Tetanus is a serious but rare condition caused by bacteria getting into a wound.

In 2017, there were only 4 cases of tetanus in England. The number is low because an effective tetanus vaccine is given as part of the NHS childhood vaccination programme.

Most people who get tetanus were not vaccinated against it or did not complete the entire vaccination schedule.

How you get tetanus

Tetanus bacteria can survive for a long time outside the body, and are commonly found in soil and the manure of animals such as horses and cows.

If the bacteria enter the body through a wound, they can quickly multiply and release a toxin that affects the nerves, causing symptoms such as muscle stiffness and spasms.

The bacteria can get into your body through:

• cuts and scrapes
• tears or splits in the skin
• burns
• animal bites
• body piercings, tattoos and injections
• eye injuries
• injecting contaminated drugs

Tetanus cannot be spread from person to person.

Symptoms of tetanus

The symptoms of tetanus usually develop 4 to 21 days after infection. On average, they start after around 10 days.

The main symptoms include:

• stiffness in your jaw muscles (lockjaw), which can make opening your mouth difficult
• painful muscle spasms, which can make breathing and swallowing difficult
• a high temperature
• sweating
• a rapid heartbeat

Left untreated, the symptoms can get worse over the following hours and days.

When to get medical advice

Contact a GP or visit your nearest minor injuries unit if you're concerned about a wound, particularly if:

• it's a deep wound
• there's dirt or something inside the wound
• you have not been fully vaccinated, or you're not sure if you have

The GP will assess the wound and decide whether you need treatment and whether you need to go to hospital.

Go immediately to your nearest A&E or call 999 for an ambulance if you develop severe muscle stiffness or spasms.

How tetanus is treated

If the doctor thinks you could develop tetanus but you have not had any symptoms yet, they'll clean your wounds and give you an injection of tetanus immunoglobulin. They may also give you a dose of the tetanus vaccine if you have not been fully vaccinated in the past.

Tetanus immunoglobulin is a medicine containing antibodies that prevent the tetanus toxin working, stopping the effects on the nerves. It provides immediate, but short-term, protection from tetanus.

If you develop symptoms of tetanus, you'll usually need to be admitted to a hospital intensive care unit (ICU), where you may be given a number of different treatments. These could include tetanus immunoglobulin, antibiotics, and medicine to relieve muscle stiffness and spasms.

Most people who develop symptoms of tetanus eventually recover, although it can take several weeks or months.

Tetanus vaccination

A tetanus vaccination is given as part of the NHS childhood vaccination programme.

The full course of the vaccination is 5 injections, usually given on the following schedule:

• the first 3 doses are given as part of the 6-in-1 vaccine at 8, 12 and 16 weeks for all babies born on or after 1 August 2017
• a booster dose is given as part of the 4-in-1 pre-school booster at age 3 years and 4 months
• a final booster is given as part of the 3-in-1 teenager booster at age 14

This course of 5 injections should provide long-lasting protection against tetanus. However, if you or your child has a deep or dirty wound, it's best to get medical advice.

If you're not sure whether you've had the full vaccination course, contact your GP surgery for advice. It's possible to fully vaccinate older children and adults who were not vaccinated when they were younger.

Tetanus travel jab

Tetanus is found throughout the world, so you should ideally make sure you're fully vaccinated before travelling abroad.

Contact your GP surgery for advice if you're planning on travelling abroad and have not been fully vaccinated against tetanus, or you're going to an area with limited medical facilities and your last vaccine dose was more than 10 years ago.

If you've never had a tetanus vaccination before, you may be advised to have as many of the 3 initial doses of the vaccine as possible before you leave (there should be a 1 month gap between each dose) and complete the full course when you return.

If you've been partly or fully vaccinated, a tetanus shot is usually still recommended as a precaution if you're travelling to an area with limited medical facilities and your last dose of the vaccine was more than 10 years ago.

You'll be offered another 3-in-1 teenage booster. This additional booster, which also protects against diphtheria and polio, is usually free on the NHS.

Read more about travel vaccinations.