Tetanus
Also called: lockjaw, Clostridium tetani infection, tetanus infection
Tetanus is a serious illness caused by a poison made by germs that get into a wound from soil, dust or dung. It causes a stiff jaw and painful muscle spasms, needs urgent hospital care, and can kill. A vaccine prevents it.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Tetanus is caused by a germ called Clostridium tetani. Its spores (tough, resting forms of the germ) live in soil, dust, ash and animal and human dung, and can survive for years. They enter the body through a break in the skin, such as a cut, puncture, burn, bite or scratch. Inside the wound the germ makes a poison (toxin) that acts on the nerves and makes muscles tighten and go into spasm. Tetanus does not spread from one person to another.
Signs usually start within about 3 weeks of the injury. The first sign is often a stiff jaw that is hard to open, which is why tetanus is also called lockjaw. Stiffness and painful spasms then spread to the neck, back, belly and limbs. Spasms can be set off by noise, touch or light, and they can block breathing.
Tetanus is a medical emergency. It is treated in hospital, often in intensive care, and recovery can take weeks or months. Newborn babies can get tetanus through the cut cord if the mother is not vaccinated and the birth or cord care is not clean. This form has its own code (neonatal tetanus). Having tetanus once does not protect you, so survivors still need the vaccine. The tetanus vaccine is given through the routine childhood programme (EPI) and to women during antenatal care.
In Pakistan
Pakistan is one of the few countries that have not yet eliminated tetanus in mothers and newborns: Punjab, Sindh, Islamabad and Azad Kashmir have been validated, but Balochistan, Khyber Pakhtunkhwa and Gilgit-Baltistan have not, and 322 newborn tetanus cases were reported in 2024, with most cases thought to go unreported. In a study from Dadu district, Sindh, about 3 in 10 newborns with tetanus died, and most cases came from rural areas where most births took place at home.
Symptoms
- Stiff jaw or difficulty opening the mouth (lockjaw), often the first sign
- A fixed grin caused by spasm of the face muscles
- Stiff neck and difficulty swallowing
- Painful muscle spasms in the back, belly, arms and legs, which may be set off by sudden noise, touch or light
- Back arching backwards during strong spasms
- Difficulty breathing
- Fever, sweating and a fast heartbeat, and blood pressure that goes up and down
- Fits (seizures)
- In newborn babies: a baby who fed and cried normally for the first 2 days and then cannot suck or feed, cries a lot, and becomes stiff or has spasms
Causes and risk factors
Causes
- Spores of the tetanus germ (Clostridium tetani) entering a wound; they live in soil, dust, ash and dung, and on objects such as nails, needles and barbed wire
- Wounds such as punctures, cuts, burns, bites, scratches, open fractures and splinters or thorns, sometimes so small they are not noticed
- Injections with unclean needles, or surgery done without clean methods
- In newborns: cutting the cord with an unclean instrument, or putting dirty material on the cord stump
- Less often, ear infections or dental infections and dental procedures
What makes it more likely
- Never having had the tetanus vaccine, or missing doses
- Babies born to mothers who were not vaccinated against tetanus
- Births at home or in unclean conditions, and unsafe cord care
- Deep, dirty or crushed wounds, burns, or wounds with soil or an object left in them
- Older adults, who have a higher risk of dying from tetanus
- People who inject drugs
- A weak immune system, such as from HIV
Complications
The most dangerous complication is spasm of the voice box (laryngospasm), which can stop breathing. Tetanus can also upset the nerves that control blood pressure and heart rhythm, and this is a leading cause of death in people in intensive care. Other problems include chest infection from breathing in food or saliva (aspiration pneumonia), blood clots in the lungs, broken bones from strong spasms, muscle breakdown, kidney failure, stomach bleeding and infections caught in hospital. About 1 in 10 people with tetanus dies, and the death rate is higher in poor settings, in older adults, in unvaccinated people and in newborn babies. Recovery is slow and can take months.
When to see a doctor
- A stiff jaw, muscle stiffness or spasms, especially after a wound: this is an emergency, go to hospital straight away
- Difficulty breathing or swallowing
- A fit (seizure) or a very fast heartbeat
- A newborn baby who stops sucking or feeding, or becomes stiff or has spasms
- A deep, large or very dirty wound, a burn or an animal bite, especially if you are not sure you are fully vaccinated
- A wound that becomes hot, swollen, red or more painful, or a fever after an injury
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Diagnosis
Doctors diagnose tetanus from the signs and the story of the illness, such as a recent wound followed by a stiff jaw and spasms. No laboratory test is needed to confirm it. Some people cannot remember any wound, because the injury may have been very small.
Tests are mainly used to rule out other conditions that can look similar, such as strychnine poisoning, reactions to some medicines that cause muscle stiffness, and other infections. A swab from the wound grows the germ in only about 3 in 10 cases, so a negative swab does not rule tetanus out. Doctors may also do a simple bedside check: touching the back of the throat makes the jaw clamp shut instead of causing a gag.
Treatment
- Go to hospital at once; tetanus is treated in hospital, often in intensive care
- The wound is cleaned, and dirt, foreign objects and dead tissue are removed
- An injection of tetanus immunoglobulin (ready-made antibodies) is given as soon as possible to mop up toxin that has not yet attached to the nerves
- Antibiotics are given to kill the tetanus germs in the wound; metronidazole is commonly used
- Medicines such as sedatives and muscle relaxants control the spasms; the person is kept calm and handled gently, as noise and touch can set off spasms
- Some people need a breathing tube and a breathing machine, and extra medicines to steady blood pressure and heart rate; good nutrition is also important
- Once the person is stable, the tetanus vaccine is started or continued, because the illness does not give protection
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Immunoglobulins (ready-made antibodies) | human tetanus immunoglobulin is given straight away in hospital to remove toxin that has not yet attached to nerves; if it is not available, doctors may use a general immunoglobulin through a drip; it cannot undo toxin already attached to nerves | Human normal immunoglobulin (IgG) (5 brands) |
| Antibiotics | kill the tetanus germs in the wound so that less toxin is made; metronidazole is commonly used and may lower deaths; your doctor chooses the medicine and the dose | Metronidazole (258 brands) |
| Benzodiazepines (sedatives) | main medicines to calm muscle spasms and stiffness, given in hospital; your doctor decides the dose | Diazepam (68 brands), Midazolam (32 brands) |
| Magnesium sulfate | given through a drip in hospital to help control spasms; doctors check reflexes closely while it is used | Magnesium sulfate (5 brands) |
| Medicines used in intensive care | pain relief and deep sedation for severe tetanus, sometimes with medicines that relax all muscles while a breathing machine is used; morphine can also help steady high blood pressure; used only by hospital specialists | Morphine (16 brands), Propofol (18 brands) |
| Tetanus-containing vaccines | prevention; given through the routine childhood programme (EPI), to women in antenatal care, after some wounds, and to people who have recovered from tetanus; your health worker decides which vaccine and when | Tetanus toxoid (2 brands), Tetanus toxoid vaccine, adsorbed (1 brand), Diphtheria + Tetanus toxoid vaccine, adsorbed (Td) (1 brand) |
Also used (not yet in our price list): Human tetanus immunoglobulin (TIG), Baclofen, used by specialists for severe stiffness, Muscle-paralysing medicines (neuromuscular blockers) such as vecuronium and pancuronium, used only with a breathing machine
Self-care and prevention
Self-care
- Clean every wound well with clean water straight away, and remove any dirt you can
- Get deep, dirty, crushed or puncture wounds, burns and animal bites checked by a doctor or health worker
- Check your vaccination card after any injury and tell the doctor if you are not sure you are fully vaccinated
- Watch a wound for heat, swelling, redness or pain, and get help if these appear
- Do not wait to see if a stiff jaw or spasms get better on their own: go to hospital
- After recovering from tetanus, complete the vaccine course your doctor advises
Prevention
- Make sure every child gets all the tetanus-containing vaccine doses offered by the EPI programme; ask your nearest EPI centre or health facility
- Pregnant women and women of childbearing age should get the tetanus vaccine through antenatal care or their local health facility; this also protects the newborn baby
- Give birth in a health facility or with a skilled birth attendant, and keep the cord clean
- Never put dung, mud, ghee or other substances on a baby's cord stump
- Clean wounds well and see a doctor about the vaccine or immunoglobulin after a risky wound
- Use only new or sterile needles and clean instruments for injections, surgery and dental work
Common questions
Can I catch tetanus from another person?
No. Tetanus does not spread from person to person. It happens when spores of the tetanus germ from soil, dust or dung get into a wound.
Does stepping on a rusty nail cause tetanus?
Rusty and dirty objects such as nails, needles and barbed wire can carry tetanus spores, and puncture wounds are a risk. But any wound can let the germ in, including small cuts, burns, bites and thorns. Clean the wound and check that your vaccination is up to date.
Do I need a tetanus injection after every cut?
Not always. It depends on how clean and deep the wound is and how many tetanus vaccine doses you have had. A doctor or health worker decides whether you need the vaccine, the immunoglobulin, or both. Antibiotics are not used to prevent tetanus after a wound.
If I have had tetanus, am I protected for life?
No. The amount of toxin that causes the illness is too small to build protection. People who recover still need the tetanus vaccine, which is started once they are stable.
Is the tetanus vaccine given in pregnancy?
Yes. Tetanus vaccines are routinely given to women during antenatal care. They protect both the mother and the newborn baby from tetanus. Your doctor, midwife or EPI centre will tell you what you need.
Sources
- CDC. Clinical Care of Tetanus (n.d.).
- CDC. Chapter 21: Tetanus | Pink Book (n.d.).
- WHO (fact sheet, WHO Viet Nam website). Tetanus (2026).
- WHO Eastern Mediterranean Regional Office. Pakistan closer to ending neonatal tetanus after new WHO validations (2025).
- StatPearls (NCBI Bookshelf). Tetanus (Archived) - StatPearls (n.d.).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Tetanus (n.d.).
- Journal of the Pakistan Medical Association. Epidemiology of neonatal tetanus in rural Pakistan (2011).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.