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Tetanus Guide for Hikers and Adventurers

Tetanus, also called Lockjaw
Tetanus, also called Lockjaw

Everyone knows that if you step on a rusty nail, you should get a tetanus shot. But people don’t realize that tetanus can be contracted in other ways. The fact is, that any puncture wound, especially a deep one, can be infected with tetanus. If you spend a lot of time outdoors, you should make sure that your Tetanus immunization is up-to-date. Getting a booster after an injury is far less effective than being up to date beforehand.

Adults aged 50 years or older account for 70% of Tetanus cases. The mortality rate for the disease is 25% in the United States and 50% worldwide, where Tetanus cases amongst newborns is devastatingly common. Natural immunity to the disease is rare. This is why it is so important for you to get a tetanus booster every 10 years.

Tetanus bacteria are found everywhere in the environment. They live in the soil, in animal feces, and animal intestines. Animal scratches and bites, burns, frostbite, splinters, thorn punctures, dental infections, in fact any injury where oxygen cannot reach the injured tissues, can provide a breeding ground for tetanus.

Tetanus or lockjaw, as it is also known, is a disease of the central nervous system, producing muscle stiffness, rigidity, and eventually convulsive muscle spasms. Difficulty swallowing, stiff necks, arms, and legs, fever and headache may also occur. As the disease progresses, victims may develop a fixed smile or facial expressions due to muscle spasms. Spasms of the diaphragm and ribs make breathing difficult, often requiring mechanical ventilation. The back muscles may become rigid and violent convulsions can occur, strong enough to break bones. The famous picture Opisthotonus, above, painted by Sir Charles Bell, shows what late stage Tetanus looks like.

The bacteria that cause Tetanus are in the same family as botulism and gangrene and thrive in environments without any oxygen – like under your skin. They form spores which are extremely tough to kill and highly resistant to heat and the usual first-aid antiseptics.

Vaccination with Tetanus vaccine is virtually 100 percent effective in preventing Tetanus and the rate of side effects is very low. Adult vaccination boosters should be received every 10 years as antibody levels decrease over time. People who receive a serious wound often receive an additional vaccination if their last booster was over 5 years ago.

For more information about Tetanus and Tetanus Vaccination, see:

Centers for Disease Control and Prevention

Written 2009/ Updated 2015.


  1. Back in the 1960s,I served in the Peace Corps and saw my 20-year-old neighbor die of tetanus (in about 3 days). She contracted the illness because she had nicked her hand while cleaning fish. The cut was trivial, but the outcome was not. I insist on a tetanus shot every 10 years, and everyone who spends time outdoors should too.

  2. I make sure my major vaccinations are done each time I hit my next decade. Easy to remember when you get it done in the "zero" years.

  3. I just got a booster this year. It was over 10 years since I had one. It got me interested in researching the topic. Tiptoe is right. People who do things outdoors should have their vaccinations up to date.

  4. Indeed. I had a fall in the Whites that resulted in a scraped shin and a bad ankle sprain. When I got treatment, they reminded me that I should get a tetanus booster, due to the scrape on the alpine rocks.

  5. Thanks for the reminder. I had a booster in 1987 and another some years later but I don’t remember when. Now that I hit 60, I’ll get another and start the “zero year” thing. I hope to require enough of them to become a real problem to my grandkids.

  6. Another good reason to have a tetanus booster: You can now get a Tdap, if you haven’t had it already. The Td is the old vaccine, T for tetunus and d for diptheria. The ap part is acellular pertussis, and the vaccine protects you from whooping cough, which is now on the rise in a pretty dramatic way. Most adults are a long way away from their last whooping cough vaccine and are no longer immune. Being immunized protects you from a pretty nasty, slow-to-resolve cough, and also keeps you from passing on an infection that can kill an infant who may not yet be completely immunized.

  7. Interestingly, earlier this year I was carving a wooden spoon (as you do), the knife slipped and removed a very small part of the little finger – ouch. On visiting the wonderful National Health Service Accident and Emergency to get fixed up, I was asked about my tetanus and said it was up to date. When visiting my local health centre for dressing the wound I was informed that when you get older and have had regular tetanus boosters, that you develop a natural immunity and she said I should never need another. Just reporting my experience, she might be wrong. But I’m still here.

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