Why get a shot for a bug nearly no one gets? - (7/16/2019)

By Dr. Ron Gasbarro

Sam, 54, came limping into the pharmacy with a prescription an antibiotic. “Where is the Bactine® antiseptic?” he asked the pharmacist through his swollen lips. The pharmacist inquired as to what happened. “I was gardening in the backyard, doing some weeding,” Sam said. “I sat down on the ground and was digging around my peonies when I unleashed an underground wasps’ nest. The wasps started stinging my face and, unfortunately, I was barefoot. So, when I got up to run, I stepped on a garden claw! Face hurts! Foot hurts!” The pharmacist then asked if Sam has gotten a tetanus shot to protect against that disease. “I guess when I was in the Army 30 years ago,” Sam said. “Does anyone even get tetanus anymore?” 

Tetanus (aka lockjaw) is a bacterial infection caused by Clostridium tetani, which is commonly found in soil, saliva, dust, and manure. The bugs generally enter through a break in the skin such as a cut or puncture wound by a contaminated object. Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil contains a lot of organic matter. In 2015, there were about 209,000 infections and about 59,000 deaths globally. Tetanus became nationally reportable in 1947. According to the Centers of Disease Control and Prevention (CDC), reported tetanus cases have declined more than 95%, and deaths from tetanus have declined more than 99% in the US since 1947. This is due to better wound cleansing and the widespread use of the tetanus vaccine. Sporadic cases of tetanus continue to occur in adults who did not get all the recommended tetanus vaccinations. This includes people who have never received a tetanus vaccine or adults who do not stay up to date on their 10-year booster shots. The CDC reports about 30 cases of tetanus in the US annually. Three of these will be fatal.

So, Sam has two big risk factors that increase his risk of getting this now relatively rare disease: He stepped on a hand tool used in the soil and he has not kept up with his 10-year booster shots. Typically, the tetanus vaccine is given with vaccines for two other infectious diseases. Called the Tdap, a single shot prevents tetanus, diphtheria (a respiratory infection), and pertussis (whooping cough). Tdap should be given at around age of 11 or 12 years, or to older individuals who have never received Tdap. Tetanus is different from other vaccine-preventable diseases because it does not spread from person to person. Think of it: we can eradicate polio, cholera, and smallpox from the planet via vaccination. But tetanus never will be because the bacteria are everywhere, waiting for your bare foot.

“What happens if I do get tetanus?” Sam asked with fear in his voice. When the bacteria invade the body, they produce a toxin that causes painful muscle contractions. These contractions start in the jaw and neck, making it difficult for the mouth to open and to swallow. Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter the body through a wound. Severe tetanus-induced muscle spasms can interfere with or stop one’s breathing. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. By getting the vaccine – and by using soap, warm water, and an antiseptic on Sam’s foot – all of these complications can be avoided. 

Sam decided he had no time to waste. The pharmacist was able to give him the Tdap shot right in the pharmacy. Afterward, the pharmacist said to Sam, “And do not garden without shoes on anymore. After all, gardening can kill!”

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at


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