Doctors are worried about even a small uptick in the terrible infection, often called lockjaw. Symptoms, which can take three to 21 days to appear, include muscle spasms that make it difficult to breathe. As the infection takes hold, a patient’s jaw clenches, forcing the face into what appears to be a wide smile, and the back muscles contort into a painful arch.
“It looks terrible,” said Dr. Mobeen Rathore, chief of pediatric infectious diseases and immunology at the University of Florida College of Medicine-Jacksonville.
Tetanus bacteria live in soil and manure. An infection can occur from a puncture wound, and the disease can persist through weeks of medical care.
Treatment can be arduous and costly. A 6-year-old unvaccinated boy in Oregon racked up almost $1 million in medical bills after he contracted tetanus in 2019, according to a Centers for Disease Control and Prevention case report.
Rathore compared the cost of vaccines to the cost of intensive care.
“It’s not even pennies to dollars; it’s pennies to hundreds of thousands of dollars,” Rathore said. “It’s very expensive.”
When a 9-year-old unvaccinated patient came to Rathore with muscle spasm in Florida this year, he recognized the signs. He remembered the tetanus wards from his medical school days where patients were cared for in dark and silent isolation.
“The slightest noise would cause many of these patients to go into spasm,” Rathore said.
Tetanus spasms, which can also be triggered by light (known as “photophobia”), are extremely painful and can constrict the muscles around the airway.
Amid the bright lights, loud noises and incessant beeping of the hospital’s intensive care unit, the options were limited for minimizing stimulation for Rathore’s young patient. The 9-year-old was sedated, intubated and given tetanus immune globulin antibodies and the vaccine to reduce future risk of disease.
The child was hospitalized for 37 days.
Dr. Matthew Davis, enterprise physician-in-chief and chief scientific officer at Nemours Children’s Health in Florida and Delaware, said that “it wasn’t until we had widespread vaccination that we saw a decline in cases of tetanus and thereby a reduction in the risk of mortality from it.”
John Johnson, a vaccination and epidemic response adviser at Doctors Without Borders, works in countries such as the Democratic Republic of the Congo (DRC) where tetanus remains a concern. Last year, there were 540 cases in the DRC, according to the World Health Organization.
“It’s one of those things that’s so stupidly easy to prevent,” Johnson said. “If you see one case of tetanus in the U.S., it’s a shame. There’s no reason we should be seeing this disease anymore.”
‘My jaw was completely locked shut’
After the initial series in childhood, a booster dose is recommended every 10 years for adults, although many are unaware of the need.
Nikki Arellano, 42, hadn’t had a tetanus shot since 2010 when she was injured while she was helping her friend set up for a wedding last month. An accident with a metal arch at the altar led to a minor cut on her leg. The following week, she found it difficult to chew during lunch at work because of pain in her jaw.
Two days later, she couldn’t open her mouth.
“My jaw was completely locked shut,” said Arellano, of Reno, Nevada. “I went to the ER, and they tried to give me a bunch of sedatives and pain medicine and muscle relaxers to get my jaw to open, and nothing was making it open.”
Arellano was diagnosed with tetanus and admitted to the hospital. She was connected to an intravenous pump so she could get antibiotics.
“Every time that it would run out, it was like a really, really loud beeping noise. When that started is when my muscle contractions would pop off,” she said.
Arellano said her spasms initially started in one arm, then progressed to both arms and then to full body spasms. “It would arch your back really bad, like, it was really, really painful muscle spasms.”
Arellano began to have difficulty swallowing, prompting worries that her airway might become compromised.
“It was very scary,” she said.
She was hospitalized for nearly a week and is still recovering.
Heightened risk with climate change
Natural disasters such as hurricanes, tornadoes and floods are known risk factors for tetanus outbreaks. As people rummage through the wreckage, they are also likelier to be injured by loose nails or broken shards of glass.
“As the Earth warms, there’s already a documented increase in the frequency, intensity and duration of many extreme weather and climate events,” said Kristie Ebi, an epidemiologist and professor of global health at the University of Washington who studies the health effects of climate change. “And as there are more flooding events, then fewer vaccinations for diseases like tetanus means that people would be at greater risk.”
Some states that are at highest risk of significant natural disasters, including Florida, Texas and Kansas, are recording notable declines in tetanus vaccination, according to NBC News data.