On April 27, 2015, the Hong Kong Centre for Health Protection (CHP) recorded a case of tetanus affecting a 74-year-old woman with chronic illnesses. She presented with locked jaw, dysarthria and dysphagia on April 18, and was admitted to a public hospital on April 21.

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

She was diagnosed to have tetanus clinically and was treated with tetanus toxoid, immunoglobulin and antibiotics. Her condition was stable. Her symptoms improved and was discharged on April 27.

She had traveled to Kaiping, Mainland China with family members from April 3 to 15 and had right leg abrasion on April 9 in Kaiping but did not seek medical attention. Her family members remained asymptomatic. She had no known history of vaccination against tetanus.

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 of opisthotonos 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.

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

Prevention of tetanus is through vaccination.