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Tetanus, Diphtheria (+/- Pertussis)

What is tetanus?

Tetanus is an illness that can occur after an injury with a contaminated object. The bacteria that cause tetanus are commonly found in soil and can get into the body through any type of break in the skin, such as wounds, burns, or animal bites.

Tetanus is often called “lockjaw” because the jaw muscles tighten, and the person cannot open their mouth. Other symptoms of tetanus include headache, painful muscle stiffness, trouble swallowing, seizures, fever, and high blood pressure. Tetanus is very dangerous. It can cause difficulty breathing and paralysis. Even with intensive care, 10%–20% of people with tetanus die.

Who is at risk?

Tetanus occurs throughout the world, and international travel generally does not increase the risk. However, people who are doing humanitarian aid work, such as constructing or demolishing buildings, may be at higher risk. Anyone who is not vaccinated against tetanus is at risk if he or she is injured by a contaminated object, uses injection drugs, or has a medical procedure in an unhygienic setting.

What is diphtheria?

Diphtheria is an illness that is spread through coughing and sneezing. If an infected person has skin sores, it can also be spread by touching the sores.  Symptoms of diphtheria include fever, sore throat, and a thick coat in the throat and nose. Neck swelling and skin sores can also occur. In severe disease, swelling of the heart and nerves can occur, as well as trouble breathing. Death occurs in 5%-10% of cases with breathing problems. People who have diphtheria with skin sores usually recover.

Who is at risk?

Travelers going to developing countries are at highest risk for diphtheria. Industrialized countries have low rates of diphtheria due to the availability of a vaccine that prevents the disease. 

What is pertussis?

Pertussis, also known as “whooping cough,” is a contagious disease spread when infected people cough and sneeze near others.

Early symptoms are similar to a cold and include runny nose, low fevers, mild cough, and a pause in breathing for babies. Later symptoms of the disease include “fits” of many rapid coughs followed by a high-pitched “whoop,” vomiting, and exhaustion. Pertussis is very serious for babies. Among babies younger than 1 year of age who get pertussis, more than half will be hospitalized and 1 in 100 will die. It is estimated that 30–50 million people get pertussis and 300,000 people die from pertussis every year worldwide.

Who is at risk?

Pertussis is seen in all countries, so all travelers are at risk. Pertussis rates are the highest in developing countries where very few people have had the vaccine. Babies who are too young to have had their first 3 pertussis shots are most at risk.  

What can travelers do to prevent tetanus, diphtheria, and pertussis?

Get vaccinated:

  • CDC recommends a tetanus vaccine before you travel, especially if you are going to an area where it may be difficult to access health care services.
  • In the United States, tetanus vaccine is only available in combination with diphtheria and pertussis. The tetanus vaccine comes in three forms: TdTdap (both for adults), and DTaP(for children).
  • Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. 
  • Tdap is similar to Td but also contains protection against pertussis. Adolescents 11 through 18 years of age (preferably at age 11–12 years) and adults 19 or older should receive a single lifetime dose of Tdap. Pregnant women should get a dose of Tdap during each pregnancy, preferably at 27 through 36 weeks gestation.  For children 7-10 years of age who are not fully immunized against pertussis, a single dose of Tdap should be given.
  • DTaP vaccine is given to children younger than 7 years of age.
    • Children should get 5 doses of DTaP, one dose at each of the following ages: 15–18 months 2, 4, 6, and 4–6 years.

See a health care provider if you are wounded during travel:

  • A health care provider will evaluate and clean your wound and decide if you need a tetanus booster shot.
  • It is especially important to seek medical attention if it has been more than 5 years since your last dose of tetanus vaccine.

Practice hygiene and cleanliness:

  • Wash your hands often.
  • If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Page reviewed on: Mar 09, 2017

Page reviewed by: Jessie L. Leyse, MD

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