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An Idiot’s Guide To – Tetanus

This is a project I wanted to do for a while.

Basically? Anti-Vax vs. Vaccination is a major problem in a large part of the developing world. Quackery movements in general are meshed together. And as I always say, the best ammunition against them is education.

So I figure we should discuss some common diseases. Just “Stuff” about how they really are.

There is a common notion among quacks (and let’s be honest, charlatans pretending to be doctors) that Tetanus is harmless. But to begin with let’s start at the very beginning. I wrote a piece on immunity that got “a lot of success”. Partly because I apparently wrote something that a lot of people could use and partly because PZ Myers linked to it and his brigade of readers outnumbers my own by “a lot”.

If you are new to the series, I suggest you start with “Immunity? Easy Peasy Lemon Squeezie” to let you understand the very basics of how the human immune system works. Why do we start here? It’s simple. Because when you build a house you must start at the foundation. And this is the foundation of disease response and indeed how a variety of things work in our body including vaccines.

I ask the question a lot to anti-vax groups who engage with me. Can you explain human immunity. To date, one person has got it right. They did so by copying out what I wrote and posting it verbatim. I let them post the whole thing before asking them to read the name on the blog… It was amusing to me but it led me to believe that the core issue in anti-vax is an ignorance of or a lack of belief in human  physiology.

So let’s define Tetanus

Tetanus is a disease  where all muscle fibre contracts simultaneously due to the presence of a nerve toxin (Tetanospasmin) produced by a bacteria that commonly grows in dirt and rust but when introduced deep into muscle tissue can cause this effect.

It is a painful disease and is a serious disease. It can and will kill.

The causative agent is a bacteria called Clostridium Tetani and it’s an anaerobic bacteria. It’s hard to culture in basic labs and it’s generally demonstrated by detection of the toxin in mice.

Clostridium Tetanii comes from the family Clostridia and it’s “not” happy family. It’s also home to the “super bug” Clostridium Difficile and Clostridium Perfringens which causes gas gangrene. It’s also home to the dreaded Clostridium Botulinum which is the source of Botulin Toxin which is one of the most toxic poisons on the planet.

So lets move onto some basic medicine. Signs and Symptoms of Tetanus include

Mild Spasms usually beginning in the jaw (hence the name of Lockjaw). These also affect chest, neck, back, abdominal muscles and bum. The spasms get worse and can lead to opisthotonos causing an arched back. The patient here literally forms an arch clean off the bed, often to the maximum flexation of the spine. This is needless to say “distressing, painful and scary”. Tetanus is believed to be one of the diseases which people assumed was caused by witchcraft due to this. The muscles of breathing can also be affected making inhalation difficult leading to respiratory distress.

Prolonged spasm causes “Tetany” or sudden, powerful and painful contractions. So powerful that you can fracture your own bones or rip your own muscles.

Patient drools, sweaats and has fever, irritability, difficulty swallowig and uncontrolled defaecation and urination due to muscle spasm. The stools passed are not watery and are solid. The neurotoxin just causes muscle spasm including the bowel.

Next? Mortality rates

Tetanus is a lethal disease which often leads to death. The mortality rate depending on nation varies from 75% to 10% depending on age and quality of healthcare available. The highest mortality rates are seen in unvaccinated people particularly children and the elderly where the damage caused by the toxin is too much to bear. It is in these individuals the bulk of the mortality is seen.

Cause of the disease

The bacteria itself is merely a factory, the heavy lifter is the toxin.

The tetanus toxin initially binds to the nerve junctions on nerves away from the core of the body. Nerves are made up of a body, little arms (dendrites) and a big arm (axon). Down the axon is how we transmit nerve impulse. We do so by depolarisation of the membrane of the “axon” by changing the concentration of ions inside and outside it via gates. This causes a detectable electric charge. This toxin is transported by the axon till it reaches the Central Nervous System which is your brain and spinal cord. Here it binds to chemicals in our brain particularly  in nerves of the motor inhibitory pathway which is a series of nerves that control and modulate our movement. When they “don’t” fire we move.

It’s a hard concept to explain. Think of it as “your muscles want to contract normally and this prevents them”. It’s like the trigger string on a catapult. Rather than you firing your muscles the toxin does it “for” you.

The lack of inhibition causes the muscular spasm that give tetanus it’s name.

Treatment

Mild cases of tetanus can be treated with

  • Tetanus Immunoglobulin
  • Diazepam
  • Metronidazole

But for those who require intensive care?

Severe cases require ICU care and the mild treatment plu

  • Intra-Thecal (injected into the space between brain and skull between layers of the membranes surrounding the brain) injections of Immunoglobulin
  • Magnesium (IV)
  • Diazepam continuously
  • Labetalol
  • Colonidine
  • Nifedipine
  • Curare-Like Drugs
  • Mechanical Ventilation
  • Airway Tracheostomy (Tube in the neck to let you breathe)
  • Percutaneous Gastrostomy (Tube to the stomach to feed you)
  • High Caloric Diet (4000 KCal or double the norm)

Full recovery takes 4 to 6 weeks due to damage to nerves.

Epidemeologically speaking?

The bacteria is found world wide and is spread via animals and indeed human carriers. While “rust” doesn’t cause the disease, rusty objects are generally found in the ground and the surface of rust is a good carrier of the bacteria. It’s a thankfully rare disease due to widespread vaccination. However, roughly 30 people a year still contract the disease per year in the USA. Nearly all are unvaccinated or have not kept up with vaccinations.

How about a little general knowledge?

Tetanospasmin was first noticed in the “mad science” days of biology when soil bacteria produced the same “effects” as tetanus infections causing the person to realise the bacteria that causes tetanus is soil borne. This was confirmed in 1884 as the causative organism for tetanus.

In 1924 the first tetanus toxoid vaccine came about and was instrumental in reducing war casualties during WW2 from secondary infection. Remember in warfare everything from “bullets” to simple clumsiness occurs in and around dirt and tetanus is one of the big killers of post trauma pre-tetanus vaccine.

It is the only vaccine preventable disease that is infectious but not contagious (AKA the bacteria that causes it won’t spread from a patient to another victim).

Tetanus Kills. It’s one of the major causes of death in neo-nates and is a preventable cause of death.

Please note, any anti-vaccine lobbyist telling you that you will gain immunity to tetanus if you “survive” is utterly wrong. Tetanospasmin is so potent that the lethal dose is insufficient to provoke and immune response.

Tetanus is prevented by vaccination with the tetanus toxoid. To understand how it works we must understand how toxins and indeed “poison” works.

Poison works either by corrosion like acid or enzymes (remember, the enzymes produced by your pancreas can  “poison” you). Or by reacting with something in the body to cause damage by stopping something important. A toxoid vaccine takes the “poisonous compound” which in this case is a organic compound with a complex structure necessary to it’s function and breaking it up into toxoids. These don’t have the same biological activity. When biological molecules interact they do so at specific sites. If the site on the toxin molecule is not provided then the toxin molecule is “rendered inert”. This toxoid vaccine produces antibodies to the various parts of the toxin which flood the immune system and overwhelm the toxin and sequester it and digest it way before it can get to the part of the body which it can effect. The immunoglobulin works the same way but is “pre-prepared” antibodies.

Tetanus is part of the standard childhood vaccination schemes and maternal vaccine schemes to prevent neo-nate tetanus. It’s also give immediately after deep wounds if the patient is of uncertain status (patient may STILL develop tetanus as it takes time to produce the antibodies but the severity of the disease is reduced).

This is not a disease to take lightly. This is a serious disease.

Any anti-vax telling you that it’s not is sadly delusional.

This is why you vaccinate for it.

So why did I write this? Well there is an anti-vaccine “article” making the rounds about how Tetanus is not that bad. I am planning to cover it tomorrow. And I figured that before we discuss that, we should really make sure we know the basics of the subject. Anti-Vax deal in fear of vaccines and a perceived notion that ignorance is an equal stance to knowledge. To understand why vaccination is important requires knowledge to understand the basics.

Remember, these anti-vax claim that a poison in the same family as botulin toxin (a poison so lethal that a millionth of a gram is considered deadly) is harmless. What could possibly make them say such a clearly incorrect statement apart from ignorance of reality.

Comments

  1. The Mellow Monkey says

    I’m so glad to see you covering this. Just the other day I saw an anti-vaccine article being passed around Facebook about how all you need to deal with a wound that could have introduced tetanus into your body is to rinse it with hydrogen peroxide. Argh.

  2. Tsu Dho Nimh says

    “Clostridium Perfringens which causes gas gangrene”
    And food poisoning too … is the third most common cause of food poisoning in the US and Great Britain. Typical culprit is poorly prepared roat turkey, or the leftover dressing and gravy … left out and the spores have time to sprout and make toxin.

  3. Karen Locke says

    Last time I got a tetanus booster, my doc didn’t even ask me. It was just prepared and ready for me when went in for something routine. He simply said, “You’re due for a tetanus booster.” End of discussion. My clinic takes vaccinations seriously.

  4. otranreg says

    These also affect chest, neck, back, abdominal muscles and bum.

    Is ‘bum’ an officially approved term?

  5. left0ver1under says

    After stepping on a nail as a kid, I ended up getting a tetanus shot. I injection felt like knives going into my skin, but considering that the potential effects of tetanus were far worse, it was worth it. (Of course, I didn’t feel the same way then….)

    otranreg (#4)

    He’s British. They think “bottom” is a dirty word. ^_^

  6. garnetstar says

    I just read yesterday of an Australian boy who was rushed to the hospital with tetanus because his parents chose to protect him from the evil vaccine. No word yet on his progress (or not).

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