The following week, the wound doesn’t look too good, your face aches, and you’re having difficulty moving your jaw. You revisit the doctor but he fails to recognize signs of tetanus. You collapse and die just four weeks after your initial injury. Such was the case of 61 year-old Sheila Creighton of Liversedge, England who had the tetanus vaccine in 1991 but failed to re-vaccinate prior to/or immediately following the incident in 2002. According to the Centers for Disease Control(CDC), you only have 48 hours from time of injury to get the tetanus vaccine in order to obtain protection against the disease. And we’re not talking about injury from rusty nails. Most people fail to realize tetanus is caused by bacteria (Clostridium tetani) which enters the skin through an injury as slight as a pinprick or as deep as a puncture wound. In fact, there were two cases of tetanus in Puerto Rico that originated from wood splinters. It’s important to note that tetanus spores lie dormant in dirt, dust and manure. These spores remain infectious for over 40 years. If you puncture the skin, cleanse the wound thoroughly and contact your physician.

“The scary thing is that 31% of tetanus cases reported in the US between 1998 and 2000 came from garden, yard, or farm injuries, “ said Susan J. Rehm, MD and president of the National Foundation for Infectious Diseases. The CDC reports that in the past two decades, 70% of tetanus cases in the US were among adults 40 and older.

Tetanus infects your body through a break in the skin. There, spores survive in an oxygen-free environment and germinate for 3 days to 3 weeks (7 days is average). A toxin called tetanospasmin is created and works its way into the nervous system where it selectively interferes with inhibitory nerve messages sent from the spinal cord to the muscles. This triggers muscles spasms. Initial symptoms may include irritability, headache, depression, fever, drooling, and sweating. The disease progresses to mild spasms in the jaw (aka lockjaw where the jaw locks up and you can’t open your mouth or swallow), neck, and facial muscles. Rigidness quickly develops in muscles of the abdomen, back (arching), chest, and larynx (breathing may be difficult). You could have uncontrolled urination/defecation. Some contractions can be so strong, they tear the muscles or cause compression fractures of the vertebrae. One in three people who contract tetanus die and for those who survive, intensive hospitalization is required.

Treatment includes a culture of the wound site to detect the tetanus bacteria; possible surgery to more thoroughly cleanse the wound; a course of drugs to kill the Clostridium tetani bacteria; muscle relaxants to treat spasms; complete bed rest in a controlled environment with low light and noise levels as well as a stable room temperature; and possible sedation.

Fortunately, tetanus is a preventable disease and it’s not contagious. Nearly all cases of tetanus occur in people who have never been vaccinated or those who had a primary series of the vaccine but failed to update every 10 years. Adults who have never had the vaccine should begin with a 3-dose primary series spread out over 7-12 months.

The vaccine, known as Td, is not a live vaccine (can’t get tetanus from the shot) and that’s why you’ll need an update every 10 years.“T” stands for modified tetanus toxin, which provokes the body to produce antibodies. The “d” stands for diphtheria , a disease which can cause breathing difficulty, heart failure, paralysis, and death. The vaccine was combined in the mid 1940's. The lower case “d” signifies a lesser amount of diphtheria toxoid because adults become more sensitive to this component as they age.  DT, DTP, and DTtaP are versions of this vaccine usually given to children.

Be sure to check with you doctor prior to getting Td if you’ve had an allergic reaction to the vaccine in the past; if you have a fever of 101+; if you’re pregnant; or if you suffer from moderate/acute illness.

There are two different Td vaccines available. Review the following vaccine components for potential allergens that could cause an allergic reaction:

Td (Aventis) contains aluminum potassium sulfate, formaldehyde or formalin, sodium chloride, and thimerosal (may contain glycine, sodium acetate, and sodium hydroxide).

Td (Massachusetts) contains aluminum hydroxide, aluminum phosphate, formaldehyde or formalin, sodium chloride, and thimerosal (may contain glycine, sodium acetate, and sodium hydroxide).

As with any shot, you should remain at the vaccination center for at least 15 minutes following  the procedure just in case you experience an immediate reaction. The following are some possible side effects from the tetanus booster:

Mild problems might happen within hours to a couple of days after vaccination. It can last for 1-2 days. Possible soreness, redness, swelling, or a small painless lump (which usually disappears within 2 months) at the vaccination site; a slight fever; irritability; and malaise are all mild reactions.

Severe problems are rare. A serious allergic reaction could occur within minutes to a few hours of the vaccine. This would include hives, wheezing, difficulty breathing, swelling of a part on the body, and anaphylaxis shock. As with any severe allergic reaction, you should proceed immediately to your nearest hospital and contact your physician. Other non-allergic reactions include deep aching pain and muscle wasting in upper arms. They can occur 2 days to 4 weeks after receiving the vaccine and last many months. Another reaction considered to be severe is paralysis and seizures.  If you experience a severe reaction, call your doctor immediately. Detail your reaction on paper listing the date, time, and any other relevant facts. Then contact the Vaccine Adverse Event Reporting System (VAERS) at (800) 822-7967 to file a report.

Receiving the Td vaccine too frequently could interfere with your body’s immune reaction. In addition, your chances of experiencing a mild reaction are greater due to a high level of tetanus antibody in your blood. That’s why it’s important to keep accurate, up-to-date records of your immunizations along with a list of any reactions.

So when you gather your gardening gear remember the words of Dr. Relm who advised, “Keep your immunity current with a Td booster every 10 years, wear gloves and protective clothing while working outdoors to guard against cuts, scratches, and other injuries.”

Because a safe gardener is a happy gardener!