Tetanus – People Forget about Prevention of the Disease

Do you know what the situation is with antibodies for tetanus?

Being sick with tetanus is not frequent today in our conditions. This is, however, due to mass mandatory vaccinations – people used to die of tetanus a lot. In 1951, a year before the start of vaccination, 140 people died of tetanus in the Czech Republic. Vaccinations against tetanus were introduced gradually in the former Czechoslovakia, the first were groups of children, nationwide vaccinations of adults started in 1974–75.

Today, however, the danger is not fully eliminated. We were mostly vaccinated in childhood and as teenagers, but the antibodies following a vaccination do not protect us forever – their levels slowly decline – and the protective function can therefore disappear. And this is an opportunity for Clostridium tetani bacteria. It is therefore possible to get sick in Czech conditions.  “Data from the State Medical Institute  (ISIN) indicates that there have been three cases in the Czech Republic since 2015. The disease is relatively serious; one patient unfortunately died,” said MUDr. Petr Podroužek, CSc., specialist director of EUC Laboratories. Over a million people a year die of tetanus in the world, 80% of them in developing countries.

What are the symptoms of tetanus?

The incubation period, i.e. the period after infection following which the first symptoms of the disease appear. is between 3 and 30 days for tetanus. The bacteria produce a toxin that spreads through nerve fibers to the brain, so in the case of peripheral injuries the incubation period is longer. The disease can have an effect only through a muscle contraction in a certain area, such as localized tetanus. It can precede a later, generalized form of tetanus that, at the start, appears most frequently as pain when opening the mouth and cramp of the facial muscles, progressively pain and tension spread to the neck, cramp in the vocal chords means that a sick person cannot talk.  Stiffness and cramp in the stomach and calf muscles occurs. General cramp progressively develops, it lasts several minutes and during it the body is bent into the characteristic form of a drawn bow, there is a loss of coordinated muscle movements.

The generalized form of the disease is most common in the case of tetanus.  Before the introduction of vaccinations against tetanus, infant tetanus was common and still accounts for a significant percentage of infant mortality in developing countries. If a mother was not vaccinated, infants do not have passive immunity against tetanus, a birth often takes place in hygienically unfavourable conditions and the possibility of infection, in particular contamination of the umbilical stump, is marked here.

Treating Tetanus

If treatment is provided in time, tetanus can be treated. A complete recovery, even in the case of good medical care, takes a long time. The disease is always regarded as very serious. At an advanced stage, despite targeted therapy it can lead to death.

First of all it is necessary to fully clean the wound and surgically remove the dead and infected tissue. After an injury, anti-tetanus human immunoglobulin is also administered as soon as possible. This gives a sick person passive immunity, which stops the disease from developing. Antibiotics are also administered. The bacteria are sensitive to penicillin, with regard to the higher risk of cramp, however, Metronidazol is frequently administered because it is good at getting into tissue. More serious cases are treated at intensive care units that provide support for breathing and blood circulation. The pain is suppressed by analgesics, soothing drugs helping suppress other symptoms, in particular cramp. In the event of illness, protective antibodies against tetanus do not arise, so it is necessary to start active immunization using a tetanus anatoxin.

How to Get Oriented in “All Those Injections”

In the case of fresh injuries (for example wounds and burns) that could be contaminated by the Clostridium tetani bacteria, but also if a patient has not been vaccinated in the last ten years or we are not aware of the state of his vaccinations, we can try to provide the patient with antibodies against tetanus directly (anti-tetanus immunoglobulin). This is passive immunization, rapid delivery of antibodies to a patient’s blood circulation that prevent the spread of the disease. These antibodies, however, disappear from an organism fairly rapidly, so it is necessary to create long-term immunity. This is obtained by active immunization using a tetanus anatoxin – vaccination with the vaccine. The organism then itself creates protective antibodies against tetanus that last for a number of years.

The generally-used terms “tetanus injection, anti-tetanus injection” mean passive and active immunization.

Vaccinations against Tetanus

Vaccinations against tetanus are mandatory vaccinations in the Czech Republic, the government pays for them. Since 2018, vaccination has been in the form of three doses of hexavalent vaccine (protects against diphtheria, tetanus, polio, whooping cough, haemophilus infections and hepatitis B). The first vaccination is performed from the start of the 9th week with two doses during the first year of a child’s life, the third dose of the vaccine is then administered between the 11th and 13th month’s of a child’s life. In the case of prematurely born children, the schedule is altered and contains a fourth dose of the vaccine. Then in the 5th/6th year of life re-vaccination is performed against tetanus, diphtheria and whooping cough; it is repeated again in the 10th/11th year. There should be an additional re-vaccination against tetanus every 10–15 years. In adulthood we have to think about the necessity of regular re-vaccination against tetanus – with regard to the long intervals between re-vaccinations (ordinarily 15 years, 10 years for persons over 60) it is not easy to remember the need for re-vaccination.

It is necessary to talk to a doctor about the contraindications for vaccinations. The contraindications include feverish diseases, some chronic diseases or allergic reactions.

Side effects after vaccination: In the place of administration there could be a local reaction that usually disappears without the need for therapy. Some people could have a temperature, headache, muscle pain or tiredness. According to vaccine manufacturers, more serious reactions are rare.

How can you ascertain your situation regarding protection against tetanus?

“It is most simple to ascertain the level of protective antibodies in a laboratory, where it is clear from the result whether protection against an infection is sufficient or re-vaccination is recommended after a certain time, or protection is sufficient,” said MUDr. Petr Podroužek, CSc., the specialist director of EUC Laboratories. “Today it is possible to have an examination performed even without a doctor’s recommendations, for a direct payment. It is only necessary – even without making an appointment – to come to a laboratory’s testing point. For example here at EUC Laboratories an examination costs CZK 396 + price of taking a sample (adults) CZK 46,” added MUDr. Podroužek.

How to Prepare for an Antibody Test in a Laboratory

If you are interested in an examination, come on an empty stomach to the sample room, do not eat for approximately 12 hours beforehand and do not smoke. It is appropriate to drink 250 ml of water or unsweetened tea. A patient that is paying themselves, when a sample is taken, chooses the method of delivery of the result – in the safe way of e-mail (mobile telephone password), by registered letter or collection from the laboratory testing point.

You can find additional information about blood tests and examinations at the website www.euclaboratore.cz