The Truth About What Causes Tetanus

Caused by a bacterial toxin, tetanus is a serious illness which affects the nervous system. And even nowadays, despite vaccinations to prevent many cases, it still causes up to nearly 300,000 fatalities a year, according to the European Center for Disease Prevention and Control (ECDC). Furthermore, sufferers can catch the disease from an array of factors that many of us are completely unaware of.

No doubt your parents or guardians warned you about the dangers of playing outside when you were younger. Indeed, the outdoors are a battlefield of potential broken glass, rusty nails and dog poop to a concerned carer. And contact with any of these objects could potentially lead to a devastating illness: tetanus.

Tetanus has been around for thousands of years, but exactly how long is not known. That’s because it doesn’t leave any telltale evidence on skeletons to indicate its presence. However, we do know from historical evidence that the Ancient Greek physician Hippocrates recognized tetanus. In fact, its name stems from his language.

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Specifically, the word tetanus derives from the Greek word tetanos. Meanwhile, primary symptoms are normally muscle seizures in the jaw, which causes the sufferer to clench their teeth so tight that they have trouble eating or drinking. And these spasms explain why the illness is also called lockjaw.

However, the muscle spasms only begin in the jaw, and they can later spread out across the body. And as anatomist and surgeon Sir Charles Bell depicted in an 1809 painting, they can cause the sufferer’s back to arch involuntarily. Furthermore, the seizures can be strong enough to fracture bones.

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Meanwhile, alongside the muscle contractions, tetanus can cause headaches, fever, sweating and an increased heart rate. Furthermore, there’s no actual cure for it, so all doctors can do when it occurs is treat the symptoms and wounds that result from tetanus until the illness runs its course.

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Symptoms typically take from three days to three weeks to surface, but tetanus can take months to recover from. Meanwhile, around ten percent of tetanus cases prove to be fateful, according to the Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases. Furthermore, the ECDC reports that it is the cause of up to seven percent of all neonatal deaths worldwide.

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There are also several different types of tetanus, each with their own symptoms and dangers. According to the Centers for Disease Control and Prevention (CDC), approximately 80 percent of patients experience generalized tetanus, but local, cephalic and neonatal forms also exist. Localized tetanus is a rare form of the disease which usually focuses on the single area where the sufferer received the injury. And though it’s not as deadly, it still poses other dangers.

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Localized tetanus often affects patients with some immunity and is often mild, though it can progress to generalized tetanus. Meanwhile, the rarest strain of the illness is cephalic tetanus, which can paralyze cranial nerves. It’s also the most deadly, with health organizations putting mortality rates between 15 and 30 percent.

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The last form of the disease is neonatal tetanus, which exclusively affects newborn babies, normally via the remains of their umbilical cord. Even as recently as 2010 it killed 58,000 infants a year, according to UNICEF. Nevertheless, that figure was a 90% decrease from 1990, following a public health awareness campaign.

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Furthermore, neonatal tetanus has been mostly eliminated in all but 25 countries as of 2013, according to UNICEF. Indeed, our understanding of the disease was instrumental in fighting it – but what actually causes tetanus? Well, your elders were certainly right to fear sharp objects hiding in the grass or lying on the sidewalk.

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People have been aware of the connection between injuries and tetanus for hundreds of years. And it became particularly concerning during the first two months of World War One, when one in every 100 men contracted the illness. And with wounded soldiers frequently suffering from tetanus, experts needed a greater understanding of the disease to prevent it.

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Meanwhile, several decades earlier in 1884, German physician Arthur Nicolaier got close to the truth with his tetanus experiments. To be specific, he injected soil into lab mice, which caused them to contract the disease. Nicolaier also noted that the pus produced from the afflicted rodents contained something called a bacillus, which is a type of rod-shaped bacteria found in water and soil.

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Nicolaier correctly deduced this bacteria was responsible for the tetanus disease, but he didn’t know how to isolate it. However, his work paved the way for another physician, Japanese bacteriologist Kitasato Shibasaburo, to learn more. And in 1889 he succeeded where his predecessor couldn’t and separated the tetanus bacillus, discovering that it could only grow in if it couldn’t access oxygen.

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Tetanus is the result of an infection from the soil bacterium Clostridium tetani. The bacteria also lives in saliva, dust and the intestines and manure from animals such as domestic pets and livestock. The animals act as the bacteria’s delivery method, sending it into the soil via, for example, their feces.

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When farmers use manure for fertilization, it may also indirectly spread Clostridium tetani, the bacteria which causes tetanus. If we get a cut or injury from anything hosting the bacteria, it enters our bodies, and can then lead potentially lead to developing the illness.

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On the subject of tetanus, you’ll often hear warnings about rusty metal and nails in particular. It seems that wounds from old metal objects have become synonymous with tetanus infection. So is there any truth to the rumors? Well, yes and no, but first you have to understand what causes metal to rust.

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Rust is known as an iron oxide, and is normally formed by the reaction of oxygen and iron when exposed to air moisture or water. But this in itself doesn’t cause the bacteria infection, as the website HowStuffWorks elaborated.

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HowStuffWorks explained, “The thinking goes that if the nail has been outside long enough to get rusty, then it’s probably been exposed to soils containing the bacteria.” As feared as tetanus is, though, these days there’s less reason to worry about it. That’s because there’s a vaccination for the bacteria.

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Indeed, even though there’s no cure for tetanus, medical experts have created a vaccine for the disease. A team of scientists led by German physiologist Emil von Behring discovered the first vaccine for passive immunology back in 1890, and the first inactive tetanus taxoid (TT) was produced decades later in 1924 by P. Descombey. And much like the modern version, it involved injecting dead bacteria particles into a patient to create an immunity to the living form.

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Meanwhile, the vaccine became widely used only a few decades later during World War II, when it prevented tetanus from battle injuries. These days, medical professionals recommend children receive five doses of the vaccine, and the CDC suggests that adults have a booster shot every ten years to protect against tetanus.

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However, for those who are unsure when they last had their shot, physicians can also give an antitoxin to people with suspected tetanus. Indeed, there’s a chance it might boost the immune system enough to prevent infection occurring.

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In addition, vaccinations have played a large part in combating neonatal tetanus. That’s because if a mother-to-be has her shots, the baby usually benefits passively from immunization, too. And thanks to the wide-spread use of TT, there’s also been a dramatic drop in cases of other kinds of tetanus. Indeed, the current rates of infection – or lack thereof – are proof of this.

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Incredibly, the U.S. saw only 233 instances of tetanus cases reported between 2001 and 2008 in the U.S., according to the CDC. And as of 2011 tetanus cases have fallen by 95 percent, while deaths from the disease have dropped by an amazing 99 percent since 1947.

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Meanwhile, to protect against the spread of tetanus further, U.S. public schools have a strict vaccination policy. Indeed, every one of them requires parents to vaccinate their children before they can begin education. Now the rate of children who have had at least three tetanus shots is around 96 percent. But that could all change.

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The World Health Organization (WHO) has warned that vaccine hesitancy represents one of the top ten threats to global health in 2019. Indeed, more and more people are rejecting the evidence on the benefits of vaccinations, despite the overwhelming scientific consensus on the issue.

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For its part, the creation of vaccinations has prompted resistance for many centuries. For example, a sermon by English Reverend Edmund Massey in 1772 made the argument that vaccinations were going against God’s will. Apparently, he thought illness was God’s punishment and no one should interfere, and his views became so popular they crossed the seas to North America.

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But without TT vaccinations, children face the possibility of preventable suffering. And in an illustration of this point, the CDC released a report in 2019, Notes from the Field: Tetanus in an Unvaccinated Child – Oregon, 2017. Here, doctors examined a youngster who had contracted the disease, and recorded what the boy went through during his ordeal.

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The report wrote, “In 2017 a boy aged six years [old] who had received no immunizations sustained a forehead laceration while playing outdoors on a farm; the wound was cleaned and sutured at home. Six days later, he had episodes of crying, jaw clenching, and involuntary upper extremity muscle spasms…”

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The study recounted how things got much worse shortly after, writing, “[That was] followed by arching of the neck and back (opisthotonus) and generalized spasticity. Later that day, at the onset of breathing difficulty, the parents contacted emergency medical services, who air-transported him directly to a tertiary pediatric medical center.”

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“Upon hospital arrival, the child had jaw muscle spasms (trismus),” the report continued. “He was alert and requested water but was unable to open his mouth; respiratory distress caused by diaphragmatic and laryngeal spasm necessitated sedation, endotracheal intubation, and mechanical ventilation.”

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The study, published in the CDC, continued, “The boy required 57 days of inpatient acute care, including 47 days in the intensive care unit.” Thankfully though, he eventually made a complete recovery, but his hospital bills were incredibly high.

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Indeed, the hospital bill ran up to over $800,000, which didn’t include ambulance follow-up costs, rehabilitation or air transportation. Amazingly, it cost around 72 times the mean 2012 cost for an American pediatric hospitalization. But even after the medical costs and, more importantly, their child’s near-death experience, his family refused further vaccinations.

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Meanwhile, it’s worth noting that vaccinations have helped abolish plenty of diseases. Take smallpox for example, which a vaccination campaign – and the efforts of then-President Thomas Jefferson – helped control in America. It struck again during a lull in vaccination rates, but has since been virtually eradicated with inoculation shots.

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Polio is another disease which a vaccination campaign has helped significantly control. Indeed, in 1988 the World Health Assembly pushed for its eradication by 2000, and the efforts had considerable success. By 2006 around five people a day contracted the illness, compared to 1000 per day in 1988. Meanwhile, Inoculations don’t just help with large epidemic-level illnesses, either; doctors use them to combat Haemophilus influenzae (HIB) too.

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HIB is responsible for causing a number of afflictions in children, including pneumonia, infectious arthritis and bacterial meningitis. However, in 1988 a vaccine to combat the illness was introduced, and by 2002 infections in the U.S. had dropped by an incredible 99 percent, according to the CDC.

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But despite compelling evidence, many people still doubt the drop in new cases of the disease is a result of vaccinations. Indeed, some argue that our increased level of hygiene and better sanitation is a likelier cause. However, scientific data does not back up this argument.

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Meanwhile, the CDC has hit back against claims that vaccines are ineffective in preventing diseases. On its website it wrote, “Are we expected to believe that better sanitation caused incidence of each disease to drop, just at the time a vaccine for that disease was introduced?”

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And the WHO can’t state the importance of vaccination enough, either. It wrote, “There is arguably no single preventive health intervention more cost-effective than immunization. Time and again, the international community has endorsed the value of vaccines and immunization to prevent and control a large number of infectious diseases and, increasingly, several chronic diseases that are caused by infectious agents.”

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The WHO continued, “[Vaccinations] prevent the suffering and death associated with infectious diseases such as diarrhoea, measles, pneumonia, polio and whooping cough. [They] also help enable national priorities like education and economic development to take hold.”

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