Can I Get A Tetanus Shot At Urgent Care – Although most people in the UK are vaccinated against tetanus in childhood, immunity does not always last into adulthood. It is important that pharmacists recognize the symptoms and know what treatments are available for this disease.
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Can I Get A Tetanus Shot At Urgent Care
. The disease is characterized by muscle contractions of the jaw and neck, including generalized muscle spasms. Although now rare in the developed world, tetanus can be fatal without proper and prompt medical care
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The Global Burden of Disease Study, published in 2015, estimates that there were more than 56,000 deaths from tetanus worldwide in 2015, 79% of which occurred in sub-Saharan Africa and South Asia.
. Since the introduction of the national tetanus immunization program in the UK in 1961, the number of cases has fallen significantly.
Tetanus can affect people of all ages; however, in the UK, the highest incidence is among the over 64s as they are more likely to have been under-vaccinated
. Newborns and unvaccinated mothers, as well as intravenous drug users, are also at higher risk of developing tetanus
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This article discusses the transmission and diagnosis of tetanus, as well as the main treatment options. This includes the prevention of the disease by vaccination.
A gram-positive, spore-forming bacillus commonly found in soil and in the feces of animals such as horses and cows
. Human infection occurs by direct contamination of a wound with these spores; Tetanus is not spread from person to person
. Under favorable anaerobic conditions, the spores germinate into toxin-producing tetanus bacilli. The potent neurotoxin travels through the blood and lymphatic system to the spinal cord and brainstem, where it enters inhibitory interneurons within the host. It then binds to membrane proteins in neurons and interferes with the release of inhibitory neurotransmitters in the central nervous system that normally modulate anterior horn cells and muscle contraction. This results in increased muscle tone, contractions, painful spasms and autonomic instability
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Tetanus toxin also affects the neural regulation of catecholamine released by the adrenal gland, causing increased activity in the sympathetic pathway, which manifests as tachycardia, sweating, and hypertension.
. Effects on anterior horn cells, brainstem, and autonomic neurons are long-lasting; recovery requires the growth of new axonal nerve endings. Therefore, tetanus usually lasts four to six weeks
This is the most common and severe clinical form of tetanus, characterized by trismus, muscle stiffness and painful muscle spasms. During generalized tetanic convulsions, patients typically clench their hands, arch their backs, and flex and abduct their arms while extending their legs. Continued spasms and stiffness can lead to breathing difficulties
Other severe symptoms include autonomic instability (ie, when the autonomic nervous system does not function properly), resulting in tachycardia, hypertension, and sweating (sometimes rapidly alternating with bradycardia and hypotension).
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It presents with tonic and spasmodic muscle contractions in a limb or body region, usually in the same area as the site of the injury. Localized tetanus often, but not always, develops into generalized tetanus
This is a rarer form of the disease. Patients with head or neck injuries may develop cephalic tetanus, which initially affects only the cranial nerves. The facial nerve is most often affected, but other cranial nerves can also be affected
. Patients may present with confusing clinical symptoms, including dysphagia, trismus, and focal cranial neuropathies, which may lead to a misdiagnosis of stroke. As with other forms of localized tetanus, patients with cephalic tetanus can progress to generalized tetanus
The diagnosis of tetanus includes the presence of clinical signs, a history of recent events (eg, recent cuts or wounds that may have introduced tetanus spores), and differential diagnosis [1].
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. Tetanus is more likely to occur if there is dirt or something in the wound and if the patient is not fully vaccinated.
Can be cultured from the wounds of tetanus patients, so these tests can only be used to support the diagnosis
Tetanus (local and generalized) is a notifiable disease, so all suspected cases must be reported to the local health protection group.
Asymptomatic patients with a tetanus-prone wound (eg, puncture wounds acquired in a contaminated environment) should be evaluated individually to determine the best approach. Their vaccinations and medical history should be obtained and the wound should be assessed (see Section 1).
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To prevent the development of tetanus, all contaminated wounds should be thoroughly cleaned and, if necessary, surgical removal of dead, damaged or infected tissue.
After that, if necessary, a tetanus-containing vaccine and/or immunoglobulin should be administered (see Table 2). If intramuscular tetanus immunoglobulin (IM-TIG) is not available, Public Health England (PHE) recommends Subgam 16% (human normal immunoglobulin; bioproducts; see Table 3).
An adequate course is when they receive at least three doses of the vaccine at appropriate intervals. Reproduced with permission from Public Health England [3]
Treatment of symptomatic clinical tetanus includes neutralization of the toxin, wound debridement, antimicrobial therapy, and supportive care for severe symptoms.
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Intravenous tetanus immune globulin (IV-TIG) is recommended for the treatment of clinical tetanus, but due to shortages in the UK, PHE also recommends the use of human intravenous immunoglobulin (IVIG), which contains sufficient tetanus antibodies.
The required dose of tetanus antibodies is based on body weight. For patients weighing less than 50 kg, 5,000 IU (international units) is recommended immediately, while for those weighing more than 50 kg, 10,000 IU is recommended.
. Because of the different concentrations of anti-tetanus antibodies in each product, the recommended amount of IVIG varies from brand to brand. See PHE guidance for IVIG dosing information
Side effects (eg, headache, flushing, and nausea) may be related to the rate at which the volume is administered, so IVIG administration should always be initiated at the recommended rate listed in each brand’s summary of product characteristics and increased accordingly. .
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. Patients should be carefully monitored during administration and antihistamines may be prescribed if necessary for those who develop a hypersensitivity reaction.
. Traditionally, benzylpenicillin (0.6–1.2 g four times a day) has been used, but its use has decreased due to concerns about penicillin as a competitive inhibitor of the GABA(A) receptor and possible increase in muscle stiffness. Therefore, metronidazole 500 mg intravenously (IV) three times daily is the antimicrobial agent of choice—it has a better safety profile and has been shown to reduce mortality compared to benzylpenicillin
Control of rigidity and convulsions can be achieved with sedation with benzodiazepines. Diazepam can be administered by various routes (ie, IV, rectally, orally); the approved intravenous dose is 0.1–0.3 mg/kg repeated every 1–4 hours, or a continuous infusion of 3–10 mg/kg every 24 hours. However, due to long-acting metabolites, long-term use may cause accumulation. Therefore, midazolam, which is available as an intravenous preparation with a shorter half-life, can be preferred
. The dose of midazolam varies; therefore, professional advice should always be sought. Side effects of benzodiazepines may include respiratory depression and lactic acidosis
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Nondepolarizing neuromuscular blocking agents (eg, pancuronium) have been used when sedation alone is insufficient to treat seizures, but pancuronium has been associated with tachycardia and hypertension. Newer agents, such as rocuronium (300–600 micrograms/kg/hour, adjusted for response), cause less autonomic disturbances but are generally more expensive.
Antispasmodics (e.g. baclofen) have also been used to relieve muscle spasms. Because oral treatment poorly penetrates the blood-brain barrier, it is not considered beneficial, so intrathecal boluses or infusions are used.
. However, this treatment option is expensive and, due to the narrow therapeutic range and the risk of side effects (e.g. respiratory depression and coma), should only be considered on the basis of clinical advice from specialists.
Because muscle spasms can compromise the airway, it is important to ensure adequate ventilation of patients to avoid respiratory failure and aspiration. Severe cases of tetanus require mechanical ventilation or tracheostomy, especially in patients receiving high doses of sedatives to control muscle spasms
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Magnesium sulfate reduces the release of catecholamines from nerves and desensitizes receptors. Studies have shown it to be effective in controlling autonomic disturbances in heavily sedated patients with severe tetanus, while helping to relieve convulsions in ventilated patients
. A loading dose of 5 g over 20 minutes was recommended, followed by a titrated continuous infusion to control symptoms. Doses of up to 4-5 g/hour may be required
Management of autonomic dysfunction is complex and may require a combination of drugs depending on the clinical situation. Beta-blockers (eg, propranolol and labetolol) have been used to control hypertension and tachycardia, but propranolol has been associated with sudden cardiac death and should be prescribed with caution.
Nutritional support for tetanus patients is important due to the reduced ability to swallow, increased metabolism and, as a result, longer hospital stays. Nutrition can be achieved by enteral nutrition or total parenteral nutrition until the patient fully recovers
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. Patients should also avoid loud noises and bright lights, as these can be sensory triggers for muscle spasms.
As a result
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