Do I need a tetanus booster?

By Jennifer Chatfield, director of Public Relations and Communications at Sharp HealthCare

Call it dumb luck — I do. While enjoying a late fall sunset from the comfort of our backyard Jacuzzi, a sharp pain radiated through my heel. The culprit? A small, quarter-inch staple.

The staple somehow managed to dislodge itself from the overhead thatched hut, fell into the Jacuzzi water, and found its way into my left heel as I attempted to move seats in the whirlpool spa.

After jokingly blaming my husband for something he must have done to cause this painful staple-in-the-spa incident, my mind quickly turned to fear. Oh no, I thought, will I need a tetanus shot? And when was the last time I had one?

According to Dr. William Bianchi, an emergency medicine doctor and the Emergency Department director at Sharp Coronado Hospital, the answer isn’t a simple one.

“Tetanus prevention in adults is a combination of wound type and vaccination history,” says Dr. Bianchi. “We essentially consider the wounds to either be simple or complex — complex being contaminated with soil or saliva — and we take into account how large the puncture is.”

The Centers for Disease Control and Prevention (CDC) reports 70% of wounds are at risk of tetanus infection. What’s more, when untreated, tetanus can be fatal. One out of four infected people die due to untreated tetanus.

Understanding tetanus

So, what exactly is tetanus? Tetanus is a bacterial infection that can enter the body through broken skin, usually caused by injury. Spores of tetanus live everywhere in our environment and are most commonly found in soil, dust and manure.

Wounds caused by contaminated objects found in dirt, feces or saliva are usually the most concerning. But tetanus can also enter your body from dog bites, burns or crush injuries.

“After assessing the wound, we determine if the patient has been vaccinated for tetanus based on their immunization history and when their last booster was,” Dr. Bianchi says. “If we can't make the determination by medical history, we err on the side of caution and update with a Tdap.”

The Tdap — or tetanus, diphtheria and pertussis vaccine — will also be administered, Dr. Bianchi says, if the wound is complex, and the patient’s booster was more than five years ago. If it’s a simple wound and the last tetanus booster was more than 10 years ago, he’d recommend updating the patient with a Tdap, as well.

Most symptoms of tetanus — such as lockjaw or jaw cramping, painful muscle stiffness, involuntary muscle spasms or seizures, and fever — appear between three and 21 days after exposure, with an average of eight days, according to the CDC. But some symptoms can appear several months later, making immediate treatment after injury vital.

Lessons learned

My wound wasn’t deep. In fact, the pain radiated through my heel so quickly that I sat down fast enough to prevent it from reaching a deep enough layer to draw blood. Additionally, I recalled that I had had a Tdap shot a few years earlier.

So, I decided to not run to an urgent care or emergency room. Instead, I planned to keep an eye on the wound and avoid putting any pressure on it while it healed.

However, I recognize that others are not so lucky — including those who have metal objects puncturing deep into their skin, and possibly entering their bloodstream, and those who might be unconscious after sustaining multiple injuries in an accident.

The moral of this story, or of my very-bad-luck day, can be summed up by saying it’s best to know when you’ve last had a tetanus shot. And if you do find yourself with a puncture wound that breaks your skin, especially if the wound is deep or the object had been buried in soil — say, on a construction site or old hiking trail — you should contact your doctor or go to urgent care.

Erring on the side of caution just might save your life.

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