Wednesday, March 26, 2003

It's not just a rusty nail

Risks of tetanus infection lurk in more places you might think

What do a police officer, gardener and rollerblader have in common? Surprisingly, they all could find themselves at risk for tetanus exposure. Most people know that stepping on a rusty nail means a trip to the emergency room for a tetanus shot, but other, simpler injuries, whether on the job or at leisure, can also put people at risk for getting this serious and possibly deadly disease. The good news is that you can protect yourself before a wound occurs, simply by keeping your tetanus immunization up-to-date.

Causes of tetanus

"Tetanus is caused by a common bacteria in our environment that enters the body through a wound," said Dr. Leslie Zun, chairman of the emergency medicine department at Mount Sinai Hospital in Chicago and professor of emergency medicine at Chicago Medical School. "If someone gets a minor wound but is not immunized against tetanus or has forgotten to get a booster shot in the previous 10 years, they could be at risk for an infection."

During the three-year period ending in 1997, 120 cases of tetanus were reported in the United States, with 93 linked to a specific wound injury. Half were due to puncture wounds, including things like stepping on nails (rusty or clean); but other common injuries were also to blame. Twenty patients had cuts in their skin, 11 had scrapes, 3 had recent surgery, and 9 were injectible-drug users. Self-performed tattooing and body piercing, animal bites, and even splinters caused the other puncture wounds included in the 120 cases. Both minor and major injuries may put you at risk for tetanus bacteria exposure, which is why health professionals consider it important to be up-to-date on your routine tetanus booster shot.

Activities, jobs increase risk

Today many adults are running, biking and rollerblading to remain fit, and older Americans who are most at risk from a tetanus infection are among the health conscious. "All wounds present a risk of tetanus infection," said Dr. Zun. "Of course, the risk of infection increases if the wound is dirty or if a person is not immunized." A recently published study found that more than half of American adults older than 20 years of age were not adequately immunized against both tetanus and diphtheria.

A leisurely afternoon in the garden can create the perfect environment for tetanus exposure imagine nicking yourself with a tool while working in soil or even puncturing your skin with a rose thorn. In the CDC report, 39 percent of the tetanus cases were related to farming or gardening.

People working as police officers, fire fighters, construction workers, farmers, landscapers and garbage workers may also have an increased risk from common work-related injuries. In most cases, employers require workers in these jobs to have up-to-date tetanus boosters.

An ounce of "protection"

Tetanus vaccination is given to virtually all children in this country. It is combined with diphtheria and pertussis (whooping cough) vaccines in a series of shots called DTaP, which most children get by the time they enter school. Because protective levels of tetanus and diphtheria antibodies both decline over time, the tetanus and diphtheria booster shots are combined into a single "Td" vaccine that should be given every 10 years, starting in adolescence and continuing throughout life.

Diphtheria is a disease caused by bacteria passed from one person to another that infects the throat and nasal passages; like tetanus, it can be fatal if left untreated. Diphtheria is still common in a number of other countries, and some strains continue to circulate in the United States. It is important for people to maintain up-to-date diphtheria immunity for protection during foreign travel and to keep the disease from recurring in the United States.

Dr. Zun advises patients to take advantage of the Td vaccine's protection. "Although tetanus cases in the United States have decreased over the years, it can be a very deadly disease. Even with proper treatment, it is fatal for 1 out of every 10 people infected in this country, so it is important that people get a booster shot every ten years to stay protected."

More information about tetanus or diphtheria is available at the CDC's Web site, www.cdc.gov.