Vaccines and Your Immune System

Tetanus

What Is Tetanus? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Barbara Kean
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body’s muscles and nerves.

It’s often referred to as “lockjaw” because it can cause painful spasms and stiffness in your jaw muscles.

Tetanus is a serious infection that can be life-threatening and is easily prevented with vaccination.

It is caused by a toxin produced by spores of the bacterium Clostridium tetani. These bacteria live in the environment, including in soil, dust, and animal feces.

Any time you get a wound that may become contaminated with soil or environmental contents, you are at risk for tetanus.

Once the bacteria get into the wound, they can produce a toxin that affects the nervous system and muscles. This can cause stiffening and rigidity of muscles, which is a very serious condition, especially once it affects the muscles used to breathe.

The disease can lead to serious complications and even death. Tetanus is a medical emergency that requires treatment in a hospital.

Most cases occur in people who have not been vaccinated.

Signs and Symptoms of Tetanus

The incubation period — time from exposure to illness — is usually between 3 and 21 days. Most cases occur within 14 days, with shorter incubation periods when there’s a more heavily contaminated wound.

The first sign of tetanus is spasms of the muscles of the jaw, called trismus or “lockjaw.”

Other symptoms include:

  • Sudden, involuntary muscle tightening (muscle spasms) — often in the stomach
  • Painful muscle stiffness all over the body
  • Trouble swallowing
  • Jerking or staring (seizures)
  • Headache
  • Fever and sweating
  • Changes in blood pressure and heart rate

Causes and Risk Factors of Tetanus

Tetanus is different from other vaccine-preventable diseases because it does not spread from person to person.

The bacteria that cause the disease are usually found in soil, dust, and manure and enter the body through breaks in the skin. These cuts or puncture wounds can be caused by contaminated objects (for example, cutting your foot on a rusty nail).

Tetanus cases have developed from the following:

  • Puncture wounds — including from splinters, body piercings, tattoos, and injection drugs
  • Gunshot wounds
  • Compound fractures
  • Burns
  • Surgical wounds
  • Injection drug use
  • Animal or insect bites
  • Infected foot ulcers
  • Dental infections
  • Infected umbilical stumps in newborns born of inadequately vaccinated mothers
People with diabetes or a history of immunosuppression and intravenous drug users may be at higher risk for tetanus.

Diabetes was associated with 14 percent of all reported tetanus cases from 2000 through 2019. Intravenous drug users also accounted for 14 percent of cases over the same period.

Neonatal tetanus is a form of the disease that occurs in newborns. A newborn’s umbilical cord stump, the part that’s left after the cord is cut, can become contaminated. Most infants who get this form of the disease die.

This form occurs very rarely in developed countries. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without sterile procedures.

How Is Tetanus Diagnosed?

Tetanus is diagnosed based on clinical signs and symptoms.

Laboratory diagnosis is not useful, as the bacterium that causes the disease cannot be recovered from the wound of a person who has tetanus.

Prognosis of Tetanus

The prognosis generally depends on incubation period and the time from first symptom to first muscle spasm.

In general, if symptoms develop and progress rapidly, the prognosis is worse.

But with treatment, patients usually survive tetanus and recover.

In recent years, tetanus has been fatal in approximately 11 percent of reported cases. Cases most likely to be fatal are those occurring in people age 60 and older and those who are unvaccinated.

Duration of Tetanus

Symptoms, including spasms, can last for several minutes at a time and continue for three to four weeks or longer.

Complete recovery from the disease may take months.

Treatment and Medication Options for Tetanus

Treatment focuses on managing complications until the effects of the tetanus toxin resolve.

A person who has tetanus will be treated in a hospital, usually in the intensive care unit.

Treatment will usually include antibiotics to kill bacteria and tetanus immune globulin (TIG) to neutralize the toxin already released.

You may also be given medicines to control muscle spasms and may need treatment to support vital body functions.

Depending on how serious the infection is, you may need to be placed on a ventilator to help you breathe.

Prevention of Tetanus

Being up to date with your tetanus vaccine is the best tool to prevent tetanus.

The tetanus vaccine is usually given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (diphtheria), whooping cough (pertussis), and tetanus.


Protection from the tetanus vaccine does not last a lifetime, which is why you should get booster shots every 10 years.

All women who become pregnant should receive the tetanus vaccine during the pregnancy (and any following pregnancies). This reduces the risk of neonatal tetanus infection by 94 percent.

Be sure to stay up to date with all of your vaccinations, and ask your doctor to review your vaccination status regularly.

If you weren’t vaccinated against tetanus as a child, you should see your doctor about getting the Tdap vaccine. (Like DTaP, Tdap protects against tetanus, but in adults).

Doctors can also use medicine to help prevent tetanus in cases where someone is seriously hurt and doesn’t have protection from tetanus vaccines.

Puncture wounds or other deep cuts, animal bites, or particularly dirty wounds put you at increased risk of tetanus infection. Seek medical attention if the wound is deep and dirty, particularly if you’re unsure of when you were last vaccinated. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage.

Your doctor may need to clean the wound, prescribe an antibiotic, and give you a booster shot of the tetanus toxoid vaccine.

If you’ve previously been vaccinated, your body should quickly make the needed antibodies to protect you against tetanus.

If you have a minor wound, these steps will help prevent tetanus:

  • Control the bleeding. Apply direct pressure to control bleeding.
  • Keep the wound clean. After the bleeding stops, rinse the wound thoroughly with clean running water. Clean the area around the wound with soap and a washcloth. If something is embedded in a wound, see your doctor.
  • Use antibiotics. After you clean the wound, apply a thin layer of an antibiotic cream or ointment. These antibiotics won’t make the wound heal faster, but they can discourage bacterial growth and infection.
  • Cover the wound. Exposure to the air might speed healing, but bandages can keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms.
  • Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection.

Complications of Tetanus

Serious health problems that can happen because of tetanus include:

  • Uncontrolled or involuntary tightening of the vocal cords (laryngospasm)
  • Broken bones (fractures)
  • Infections acquired by a patient during a hospital visit (nosocomial infections)
  • Blockage of the main artery of the lung or one of its branches by a blood clot that has travelled from elsewhere in the body through the bloodstream (pulmonary embolism)
  • Pneumonia, which is a lung infection
  • Breathing difficulty, possibly leading to death
Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing. Respiratory failure is the most common cause of death. The lack of oxygen induces cardiac arrest and death. Pneumonia is another cause of death.

Research and Statistics: How Common Is Tetanus?

Tetanus is uncommon in the United States today.

On average, there are only about 30 reported cases each year. Nearly all cases of tetanus are among people who did not get all the recommended tetanus vaccinations. This includes people who have never received a tetanus vaccine and adults who don’t stay up to date on their 10-year booster shots.

Tetanus first became a reportable disease in the late 1940s. At that time, there were 500 to 600 cases reported per year. After the introduction of the tetanus vaccine in the mid-1940s, reported cases of tetanus dropped steadily.

Most reported cases occur in adults. From 2000 to 2019, more than 55 percent of the 579 reported cases in the United States were among people ages 20 through 59. In addition, more than 30 percent of those reported cases were among people age 60 or older. The risk of death from tetanus is highest among people age 60 or older.

In 2015, approximately 34,000 newborns died from neonatal tetanus. This is a 96 percent reduction from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life (a decrease linked to higher rates of tetanus shots given during pregnancy).

Related Conditions to Tetanus

Strychnine poisoning is the only condition that truly mimics tetanus by causing muscle spasms.

However, a number of conditions may also be associated with trismus, a painful condition in which the chewing muscles of the jaw become contracted. These include:

  • Local infections
  • Trauma to the jaw
  • Systemic diseases (such as lupus and scleroderma)
  • Neoplasms (an abnormal mass of tissue)
  • Central nervous system disorders
  • Side effects of certain medications

Resources We Love

Centers for Disease Control and Prevention (CDC)

This agency is a great source for up-to-date health information for many diseases, including tetanus.

Mayo Clinic

Here you can find helpful information on the symptoms and treatment for tetanus, as well as immunization schedules and details on vaccinations.

Additional reporting by Cathy Cassata.

Editorial Sources and Fact-Checking

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