Holy Week is being celebrated throughout the Christian world and in the predominately-Catholic Philippines; this week is taken very seriously, so much so that the practice of self-flagellation and crucifixion is practiced, most famously in the Pampanga province.

Tetanus in a 46-year-old man, Manila/CDC
Tetanus in a 46-year-old man, Manila/CDC

However, there are serious risks of deadly bacterial infection when these acts of penitence are performed. It is important that penitents be cautious about the dirty environment and instruments used in these rituals.

Each year, the Philippines Department of Health (DOH) warn of the risk of tetanus from the instruments used in the ritual; contaminated blades, whips and nails  and advise if you’re going to partake in these rituals, ensure that your tetanus shot is up-to-date and 2016 is no different.

The DOH says tetanus respects no faith. “We really discourage these practices (of self-flagellation and crucifixion), health-wise, but if (people) cannot avoid these as part of their devotion, the least they can do is observe health and safety precautions,” said Health Secretary Janette Garin in an interview.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, Clostridium tetani. The spores of this organism are very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail; however the rust has nothing to do with tetanus. At this point the spores germinate into the bacteria which multiply and produce toxin.

Depending on the extent of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks. The typical features of a tetanus spasm are the position ofopisthotonos and the facial expressions known as “risus sardonicus”. The death rate for this disease ranges from 10-80% depending on age and quality of care.

There are really no laboratory findings that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation.

This disease in not transmitted from person to person. Even if you had tetanus and recovered, this potent toxin produces no immunity.