According to the Centers for Disease Control and Prevention (CDC), tetanus is uncommon in the United States, with an average of 29 reported cases per year from 1996 through 2009. Nearly all cases of tetanus are among people who have never received a tetanus vaccine, or adults who don’t stay up to date on their 10-year booster shots.

Clostridium tetani/CDC
Clostridium tetani/CDC

In Alaska, the Bureau of Epidemiology released a bulletin last week on two relatively recent cases of tetanus (2012, 2014), which contains detailed case reports.

To look at the 2014 case they describe a 77-year-old non-English speaking male living in Southeast Alaska presented in August with hand swelling with presumed cellulitis without an obvious wound. The man was a diabetic whose only documented tetanus shot was a single vaccination in 2007. He was treated with the antibiotic Augmentin, which appeared to help his hand swelling.

However, 10 days later he arrived at the hospital with the following symptoms:

Difficulty walking, possible altered mental status, fever, sore throat, and altered speech. While hospitalized, the patient subsequently developed dysphagia, rigidity, grimacing, clenched hands, and tremors. He was clinically diagnosed with tetanus 5 days after admission once alternative diagnoses (e.g., metabolic imbalance, subdural hematoma, and stroke) were ruled out. He received Td vaccine and TIG, slowly recovered with supportive care, and was discharged 3 weeks after admission.

Alaska health officials say this and the other case demonstrates the risk of tetanus among persons who are not up-to-date with vaccinations. They suggest that health providers may not always assess wound patients for tetanus vaccination status and miss an opportunity for tetanus prevention.

Tetanus diagnosis is based entirely upon clinical findings; therefore, clinicians need to keep tetanus in their differential diagnosis in persons presenting with acute onset of muscle spasm. Nearly all cases of tetanus occur in people who have
never received a tetanus vaccine or adults who are not current with their tetanus booster.

Tetanus is different from other vaccine-preventable diseases because it does not spread from person to person. The bacteria are usually found in soil, dust and manure and enter the body through breaks in the skin – usually cuts or puncture wounds caused by contaminated objects.