The World Health Organization (WHO) estimates that about 4.5 million dog bites incidents occur annually in the US. About 885,000 people seek medical help for dog bites every year. Out of these individuals, about 3 to 18 percent contract infections like tetanus.
Compared to the past, the incidence of tetanus infections has now been reduced in the United States and many other advanced countries because of the tetanus vaccine. However, Mayo Clinic estimates that about one million tetanus cases are still seen annually across the world. If a dog bites you, it is vitally important to check whether you require a tetanus shot. In some cases, this could prove to be a lifesaver.
Consequences of Tetanus
Clostridium tetani bacteria cause tetanus. This bacterium has an adverse impact on the nervous system of most mammals and can even prove fatal. The symptoms in humans include muscle contractions that can be painful, particularly in the jaw, abdomen, and neck muscles. If tetanus is not treated in a timely manner, it can lead to respiratory failure and other serious conditions.
Tetanus can be particularly dangerous for older adults and others with weaker immune systems. According to Mother Earth News, nearly 18% of the individuals who develop a tetanus infection die. The largest number of fatalities is seen in people who are above 60 years of age.
Tetanus can make its way into the bloodstream from lesions or cuts caused by frostbite, fractures, burns, surgery, or injury. Dogs primarily contract tetanus through wounds that are left unattended, leaving openings for the bacteria to enter the bloodstream for a prolonged period of time. In case of a dog bite, the cut that occurs to the skin can allow the tetanus bacteria into the bloodstream. This is how the infection takes place.
Diagnosis of tetanus in a dog can be made after a physical examination of the muscles around the wound, which might have turned rigid. Stiffness, uncoordinated movement, and weakness are some symptoms that might be seen in the animal. Dogs that are outdoors for a long time and stray dogs are at the greatest risk of getting and remaining infected.
Clostridium tetani bacteria are more likely to germinate in lesions with considerable tissue injury or puncture wounds. These bacteria make tetanospasmin, which is a potent toxin that binds at the neuromuscular junction.
This toxin might also get absorbed by the lymphatic system as well as the blood stream. Violent and painful contractions can occur after the toxin gets to the nervous system. At first, the muscle stiffness is seen in the neck and jaw but later this turns generalized. Tetanus cannot be spread from person to person – it’s a non-communicable disease.
Need for a Tetanus Shot after a Dog Bite
Domestic dogs are just as likely as strays to growl and bare their teeth the moment they perceive a threat. Nearly two percent of the population in the United States becomes a victim of dog bites every year.
Statistics indicate that most dog bites are caused by pets. This is quite contrary to the popular belief that a domesticated canine will not bite the hand that feeds it (dog trainers know this is not the case). Therefore, it is vital that dog owners and those who live around canines be aware of what to do in the event of a dog bite.
A dog bite is often not a life threatening event. Most people are aware that after being bitten, it is essential to clean the wound well to prevent infection. A majority of people also know that a rabies shot is mandatory after being bitten if it was a stray dog or one whose rabies vaccination is not up to date.
But not many people know that anyone bitten by a dog also needs tetanus shots. The bacteria that cause tetanus can exist in the soil for a long time as spores. Another common misconception is that tetanus is connected to rust. If someone is wounded by a rusty nail, they might have to get a tetanus shot from a doctor.
But it is not the rusty nail that causes tetanus.
When the nail punctures the skin, it transmits spores far down into the skin where the oxygen-free environment is conducive to their survival. When these spores are activated, it results in the production of gram-positive bacteria that proliferate. This leads to the generation of a particular toxin that triggers unmanageable muscle spasms.
Death can occur if tetanus causes spasms in the muscles that control breathing because this will deprive vital organs as well as the brain of oxygen. Those with dog bites must look for signs of pain and swelling in the affected area, severe muscle spasms, and headache. Such signs are indicative of tetanus.
A tetanus shot is essential following a dog bite because there is the possibility of the animal being a bearer of tetanus bacteria. Just like rabies, these bacteria can be transferred through the canine’s saliva. Failure of the dog bite victim to get tetanus shots can lead to infection when the bacterium gets inside the body. Like rabies, tetanus occurrences can be avoided with a tetanus toxoid vaccine.
Who does not require Tetanus Shot after a Dog Bite?
Tetanus shots are not mandatory for all who are bitten by dog bites. If the victim has received a booster shot in the past 10 years, tetanus shot in the event of a dog bite will not be necessary. However, if the victim is unsure about when he or she was vaccinated, a tetanus shot should be given.
In such instances, the booster shot must be administered within 72 hours of the dog bite or earlier if possible. As schools in the US mandate a full tetanus vaccination record, kids are usually given booster tetanus shots. Children who have received booster shots within 10 years do not require tetanus shots if they are bitten by dog. Even though you may be scared of needles, it is essential to visit the doctor after a dog bite and receive a tetanus shot if a doctor suggests you do so.
When a dog bites you, you may also call 911 or head for an emergency care center if you are unable to reach your doctor. The dog bite will be checked and evaluated for damages to the muscle, skin, nerves, and bones.
The treatment provider will clean the wound thoroughly to minimize the risk of infection. They will need to know when you last had your tetanus shot or vaccination. Columbia University researchers recommend that a tetanus shot must be given within 24 hours of the skin being punctured.
If a dog leaves even a small scratch on your body, the tetanus bacteria can find a way in. According to Kathleen Clem, MD, American College of Emergency Physicians, vaccination is the best protection you can have against tetanus.
As a result of vaccination, this disease has become relatively rare in the United States. But a considerable number of people, particularly babies and senior citizens, still contract the tetanus infection.
Included in the list of important childhood immunizations, tetanus vaccination should be provided right in infancy. In a large part of the US, tetanus immunization is mandatory prior to beginning school.
The first phase of vaccination consists of a sequence of five shots across a period of many months. Kids are typically first vaccinated when they are two months old and the series is completed by five years of age. Following this, booster shots are recommended every 10 years.
If you had your last tetanus shot over ten years ago and have a wound that is deep and grimy, you should seek immediate medical attention. Rinse the injury with water from the tap without using soap. When there is a deep wound, do not apply antiseptic.
Along with the tetanus shot, your doctor might administer an injection of tetanus immune globulin which works quickly to keep the infection at bay. Seek medical care without delay because there is a short time frame for the tetanus immune globulin to do its job.
It is necessary to recognize the first symptoms of a tetanus infection. A stiff neck, rigid abdominal muscles, spasms, difficulty swallowing, fever, and sweating are likely. It takes on average about eight days post infection for symptoms to appear (but this can occur any time between three days and three weeks, depending on an individual case).
Dr. Clem recommends maintaining immunization records for every member of the family. She says that a primary reason for fatalities due to this disease is the lack of knowledge about when the vaccination has expired.
Tetanus Prevalence in the US
From the early 1990s, there has been a steady decline in the tetanus mortality rates reported in the US. Documented incidences of tetanus have witnessed a decline since the 1940s which was when tetanus cases began to be nationally reported.
There are many reasons behind the reduction in tetanus mortality as well as morbidity. A major reason is the extensive use of vaccines containing the tetanus toxoid. This vaccine was first launched around the end of the 1940s. Better wound care alongside increased use of tetanus immune globulin (TIG) following exposure is another reason for a decline in cases of tetanus infection.
Reduced exposure to tetanus spores as a result of greater rural to urban migration could also be one reason for the reduction in rates of tetanus mortality seen in the early 20th century.
A total number of 29 tetanus cases were reported via the National Notifiable Diseases Surveillance System (NNDSS) in 2015, which included 2 deaths. The success rate of vaccines with tetanus toxoid is extremely bright, though still not a hundred percent.
According to the study, of the 197 tetanus cases in the US from 2009 to 2015, the vaccination status of 49 (25%) was known. Only 10 (20%) had received three or more doses of tetanus toxoid. The remaining patients received less than three doses of tetanus toxoid or were unvaccinated.
A notable decrease in the incidence of tetanus is seen in regions where effective immunization programs have been implemented.
High Risk of Death from Tetanus for Older Patients
In all, 16 tetanus related deaths were recorded from 2009 to 2015 in the United States (apart from 197 reported infections). A total of 49 (25%) cases involved people aged 65 or older while 124 (63%) were in the age group of 20 to 64. There were 24 (12%) people under 20 years of age inclusive of two instances of neonatal tetanus.
The deaths caused by tetanus were all seen in patients older than 55. One of the reasons is that the number of people receiving booster doses declines as their age increases. As per a survey conducted in 2014, 62.65% of people aged between 19 and 49 were vaccinated with a tetanus toxoid shot in the previous 10 years as opposed to only 57.7% of people 65 and older.
Serologic reports in relation to vaccination coverage with regard to the population in the United States older people also suffer from reduced immunity. A sero-prevalence survey conducted across the national population from 1988 to 1994 showed that 69% of people aged 70 or more had a shortfall of protective levels of tetanus antibodies, while this figure stood at 20% for adolescents in the age group 12 to 19 years.
Some risk factors for tetanus are intravenous drug use, diabetes, and a history of immune suppression. Individuals with diabetes made up 13% of all recorded instances of tetanus from 2009 to 2015 and accounted for 25% of all tetanus deaths. From 2009 to 2015, 6% of cases involved IV drug users.
Tetanus continues to be a significant health challenge across the world, even though proven and safe vaccines including tetanus toxoid are available.
Immediate diagnosis of tetanus is essential and treatment in the hospital is usually necessary. The seriousness of the illness can be mitigated with if TIG and tetanus toxoid medications are introduced immediately.
Every individual must get the vaccination in order to stay protected against tetanus because herd immunity does not help here. The ‘Healthy People 2020’ initiative underlines the significance of attaining and retaining maximum tetanus-containing vaccine coverage in the US. It also needs continued work to guarantee effective and widespread tetanus vaccination across different age groups.
When and How to Receive Tetanus Vaccines?
Five doses of the inactive vaccine, tetanus toxoid (TT) are administered during childhood, while the sixth one is provided during adolescence.
Three doses are sufficient to make nearly everyone initially immune. For those who have not been vaccinated as per this schedule must be given a booster within 48 to 72 hours of any injury or a dog bite.
A tetanus antitoxin might be suggested for people who have high risk injuries but have not been fully immunized. Ensuring that pregnant women are current on tetanus immunization and immunizing those who are not can safeguard against neonatal tetanus.
This vaccine can be safely given to pregnant women as well as individuals with HIV/AIDS. About 25% to 85% of people who receive the vaccine might experience pain and redness at the injection site. Fewer than 10% of people might experience tiredness, minor muscle aches, and fever. Only less than one in a hundred thousand people get severe allergic reactions.
Tetanus shots are usually administered in the shoulder (deltoid) muscle. If you were not vaccinated as a child, then you need to begin the three-dose primary series. Here, the first shot will be a combination (Tdap) that safeguards against three diseases—tetanus (T), diphtheria (d), and pertussis (p), also known as whooping cough. The next doses will be a dual vaccine (Td) for diphtheria and tetanus. The doses will be administered in a sequence spread over seven to twelve months.
It is essential to get a Td booster every 10 years, after completing the primary sequence.
Artificial active immunity is the term used to describe the vaccination for tetanus. In this case, immunity is created when a weak or dead variety of the disease is introduced into the body leading to an immune reaction which results in the generation of antibodies.
This helps the body because, at any time, if the disease again makes it way in, the immune system will identify the antigen and quickly produce the right type of antibodies.
Who should Avoid the Tetanus Vaccine?
Do not choose a tetanus vaccine if you have had a serious allergic reaction to it at some point in the past. Also, it is not for people with who have experienced coma or seizures within a week when the vaccine was administered previously.
If you suffer from problems of the nervous system, epilepsy, or developed swelling or severe pain following a previous dose of the vaccine, or have a history of either chronic inflammatory demyelinating polyneuropathy or Guillain-Barre syndrome, then discuss these conditions with your doctor first before receiving a tetanus shot/s.
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