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    Childhood Illnesses Up Close: Tetanus

    September 1, 2007 by Brandy Vencel

    I took leave of this series for a while because, honestly, a person can only talk about disease for so long. However, I decided that, for my own educational purposes, if nothing else, I really do want to continue on to the end. Since I already covered diphtheria and pertussis, it seems logical to finish up with tetanus as that is the third and final component of the DTaP or DTP injections. There is also a DT shot for people wary of the pertussis injection in any form.

    What is tetanus?
    As a child, I was always told that tetanus was contracted from stepping on something rusty. Usually, the culprit was a rusty nail. Old people would warn you from walking out back barefoot because you might get tetatnus from all those rusty nails out there.

    Imagine my surprise when I first learned that tetanus had nothing to do with rust whatsoever. Tetanus, also called lockjaw, is a bacterial infection. The bacteria in question, Clostridium tetani, is often found in soil. Perhaps this is where the backyard part of the mythology came from. This particular bacteria can infect a wound. I am assuming this takes care of the nail part, considering that stepping on a nail would cause a nasty injury.

    Maybe the rust was for effect because a rusty nail seems so much scarier when compared with a shiny, new nail.

    Anyhow, poor wound care contributes to tetanus, so making sure wounds are properly cleaned and dressed with an antimicrobrial agent like raw honey is important.

    “Injuries that involve dead skin {such as burns, frostbite, gangrene, or crush injuries} are more likely to cause tetanus,” says my handy source at KidsHealth. It also says that babies born in unsanitary conditions can experience a tetanus infection of the umbilical stump. This is why cord care is necessary.

    The reason for the term lockjaw is that a tetanus infection causes the production of a neurotoxin that in turn causes muscle spasms. The spasms begin in the jaw area and later move to other parts of the body.

    Is tetanus treatable?
    Tetanus antitoxin can be used to combat the neurotoxin if it hasn’t already combined with nerve tissue. Also, there are strong antibacterial agents that can be used to combat the actual infection. However,

    In most cases of tetanus, the illness is severe and widespread, and there’s a risk of death despite treatment. Death may result from constriction of airways, pneumonia or instability in the autonomic nervous system. The autonomic nervous system is the part of your nervous system that controls your heart muscles, other involuntary muscles and glands.

    People who’ve had tetanus often recover completely. However, some people have lasting effects, such as brain damage caused by a lack of oxygen when muscle spasms in the throat cut off the airway. {Mayo Clinic}

    What are the possible side-effects of the vaccine?
    I already discussed the DTaP shot in the pertussis post, as well as the DT shot in the diphtheria post. However, there is an isolated tetanus shot if a parent has decided to skip the diphtheria and pertussis components. So here I will list potential problems with the tetanus-only vaccine:

    Adverse reactions may be local and include redness, warmth, edema, induration with or without tenderness as well as urticaria, and rash. Malaise, transient fever, pain, hypotension, nausea and arthralgia may develop in some patients after the injection. Arthus-type hypersensitivity reactions, characterized by severe local reactions {generally starting 2 to 8 hours after an injection} may occur, particularly in persons who have received multiple prior boosters. On rare occasions, anaphylaxis has been reported following administration of products containing tetanus toxoid. Upon review, a report by the Institute of Medicine {IOM} concluded the evidence established a causal relationship between tetanus toxoid and anaphylaxis. Deaths have been reported in temporal association with the administration of tetanus toxoid-containing vaccines.

    And also:

    neurological complications including cochlear lesion, brachial plexus neuropathies, paralysis of the radial nerve, paralysis of the recurrent nerve, accommodation paresis, Guillain-Barré syndrome, and EEG disturbances with encephalopathy. The IOM, following review of the reports of neurologic events following vaccination with tetanus toxoid, DT or Td, concluded the evidence favored acceptance of a causal relationship between tetanus toxoid and brachial neuritis and GBS.

    Yes, that GBS is Guillain-Barré Syndrome again. It seems to be associate with almost all of the vaccines I have gone over.

    Is the trade-off worth it?
    Since the tetanus vaccine is an ethical vaccine, then this one is, again, an area for wisdom. Only about 100 people in the US contract tetanus each year. However, I can’t find any statistics that indicate how many of these patients were vaccinated. Until I have that number, I can’t give a definite opinion. If 50% or more of those who contracted were vaccinated, I would say that the efficacy of the vaccines are questionable and the low rate of tetanus is more likely due to advances in wound care. Without such information, it is hard to know.

    Many health officials will say a vaccine is “effective” because they can “see” the antibodies in a person when drawing blood. It is my opinion that this is a poor method for determining effectiveness. A superior methodology is to research the people who actually became ill and find out how many of them were vaccinated, unvaccinated, or partially vaccinated. There are plenty of unvaccinated or partially unvaccinated individuals who do not get tetanus.

    I think when making this decision it is important to realize that the parent is allowing a physician to inject a known neurotoxin into a child whose neurological system is far from fully developed. Dr. Mendelsohn once explained that there was a growing concern over “the huge increase in recent decades of auto—immune diseases, e.g., rheumatoid arthritis, multiple sclerosis, lupus erythematosus, lymphoma, and leukemia” being linked to vaccinations.

    I would suggest that a parent at least calculate the likelihood of their infant getting a dirty, infected puncture wound and then consider delaying the vaccine.

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    1 Comment

  • Reply SB September 3, 2007 at 1:11 pm

    The “rusty nail” story comes from the fact that tetanus infections commonly stemmed from puncture wounds, where the surface of the wound on the skin would heal but infection lurked below the surface. I remember hearing as a child that the tetanus germ was especially common in horse pastures and barnyards, where stray discarded nails were probably also found more frequently.

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