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Why summertime is tetanus time - (6/12/2018)

By Dr. Ron Gasbarro 

Bob is barefoot all summer. He washes his car and mows the lawn barefoot. He plays with his kids in the yard barefoot. Last week, he stepped on a bee, which stung him on his big toe. Then, one of his kids dropped a glass on the patio that shattered into a gazillion pieces. The kids also got a new puppy that is learning to do its business in the yard. However, the kids are not learning to pick up after the puppy. When Bob stepped in a poop pile just after he yanked a tiny shard of glass out of his foot, his wife said, “When was your last tetanus shot?” “When I was in the Army about 20 years ago,” Bob replied. 

Tetanus, also called lockjaw, results from infection of deep and dirty wounds by spores of the tetanus bacteria (Clostridium tetani). The spores grow into bacteria and produce a toxin that damages the human nervous system. Common symptoms include painful muscle contractions, difficulty in swallowing and increased heart rate. Tetanus has the potential to be fatal. There is no cure for tetanus but methods used to treat symptoms include wound care and medications. 

The number of tetanus cases each year in the US rarely exceeds 30. However, those that do contract tetanus have never received the tetanus vaccine or they do not realize that the vaccine must be given regularly throughout the person’s life – about once every 10 years. Outside of the US, tetanus remains a global problem, particularly in India and central and western Africa, although the situation is improving. In 2013, it caused about 59,000 deaths – down from 356,000 in 1990. 

Manure-treated soils may contain spores, as they are widely distributed in the intestines and feces of many animals such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. The spores are also found in contaminated heroin. Heroin users, particularly those that inject the drug rather than smoke it, are at high risk of contracting tetanus. Stepping on a nail, whether or not it is rusty, can result in tetanus if the nail harbors spores. 

The tetanus vaccine was developed during World War I and was widely used to prevent tetanus caused by battle wounds. By the time of World War II, the incidence of tetanus among US soldiers was reduced by 97% because of the prophylactic vaccine. Today, the tetanus vaccine is found only in combination with other vaccines. It is available with the diphtheria and pertussis vaccines in 2 formulations – the Diphtheria, Tetanus and acellular Pertussis, or whooping cough, vaccine (DTaP) and the Tetanus, diphtheria and acellular pertussis vaccine (Tdap). It is also available with the diphtheria vaccine alone in 2 formulations - the Tetanus and diphtheria vaccine (Td) and the Diphtheria and Tetanus vaccine (DT). 

Even if you receive a tetanus vaccine, good wound care is essential to prevent infection. Do not delay first aid of even minor, non-infected wounds like blisters, scrapes, or any break in the skin. Wash the broken skin with soap and water or use an alcohol-based hand rub if washing is not possible. Immunization against infectious diseases, such as smallpox, polio, diphtheria, pertussis, measles, and tetanus, is one of the most successful public health interventions in human history. That is why it is important to receive all available vaccines. Check with your pharmacist or doctor.  

Bob’s wife laid it on the line: Either he gets a tetanus shot or he cannot go barefoot outdoors this summer. Guess what Barefoot Bob chose to do?

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com     


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