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The Informed Parent

Tetanus Shots: Not Just For Kids

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jun. 07, 1999

What goes around, comes around is an expression that most people are familiar with. It is not revenge per se, but rather a universal law that is experienced day in and day out.

This brings me to the day that Mr. X. brought his 5 year old son to the office for his kindergarten physical. Dad was given the dubious honor of bringing Cody because the word had gotten out just how "horrible" this visit was. The kindergartner-to-be would need to receive three shots, a blood test for anemia, and a TB test (another needle). Cody was forewarned by his little buddies and was NOT at all thrilled about this much so, that mom made sure that dad brought him.

Mr. X. was in his late twenties and had himself been a patient at our group all of his life. He is a rugged individual who works outdoors and manages to keep a tan year round. He is very fit and works out regularly. While Cody sat nervously in his chair awaiting his fate, dad boisterously recounted the stories of how many times he had been in the office on the receiving end of unpleasantries. There were the stitches in the chin, the broken wrist, the time he stepped on a nail, and the concussion. In spite of dad’s feigned attempts to make light of the situation, Cody wasn’t buying it. This made dad try even harder.

He changed tactics. He winked at me and said, "Hey doc, isn’t the needle you guys use about this big?" then he held his hands about six inches apart. Cody just paled. It was then that I noticed that Mr. X.’s hand was bandaged. I asked what happened and he told me that he cut his hand with an Exacto knife... a foolish mistake. He was careless and not paying attention. As he took off the bandage to show me the wound, he proudly stated that it probably could have used a few stitches but he decided to take care of it himself. "I can do without doctors, thank you very much," he boasted. Then he went on to tell me that he hadn’t needed to see a doctor for over 15 years. When I asked him when his last tetanus shot was, he said it had to be in our records because it surely was here. I had the nurses dig up his old chart and sure enough, it was when he was 15 years old (the stitches in the chin).

Cody’s eyes got as big as saucers when I told Mr. X. that he too would need to get a tetanus shot. At first he thought I was kidding, but when he realized that I was dead serious, he tried to bargain with me. "Aw c’mon doc, I really don’t like needles--how about I come back in a day or two?"he pleaded. It was a weak attempt and he grudgingly acquiesced...much to the amusement of Cody.

Tetanus, or lockjaw, is an acute paralytic illness that is caused by a bacteria, Clostridia tetani. This bacteria forms spores that can be found in dust and soil all over the world. Clostridium tetani produces a neurotoxin (tetanus toxin) that is the second most poisonous substance known to man surpassed only by the botulinin toxin of botulism. Most cases of tetanus occurring in the United States are the result of a traumatic injury, usually a penetrating injury with a dirty object such as a rusty nail, a splinter, stepping on a piece of glass, or being cut with a can. There are however, a number of cases of tetanus each year where no history of trauma can be elicited. There are approximately 50 cases of tetanus in the U.S. each year and the majority of cases occur in individuals over 50 years. This is most likely because they stopped receiving their tetanus boosters and their protection has drifted to nil.

While there are only 50 annual cases in the U.S., this is in stark contrast with the worldwide experience. In developing countries, tetanus is an endemic problem. Over 500,000 infants die each year from neonatal tetanus that is acquired during the birth process because their mothers were not immunized or protected. As many as 30,000 un-immunized women die annually from tetanus that is acquired during birth or abortions.

The reason that there is so little tetanus in the U.S. is because of the vigilant standard set by the Public Health Department. The routine immunization schedule calls for a DTP vaccine (diptheria, tetanus and pertussis) at 2, 4, 6 months with a booster at 18 months and 5 years. With few exceptions, children cannot register for school unless they have received ALL of their vaccines. After the 5 year old booster, everyone should receive a dT booster (tetanus booster) every 10 years. The subsequent boosters do not have the P for pertussis because this is not a problem in adults. The d represents a small amount of the diptheria which helps "boost" the response by the immune system for the tetanus protection. This booster given every 10 years should confer protection for any seemingly insignificant injury. Should one sustain a particularly dirty or suspicious injury 5 years after getting a booster, they should seriously consider receiving a booster at that time because the level of protection is unpredictable.

While we are fortunate in this country that tetanus is not a major health problem, the risk does exist, especially for adults. A simple enjoyable task such as gardening or working with tools can heighten the risk. For the over twenty population, ask your doctor about your tetanus status. If it has been over 10 years since the last booster plan to get one. As the adage goes, an ounce of prevention is worth a pound of cure.

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