Let's Talk About Tetanus

Today, let’s talk about tetanus.

One thing I often hear people ask about, when debating whether or not to vaccinate, is “Well, I think I could skip most of the jabs, but what about tetanus?” It isn’t something I’m overly concerned about – not because I don’t understand it is a nasty disease, and people do catch it, and it is a risk, and it’s certainly not something I ever wish to experience or to watch a loved one experience (I think that goes without saying!), but because I feel comfortable enough with what I understand of the disease, after much reading, to be able to minimise those risks.  To me, the chances of getting tetanus are smaller than the chances of having an adverse reaction to the vaccine, or something within it making me ill in the long-term. As with all things in life, it’s about weighing up the odds, and risk vs benefit.

So, what about it? What is tetanus? What are your chances of contracting it? What does it do? What can you do if you’re unfortunate enough to contract it? What’s in the vaccine?

Let’s start with question one: What is it.

Tetanus is the name for the disease caused by the bacteria Clostridium tetani. Symptoms occur because of the toxin the bacterium releases, called tetanospasmin, which is extremely toxic and affects the nerves, producing symptoms that can range across the various kinds of tetanus from a sore throat and runny nose, to full-blown rigidity and muscle spasms that can last several days.

Rather than re-inventing the wheel, I’m going to refer anybody interested in this topic to simply read Hilary Butler’s excellent resource on it, which I will refer to throughout this blog, which can be found at the following link. Tetanus is far too complex, with too many issues involved, to possibly do it justice in a blog such as this, so please do consider this just an overview to use as a starting point and do your own further reading from.
http://www.beyondconformity.co.nz/resources/tetanus

Ok, so what are the chances of catching this disease?

Well, the first thing you need to know is that tetanus spores are found everywhere. The ‘rusty nail’ is a bit of a myth, stemming from horse-shoe nails on dirty roads laden with horse poo – a great source of tetanus. Not your average run-of-the-mill rusty building waste nail you might find on a pavement today, necessarily. The second thing to understand, is that the chances are we’ve all encountered it many, many times throughout our lives and been perfectly ok.

Then, we need to figure out what’s actually required in order to catch the disease. C. tetani is what we term an anaerobic bacterium. This means it can’t survive in an oxygenated environment – this is why the highest-risk wounds are puncture wounds that don’t bleed. If the spores get in, and the immune system is compromised to the point that infection can set in while there is no oxygen present (or blood, which is oxygenated), there’s a risk of developing the disease. Bleeding, open, well-oxygenated wounds in healthy people are generally not a risk at all – especially if proper wound management is exercised, and it is allowed to bleed, flushed out properly with saline or water, and then some form of antiseptic is utilised (hydrogen peroxide solution, lavender oil, manuka honey or oil, or colloidal silver are all good natural options for those avoiding pharmaceutical antiseptics, which would also work but may contain undesirable chemicals and additives). There are of course rare exceptions to this rule, but given the rarity of the disease itself they are very, very, VERY rare.

Imagine my surprise, then, when my partner was offered four tetanus shots in two days recently after slicing into his finger with a clean bread knife (yes, very clever darling!) and producing a deep but open, profusely bleeding, very clean wound!!

Again, I’d strongly suggest reading through the resource linked above for more information on tetanus and its risk factors, symptoms, treatments, and so on.

Next thing to consider, is what the vaccine actually is.

When people say ‘tetanus vaccine’, they don’t actually mean ‘tetanus vaccine’ anymore. Instead, what we’re offered in NZ is:

For infants (starting at just six weeks) a combined vaccine against tetanus, diphtheria, pertussis (whooping cough), polio, hepatitis B, and hib. Six for the price of one!! Oh, goodie.

What’s in it?

Aside from the inactivated viruses and toxoids, some of which are cultured on aluminium, there are also such treats as the antibiotics neomycin and polymyxin b sulfate, the carcinogen formaldehyde, the penetration enhancers polysorbate 20 and 80 (which can cross the blood-brain barrier), and ‘Medium 199’.

You can read all about it here: http://www.medsafe.govt.nz/profs/datasheet/i/infanrixhexainj.pdf

That’s just the one for the babies…

Alternatively, you may be offered Quadracel for your baby or child, which also covers tetanus, pertussis, diphtheria, and polio. This one contains aluminium, polysorbate 80, neomycin, and formaldehyde, among other things…

Read about it here: http://www.medsafe.govt.nz/profs/datasheet/q/quadracelinj.pdf

Or if you’re really lucky and an adult, you may just get away with the ADT jab, which has pertussis and tetanus as well as aluminium. Or, you could be offered one of the others. Who knows?

http://www.medsafe.govt.nz/profs/datasheet/a/adtboosterinj.pdf

Note the distinct lack of an actual ‘tetanus’ vaccine?

Ok… so how about the biggie: Does the vaccine actually offer any protection?

Let’s have a look at current New Zealand figures.

So far, there has been one case of tetanus this year – in September.

http://surv.esr.cri.nz/PDF_surveillance/MthSurvRpt/2012/201209SepRpt.pdf

From 1997 to 2010, there were just 28 cases of tetanus reported in NZ.

(All data can be found on the Public Health Surveillance website, which is very interesting for those interested in seeing the actual figures for notifiable and ‘vaccine-preventable’ illnesses in NZ!)

A victory for vaccination, we may ask?

Well, how about we look at the figures from before vaccination was brought in in 1960.

According to New Zealand figures, the rate of tetanus prior to the vaccine – so in an unvaccinated population – between 1920 and 1960 was 1.1 cases per 100,000 per year (data from NZ records, via the above resource). Has that really changed all that much, taking into account ongoing improvements in sanitation, hygiene, nutrition, infrastructure, etc, all of which can have a bearing on this particular disease?

Big questions. What is clear, however, is that tetanus is not a common disease – in vaccinated or unvaccinated populations – and that, as with most illnesses, the already ill or immune-compromised tend to be the most affected. Proper wound management, avoidance of puncture wounds (wear shoes, people!), and understanding of what constitutes a genuinely risky injury will of course help. So does the risk outweigh the benefit? A Google of the search term ‘DPT vaccine reaction stories’ may just be a good idea, as many believe it to be most of the most problematic in terms of ‘adverse events’…

A quick glance at some old annual summary reports to CARM is also interesting, especially given it’s believed only around 10% of all adverse vaccine reactions are officially reported. Consider, when reading this then, that the number is likely 10 times higher, and the number of cases of tetanus in those 13 years to 2010 (28 cases). And that this is just New Zealand figures.

One of the most recent I could find is the following, though it’s possible to view many from the early 1980s to the mid-90s, with other more recent comprehensive reports on particular issues available too. Data from overseas is also available online.

https://nzphvc-01.otago.ac.nz/carm-adr/annualreports/AnnualReport1Jul1993-30Jun1994.pdf

Ultimately, whatever we do in life, whatever choices we make, it so often comes down to weighing up the risks and the benefits for ourselves. We can’t do that without knowing the full ins and outs and potential consequences of each. I hope this has provided at least a small, cursory overview of the huge issue that is tetanus, the disease, and will inspire you to do some further reading – including the medical literature, for the more dedicated readers! – in order to make your next decision a more informed one.