sterile precautions are not followed. Infants can develop a dangerous form of tetanus via the umbilical cord stump.

Is tetanus contagious?

No. Tetanus cannot spread from person to person.

Tetanus is becoming a rare disease among India's urban population.

If you are injured, the first thing you need to do is get a tetanus shot.

Tetanus toxoid (Tt) is given twice during pregnancy. It is also given to infants thrice in combination with the diphtheria and pertussis (whooping cough) immunisations as the DTP, an integral part of the vaccination schedule.

These precautions have lowered the incidence of tetanus.

But it is more important to know everything about the vaccine rather than the disease itself.

Why should I get vaccinated? Does my body have no immunity?

Natural immunity to tetanus is rare.

This makes immunisation very important. Vaccination with tetanus toxoid (which is the same as tetanus vaccine or the colloquial tetanus shot), causes the body to respond to an inactivated form of the tetanus toxin by developing antibodies to tetanus. Tt is almost 100 percent effective in preventing tetanus.

How many doses of DTP vaccine are needed?

The usual schedule for infants in India is a series of three doses given at 8 weeks, 12 weeks and 16 weeks of age, followed by a fourth dose at 15 to 18 months of age.

A fifth shot, or booster dose, is recommended at four to six years of age.

I was immunised in childhood. Why do I have to keep getting immunised?

Infants receive the DTP vaccine as part of their routine immunization. But adults should be given a routine booster dose of Tt every ten years.

Unlike the Polio vaccine, Tt is not a live vaccine; hence your immunity tends to wane with time, which is why booster doses are required.

Other than getting immunised every ten years, what else do I need to do?

In some individuals, antibody levels may fall too low to provide protection even if 10 years have not passed.

That is the reason you get a shot every time you are injured.

Everyone knows that being pricked by a rusty nail means getting a Tetanus injection. But the requirement for immunisation goes beyond just rusty nails.

If you experience a deep or puncture wound, or a wound contaminated with dirt, undergo a surgery, get burnt or develop an ulcer, an additional booster dose may be given if the last dose was more than five years ago.

In pregnancy, two doses, a month apart, are given in the second trimester.

Since adults 50 years or older account for 70 percent of tetanus infections, make sure everyone in your family above 50 has received boosters within the last 10 years.

Do keep an up-to-date record of all immunisations so that repeat are not necessary.

For some people, receiving more doses than recommended can lead to increased local reactions, including painful swelling at the injection site.

How safe is this vaccine?

Most children have no serious reactions after the combined DTP vaccine.

Local reactions at the injection site might occur such as redness and swelling. Icepacks can be used to counter this.

Occasionally, there might be fever, fuzziness, vomitting and loss of appetite. Fever can be treated with Paracetamol, but consult your doctor before you give your child any medicine at all.

For adults receiving the Tt vaccine, localised side effects are common (pain, redness, soreness, etc). But these resolve within a few days and don't require any treatment.

Serious allergic reactions are extremely rare. Contact your doctor if you have non-local symptoms.

Who should NOT receive tetanus toxoid?

People who had a serious allergic reaction to one dose of tetanus toxoid should not receive another dose.

Persons with a moderate or severe acute illness should postpone receiving the vaccine until they are better.

Sometimes the benefit of getting immunized outweighs the risk. Let your doctor decide if you need the shot or not.

Are there any restrictions on food, beverages or activity following or before the vaccine?

No.

Can the vaccine cause tetanus?

No.

Remember, tetanus has become uncommon not because tetanus bacteria have been eliminated from the environment (they are still everywhere), but because appropriate immunisation provides adequate protection against the disease.

Dr Roopa Nishi Viswanathan has an MBBS from KEM Hospital, Mumbai, with a Masters in Nutrition from the University of Texas at Austin. She also writes for chillibreeze.com and outsource2india.com