Antivax Myth: “Tetanus isn't a risk if the wound bleeds"

Fact: the tetanus bacterium easily survives in a bleeding wound.

Why the Myth Exists

Tetanus is caused by the bacterium Clostridium tetani, which is unable to survive in the presence of oxygen (that is, it is anaerobic). Our blood contains oxygen, so the reasoning is that when the bacteria is exposed to bleeding, the blood will flush it out and kill it along the way. Alternately, you can douse the wound in hydrogen peroxide, which releases oxygen. These explanations sound like common sense but oversimplify the reality.

Variations on this Myth

“Tetanus isn’t a risk if you clean the wound properly.”
“If I get wounded, all I need is the tetanus immunoglobulin, not a vaccine.”
“Tetanus can only be contracted if the open wound comes in contact with animal feces.”
“Heat and hydrogen peroxide help to kill tetanus bacteria.”
“If you get a tetanus shot after you’re wounded, it’s too late.”
“You can’t get tetanus from a burn/scratch/paper cut.”
“The tetanus shot takes too long to make a difference after the fact.”

Examples Found Online

: Source: Facebook/Modern Alternative Mama

The Real Deal: What the Evidence Shows

What Causes Tetanus?

Clostridium tetani in active and spore forms. Source: Wikipedia.

The infectious agent is bacterium Clostridium tetani, which comes in two forms. In its active (vegetative) state, it is an obligate anaerobe, which means it is poisoned and dies in an oxygenated environment, such as when oxygen-carrying blood is around. But in its dormant state, it is a spore wrapped in a very resistant coating. In this spore form, it can withstand oxygen, chemical agents, and even boiling water.

While proper wound cleansing is always good practice, it will not prevent tetanus. The spores can easily survive washing with water or hydrogen peroxide. They will easily survive in a person’s bloodstream as well. They will not get flushed out completely if the wound bleeds.

Where Is Clostridium tetani Found?

C. tetani can live in this dormant spore form for as long as 40 years in animal intestines and in soil/feces in the environment.

These spores are plentiful almost everywhere. If your skin is punctured by any non-sterile object, you may become infected by this bacterium. This includes nails as wells as rose thorns, sewing needles, splinters, insect bites, and burns. Only one or two spores is needed to start an infection.

Continuing the Clostridium tetani Life Cycle

Once the wound closes, your body puts things back in place and your blood returns to your capillaries. The bacterium is now safe from oxygen and the spore germinates, reverting back to its active state. Then it multiplies freely.

What is Tetanus, Exactly?

Tetanus patient in a convulsion, 1847 (Wellcome)

In three to twenty-one days after germination, tetanus (also known as lockjaw) disease symptoms begin. These are typically fatigue, soreness, and irritability.

C. tetani excretes two neurotoxins called tetanolysin and tetanospasmin that damage tissue and interfere with nerves and muscle contractions. This unregulated muscle contraction leads to severe muscle spasms that can result in bone fractures.

Tetanus Infographic (click for a larger version)

There is no cure. Recovery can take an agonizing several months in an intensive care setting. Treatment may include sedatives, muscle relaxers, weeks in a dark, silent room to give your nervous system time to recuperate, medically-induced temporary paralysis, and perhaps surgery. Tetanus may have permanent, life-long complications such as neurological damage.

Without treatment, 1 out of 4 infected people die due to respiratory or heart failure (higher rate for newborns). Even with treatment, 1 in 10 die.

If you do survive tetanus, you still are not immune to a subsequent tetanus infection. The is no such thing as “natural immunity” to tetanus. Tetanus is not spread from person to person, so there is also zero protection from herd immunity.

Keep in mind that most doctors today have never seen a tetanus case, which can lead to a fatal delay in diagnosis should symptoms begin.

How Do I Prevent Tetanus?

Tetanus Incidence per 100,000 in the United States, 1947-2000

Getting the tetanus vaccine, along with regular boosters, is the only sure way to prepare your immune system to fight the bacterium before it can infect you. The vaccine contains an inactivated toxin called a toxoid, which stimulates your immune system to create antibodies and memory B cells against the tetanus toxin.

If your boosters have lapsed, you can still receive a tetanus shot and an antitoxin injection post-puncture. The Tetanus Immunoglobulin (TIG) antitoxin (also known as a toxoid) can attack and neutralize C. tetani toxins circulating in your bloodstream.

So it is vital to get TIG and tetanus shots immediately after getting injured.