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Tetanus (child care and schools)

What is tetanus?

Tetanus is caused by Clostridium tetani, which is a spore-forming bacteria found in soil and human and animal feces. The spores enter the body through wounds and other breaks in the skin, and grow under low-oxygen conditions. The bacteria excrete a potent toxin (poison) that affects the central nervous system. Tetanus can be deadly. There are very few cases of tetanus in the United States due to routine vaccination. 

Signs and symptoms

  • The jaw and neck are usually involved first, causing lockjaw, stiff neck, and difficulty swallowing
  • Painful, severe muscular contractions (spasms)
  • Generalized tonic seizure-like activity
  • Eventually the entire body is affected (usually in a descending pattern)

Incubation period

Ranges from two days to several months (usually 8-14 days)

Contagious period and spread

  • Tetanus is not transmitted person-to-person, so there is no contagious period.
  • People get tetanus when spores from the bacteria enter the body through breaks in the skin (wounds). 

Public health reporting requirements

  • Confirmed or suspected cases of tetanus must be reported to the local or state health department within four days of diagnosis.
  • Report the infection to the facility director, school nurse, or child care health consultant.
  • Consult with the state or local public health agency about sending out notifications. 

Control of spread

  • Tetanus can be prevented with vaccination and is part of DTaP, DT, Tdap, and Td vaccines.
  • Tetanus vaccine and/or tetanus immune globulin (TIG) may be recommended after an injury in certain situations, depending on the type of wound and the person’s tetanus vaccination status. 
  • Instances where tetanus vaccine and/or TIG may be needed include animal bites, cuts, burns, puncture wounds, and wounds contaminated with soil, feces, or saliva. Appropriate wound care can reduce the risk of tetanus and other wound infections.

Vaccination:

Routine child/adolescent recommendations:

  • Children should receive five doses of diphtheria, tetanus, pertussis (DTaP) at 2, 4, and 9 months, and at 4-6 years of age. Some children may only receive four doses if the fourth dose is given on or after the 4th birthday and the dose is administered six months after the previous dose.
  • Children 10 years and older and adults should receive a single ‘adolescent’ dose of Tdap. Tdap can be given as early as 7 years of age to complete an incomplete series of DTaP. 

Colorado school-required vaccines:

  • Child care/preschool: Infants and children are required to have DTaP vaccine starting at 2 months of age. When children are on schedule, five doses are required to start kindergarten.
  • School (K-12): Five doses are required for kindergarten entry (dose 5 is not required if dose 4 was administered on or after the 4th birthday and at least 6 months after dose 3). Tdap is required for students aged 10 years and older prior to sixth-grade entry. 
  • A complete school-required vaccine exemption provided to the child/adolescent’s school may be accepted in place of documentation of an age-appropriate DTaP vaccination series. 

Routine adult/other recommendations:

  • Tetanus (tetanus, diphtheria, pertussis [Tdap]) vaccine is recommended for all adults who did not receive a primary vaccination series for tetanus, diphtheria, or pertussis.
  • Tdap vaccine is recommended for for all pregnant persons during weeks 27-36 of each pregnancy. 
  • DTaP (if under age 7) or Tdap vaccine may be recommended for tetanus prevention following a wound or animal bite. See CDC’s page on tetanus vaccination status evaluation for more information. 

Treatment

Tetanus is an emergency that requires hospitalization.

Exclusion

Exclusion is not necessary because tetanus is not spread person-to-person.

Role of teachers, caregivers, and family

  • Encourage routine vaccination.
  • Don’t delay first-aid of even minor, non-infected wounds like blisters, scrapes, or any break in the skin.
  • Wash hands often with soap and water, or use an alcohol-based hand rub if washing is not possible.