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Locking horns with lockjaw.

Tetanus--once called "lockjaw"--is a disease for which there is no excuse. Because tetanus spores are found worldwide in soil and animal feces, there is no way to eradicate the source of the disease, as with smallpox. However, tetanus toxoid is one of our safest and most effective immunizing agents. It provides immunity for 10 years or more and is readily available--so there is no reason anyone, at least in this country, should get the disease.

An article in Postgraduate Medicine reports that 70 percent of U.S. tetanus cases occurring from 1985 through 1988 were in persons over 50. Children have received immunization routinely against tetanus for the past 35-40 years. All military personnel in World War II also received the familiar DPT shots for diphtheria, pertussis, and tetanus. Persons born before 1940 who did not serve in the military may never have been immunized--and many who were have failed to obtain boosters every 10 years.

Although rare, tetanus is difficult to treat and is often fatal. The incubation period (the time between exposure to the tetanus bacillus and the development of clinical signs and symptoms) varies from a few days to a few weeks. Contrary to popular belief, a rusty nail is not itself a carrier of tetanus bacilli unless it has already been in the soil. The most likely source of tetanus infection is an open wound that has come into contact with soil or animal feces.

Prevention, therefore, consists of adequate immunization. Adults who have never been immunized against tetanus should receive a full immunization course with tetanus-diphtheria toxoid (Td). This product combines a small amount of diphtheria toxoid with the tetanus toxoid, because diphtheria is still a problem in some areas of the world. Diphtheria toxoid given alone often causes reactions in adults.

The full course of immunization involves two Td doses spread 4-8 weeks apart, with a third dose to be given 6-12 months after the second. One should receive a booster Td dose every 10 years from then on. Individuals who have gone more than 10 years since their primary series or last booster need only get a booster; one need not repeat the primary series.

One needs an additional Td dose for major or dirty wounds only if more than five years have elapsed since the last dose was given. Persons with tetanus-prone wounds who have never been immunized should receive a single dose of Td, as well as a dose of human tetanus immune globulin. These individuals should then complete the primary immunization series at the appropriate intervals listed above.
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Publication:Medical Update
Date:Sep 1, 1993
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