Take a shot to protect yourself

Sondra Finley, 63, waited six months to dig her fingers into her garden. Gardening had become an obsession over the years and she’d been known to spend full days puttering and planting. When she cut herself on a piece of glass embedded in the soil, it was serious enough to require stitches. While at the emergency room, she was asked about her immunization status. Like many older Canadians, she was unable to recall the last time she’d had a tetanus shot. The emergency room physician administered a tetanus vaccine coupled with an immune globulin. Taken together, she was protected from infection by the rare but often fatal bacteria tetanus.

What is Tetanus?
According to the Canadian Immunization Guide, tetanus is an acute and often fatal disease caused by an extremely potent neurotoxin produced by Clostridium tetani. “As the organism grows, it produces a toxin that circulates through the bloodstream and attaches itself to the nerve endings in the spinal chord and neural tissue which control motor function,” explains Dr. Ashley Yeats, a Canadian physician and currently the Clinical Director of the Dertment of Emergency Medicine at Brigham & Women/Faulkner Hospital in Boston, Massachusetts.

It can take from three days to three weeks to develop symptoms, which can include rigidity in the jaw and neck and a difficulty swallowing. Health Canada reports that muscle spasms can also become so severe they cause broken bones.

When people think of contracting tetanus, they often think of stepping on a rusty nail, but the truth is the bacteria is found everywhere. Wounds considered at risk for developing tetanus include those contaminated with dirt, feces, soil or saliva. Major wounds including punctures, gun shot wounds, avulsions, crushed skin, burns or frost bite can all be at risk for infection, as well as minor wounds including scrapes,small cuts, a stubbed toe and even a paper cut.

Older Canadians and Immigrants Most at Risk
It was once believed that young children were most at risk for contracting tetanus, but the reality is the risk increases with age. “The reason is that as your immune system gets older, your ability to maintain a level of immunity in response to vaccines wanes,” says Dr. Yeats.

Older adults may have also missed childhood immunization programs by the government, so they may not have received the initial series of shots to establish protection. A tetanus booster shot is required every 10 years to maintain immunity. If they haven’t kept up with their shots, immunity can wear off. A compromised immune system can also be a risk factor so those on immune suppressant drugs to control arthritis, lupus or other immune disorders are at risk. Also people who have HIV or who have undergone chemotherapy, bone marrow transplant or stem cell transplantation.

Other groups at high risk, according to a study in the Annals of Emergency Medicine, include immigrants from outside North America or Western Europe and people without education beyond grade school.

Immune globulin offers immediate protection
When a wound is serious enough to require medical attention and is considered to be of risk for tetanus, getting a booster shot won’t be enough to protect you if your immunizations aren’t up to date or are non-existent. “You need three tetanus vaccinations to train your immune system to be able to deal with tetanus,” explains Dr. Yeats. “The vaccine causes your body to make these antibodies that neutralize the toxins.”

If you aren’t adequately immunized, a doctor should prescribe a dose of immune globulin as well as the tetanus shot. “ It doesn’t stimulate your body to make its own antibodies, it actually is the antibody that can neutralize the toxin,” says Dr. Yeats.

According to Dr. Yeats, physicians should be using the immune globulin for people who have not had their primary series of three tetanus shots and people who don’t know if they have had the immunization. “While tetanus is rare in North America, it does have a high mortality rate,” says Dr. Yeats. “But it’s entirely preventable with vaccinations.”

This Special Educational Feature was produced by the editors of CARP magazine with an unrestricted educational grant from Bayer