Tetanus

Tetanus is an acute infectious disease caused by spores of the spore-forming bacterium Clostridium tetani, which are ubiquitous in soil, ash, animal and human intestinal tracts, dust, saliva, manure, and on surfaces such as rusty tools ^[1][2][3]. The organisms release a potent neurotoxin that acts on the nervous system after entry through wounds or burns ^[1][2][3]. Maternal tetanus occurs during pregnancy or within six weeks postpartum, and neonatal tetanus occurs within the first 28 days of life ^[2][3].

The illness produces muscle spasms, rigidity, and dysautonomia, with painful contractions particularly affecting the jaw and neck, a presentation commonly termed lockjaw ^[1][3]. Additional manifestations can include jaw cramping, difficulty swallowing, abdominal or extremity spasms, seizures, fever, sweating, and blood pressure or heart rate changes ^[3]. In newborns, muscle spasms are often preceded by inability to suck or breastfeed and excessive crying ^[2][3].

Deaths from tetanus fell by almost 90% between 1990 and 2019, largely reflecting the success of WHO's Maternal and Neonatal Tetanus Elimination campaign ^[1]. However, deaths among children and adults have plateaued, and tetanus remains an important vaccine-preventable cause of morbidity and mortality, notably in southern Asia, southeast Asia, and sub-Saharan Africa ^[1]. Currently a rarity in high-income countries, tetanus is a diagnosis not to miss ^[1].

C. tetani spores are acquired from the environment and enter the body through contaminated wounds, deep cuts, or burns, including via nonsterile umbilical cord cutting or contaminated stump coverings in newborns ^[1][2][3]. The spores are highly resistant to heat and most antiseptics and can survive for years in soil, feces, and on skin or tools ^[2]. The incubation period ranges from 3 to 21 days, with most cases appearing within 14 days ^[2][3].

Tetanus is prevented by vaccination with tetanus-toxoid-containing vaccines (TTCV), which are included in routine immunization programs globally and offered during antenatal care ^[2][3]. WHO recommends six lifetime doses (three primary plus three boosters), with the primary series starting at six weeks of age and boosters in early childhood, at 4–7 years, and at 9–15 years ^[2]. Nearly all cases occur in unvaccinated individuals or adults who have not maintained booster shots ^[3].

1. 1 Sudarshan R et al. Tetanus: recognition and management. Lancet Infect Dis. 2025 Nov. PMID: 40543524. doi: 10.1016/S1473-3099(25)00292-0. PubMed: https://pubmed.ncbi.nlm.nih.gov/40543524/
2. 2 World Health Organization. Tetanus [Internet]. cited 23 Oct 2026. Available from: https://www.who.int/news-room/fact-sheets/detail/tetanus
3. 3 World Health Organization. Tetanus [Internet]. cited 23 Oct 2026. Available from: https://www.who.int/health-topics/tetanus