Tetanus : information and vaccination

Tetanus (lockjaw) is an infectious disease caused by bacteria called Clostridium tetani. These bacteria can enter the body through a wound where dirt has entered, such as street dirt, manure or soil. You can also contract the bacteria through a burn wound or animal bite.

People cannot infect each other.

Tetanus is a serious disease that used to have a high fatality rate. Because most people are vaccinated against tetanus as children in the Netherlands, it is almost non-existent here. Tetanus is more common in countries with poor medical facilities.

If you are not fully vaccinated and become infected with the tetanus bacteria, you will usually get sick within three weeks. Tetanus can cause severe muscle cramps, swallowing problems and breathing problems. You should seek treatment as soon as possible.

If left untreated, tetanus can be fatal.

Children are vaccinated against tetanus three times in the first year; the first shot is given when they are three months old. The shot against tetanus (T) is part of the DTaP-IPV shot, along with the shot against diphtheria (D), whooping cough (aP) and polio (IPV). These shots are given at the child health clinic.

Each shot gives your child extra protection. After the full set of three shots (given at 3, 5 and 11 months old), children are protected against tetanus. The booster shots (at 4 and 9 years old) provide longer protection. The shot against tetanus at 9 years old is part of the DT-IPV shot, which also protects against diphtheria and polio.

If you receive all the childhood tetanus shots according to schedule, you are extremely well protected for at least 10 years. In other words, until the age of 19. The vaccination does not protect you for the rest of your life.

Wounds

You are at risk of contracting tetanus if you have a wound that has or may have had dirt in it. Specifically, this concerns the following wounds:

• cut or abrasion that may contain street dirt, soil or manure
• animal bite
• severe burn (second or third-degree)

Travel

If you are going on a long trip and it has been more than 10 years since you were vaccinated against tetanus, it may be wise to get a booster shot. Contact the Municipal Health Service or your GP to arrange a booster shot.

Work

Certain professions have a higher risk of tetanus infection. We recommend that people in these professions get a booster shot every 10 years. Specifically, this concerns the following professions:

• veterinarians and livestock veterinarians
• gardeners
• farmers and horticulturists
• livestock farmers
• garbage collection workers
• people who work a lot with horses

Cleaning the wound

• If you have an abrasion or cut that has been contaminated with soil, street dirt or manure, rinse the wound thoroughly with tap water.
  Do not use soap or disinfectant (including iodine, baking soda or biotex). If no water is available for rinsing, a disinfectant, such as iodine, is better than nothing.
• If you have been bitten by an animal or human, rinse the bite wound thoroughly under the tap with lukewarm water. Large wounds should be covered with a clean bandage or cloth after rinsing.
• If you have a burn wound, cool the wound immediately with lukewarm, running tap water for 10 to 20 minutes. Only leave clothing near the burn if it sticks to the wound and is difficult to loosen.

If you think you may need a tetanus shot, contact your doctor to have your wound examined. The doctor will also check if and when you were last vaccinated against tetanus.

You do not need a tetanus shot:

• if you had all your tetanus shots as a child; and
• are under 20 years old; or
• were vaccinated against tetanus less than 10 years ago.

You also do not need a tetanus shot for:

• a clean wound;
• a first-degree burn (without blisters);
• a small second or third-degree burn.

In other cases: call your doctor. You may need one or more shots.

We strongly recommend getting the vaccination(s) as soon as possible after the injury. If you did not do so initially, do it as soon as possible. The vaccination can be effective up to three weeks after injury.

Children

Children receive the tetanus vaccination in a combination shot: the first vaccinations are with the DTaP-IPV shot; when they are older, they receive the DT-IPV shot.

Wounds, travel, work

If you need another tetanus shot, you may be given the DT-IPV shot again or an “individual” tetanus shot. The DT-IPV shot is the most common choice, as it also protects against diphtheria (D) and polio (P). The DT-IPV shot also contains no thiomersal, which the individual tetanus vaccine does contain. Thiomersal is a preservative that contains mercury. There is no evidence that thiomersal is harmful during pregnancy, but pregnant women who need to be vaccinated against tetanus still often get the DT-IPV shot instead.

If you have a wound, you will decide with the doctor whether to get a tetanus vaccination.

Tetanus vaccination more than 10 years ago 
If you had a tetanus vaccination more than 10 years ago, you will only receive a booster shot. You do not need to come back for follow-up shots.

No previous tetanus vaccination
If you have never had a tetanus vaccination, you will need three shots to be protected against tetanus. Your arm may feel a little sore after the vaccination. This can last for a few days and goes away on its own.