Tetanus: symptoms, causes, treatment and vaccination

The NHS says the symptoms of tetanus usually start around 4 to 21 days after infection, and most people get symptoms after about 10 days. UKHSA gives the incubation period as usually between 3 and 21 days, although it may range from one day to several months depending on the wound.

The first sign is often a stiff jaw, which makes it hard to open the mouth. This gives the condition its popular name, lockjaw. Painful muscle spasms follow, often in the back, tummy, arms, legs, hands and feet, according to the NHS. Swallowing and breathing can become difficult.

UKHSA describes three forms. Generalised tetanus is the commonest, with lockjaw and spasms that can cause a rigid abdomen and, in severe cases, breathing difficulty. Autonomic instability is typical, while consciousness is not affected. Localised tetanus causes rigidity and spasms around the wound and may be more common in partially immunised people. Cephalic tetanus follows a head or neck injury.

UKHSA grades severity from mild to very severe, with the most severe involving prolonged spasms and swings in heart rate and blood pressure.

• Stiff jaw that is hard to open

• Painful spasms in the back, abdomen and limbs

• Trouble swallowing or breathing

• High temperature, sweating and a fast heartbeat

• Fits

Tetanus is not passed from person to person. UKHSA explains that the bacterium produces a toxin that acts on the nervous system, and that spores can live in soil and in the gut of horses and other animals. They survive hostile conditions for long periods. Infection happens when spores get into a wound.

The NHS says there is a risk when soil or manure containing the bacteria gets into a wound such as a bite, burn or scratch. The chance is higher if you have not been fully vaccinated, if the wound is large or deep, or if it is very dirty or has something stuck in it.

UKHSA also notes that tetanus can follow injecting drug use or abdominal surgery. In some cases no injury is reported and it is assumed that a minor wound went unnoticed.

UKHSA gives guidance to clinicians on tetanus-prone wounds. These are wounds likely to encourage the bacteria to grow without oxygen. Examples include puncture-type injuries such as a gardening injury from a rusty nail, wounds containing foreign bodies such as splinters, compound fractures, burns with sepsis and certain animal bites.

Doctors then separate high-risk from low-risk wounds. UKHSA says high-risk wounds include any of the above with heavy contamination with material likely to contain spores such as soil or manure, surgery delayed for more than 6 hours, or extensive dead tissue. The person's vaccine history decides whether a booster, tetanus immunoglobulin or both are advised.

The NHS advises cleaning a wound and asking for an urgent GP appointment or NHS 111 help if you are not fully vaccinated or not sure, dirt or an object remains in the wound, the wound is hot, swollen or increasingly painful, or you have a high temperature.

The NHS says if you have tetanus, or a wound with a high risk of infection, you will be treated in hospital. Treatment includes cleaning the wound and removing any dirt, soil or dead tissue, an injection of tetanus immunoglobulin, antibiotics, medicines to control painful muscle spasms and stiffness, and help with breathing using oxygen or a machine.

UKHSA stresses that tetanus is primarily a clinical diagnosis. Treatment should not wait for laboratory results. Tests on wound tissue and a blood sample can support the diagnosis, but a negative result does not rule tetanus out and some cases occur despite protective antibody levels. You may also need a vaccine or booster if your vaccination history is uncertain.

The NHS says recovery from tetanus can take several weeks or sometimes months. UKHSA reports that, among cases in England and Wales, the case fatality rate was 29% from 1984 to 2000 and 11% in the following 14 years, and estimates 27% between 2015 and 2025 among cases with known outcomes, with caveats about missing surveillance forms.

These figures describe a very rare disease and should be read with care. The doctor treating you can explain what to expect and what vaccination follow-up is needed.

The NHS says the best way to avoid tetanus is to be fully vaccinated. The vaccine has been routinely given since 1961. In the childhood schedule it is part of the 6-in-1 vaccine at 8, 12 and 16 weeks and at 18 months, the 4-in-1 pre-school booster at 3 years 4 months, and the 3-in-1 teenage booster at 14 years. The NHS defines full vaccination as at least 5 doses in total.

UKHSA points out that immunisation gives personal protection only, because the bacterium comes from the environment and there is no herd immunity effect. Its surveillance shows the highest incidence in people over 64, who are most likely to be under-immunised. If you are unsure which vaccines you have had, the NHS says to check with your GP surgery.

The NHS adds travel advice. A tetanus vaccine may be recommended before travel if you are going somewhere medical help may be hard to reach quickly and your last dose was more than 10 years ago, or if you have not been fully vaccinated.

Call 999 or go to A&E if you have a wound and it is large or deep, or you have a stiff jaw, difficulty swallowing, painful muscle spasms or stiffness, trouble breathing, a fast heartbeat or fits. The NHS says not to drive yourself. Ask someone else or call 999.

For smaller wounds where you are unsure about vaccines, ask for an urgent GP appointment or call NHS 111. Tetanus is rare, but a wound that could become infected should be checked.

Routine tetanus vaccination is delivered free through the NHS schedule, and wound assessment is available at GP surgeries, urgent treatment centres and emergency departments. Tetanus immunoglobulin is given in hospital settings.

Travel clinics may offer boosters before trips. Suspected tetanus is an emergency whichever route you started with, and tetanus is a notifiable disease, so doctors report cases to public health teams.