Tetanus (lockjaw) factsheet


Tetanus (lockjaw) is caused by toxins produced by a bacteria found in soil that can contaminate cuts and wounds. Tetanus may cause widespread muscle stiffness, muscle spasms and breathing difficulties. Tetanus is uncommon in Australia due to the widespread use of the tetanus vaccine.

 Signs and symptoms

Tetanus bacteria live in soil, dust and manure. Infection occurs when bacteria enter the body through a break in the skin. Tetanus symptoms include:

  • muscle spasms that begin in the jaw and neck
  • inability to open the mouth (lockjaw)
  • swallowing problems
  • breathing difficulties
  • painful convulsions
  • abnormal heart rhythms.

Serious and potentially lethal complications include:

  • suffocation
  • respiratory failure
  • pneumonia
  • hypertension
  • heart attack.

Symptoms occur between three days and three weeks after infection. Most cases occur within 14 days. Generally, if symptoms appear quickly, the infection is severe.

Anyone who has not been immunised against tetanus is at risk, in particular:

  • people who work with soil, horses, or in dusty environments
  • intravenous drug users
  • Australians travelling overseas to parts of Asia, South America or Africa
  • people who have high-risk wounds are more likely to be infected with tetanus bacteria.

High-risk wounds

Some wounds are more likely to encourage the growth of tetanus bacteria, including:

  • compound fractures
  • burns
  • animal bites
  • any type of penetrating wound, such as from a rusty nail or rose thorns
  • wounds contaminated with soil, manure or foreign objects like wood fragments.


Diagnosis is usually made by physical examination and taking medical history, including information about immunisation. It is difficult to confirm a diagnosis through laboratory tests.


Tetanus is a life-threatening disease and sometimes, death will occur, even with prompt medical attention.

Treatment for tetanus includes:

  • antitoxins to neutralise any tetanus toxin
  • hospitalisation
  • anti-convulsive medications
  • antibiotics
  • life support (if a child has severe breathing problems)
  • vaccination.

Seek medical advice for dirty wounds/wounds where the skin has been penetrated. Doctors may advise a tetanus booster shot, depending on how long since the last tetanus dose.


In NSW, the tetanus vaccine is available in a combined immunisation that also contains vaccines against other serious and potentially fatal diseases. For the treatment of a tetanus-prone wound, the doctor/nurse will administer a dose of diphtheria and tetanus vaccine.

Who is tetanus immunisation for?

In NSW, immunisation against tetanus is free for:

  • children at two, four and six months of age: a diphtheria, tetanus, whooping cough, hepatitis B, polio and haemophilus influenzae type b (Hib) vaccine (as a six-in-one vaccine)
  • children at 18 months: a diphtheria, tetanus, whooping cough vaccine
  • children at age four: a diphtheria, tetanus, whooping cough and polio vaccine
  • adolescents in secondary school: a booster dose of reduced antigen diphtheria, tetanus and whooping cough vaccine

Catch-up immunisations are available for anyone who has not been fully vaccinated, including Aboriginal and Torres Strait Islander people, refugees and asylum seekers over the age of 10.

Immunity against tetanus reduces with time and further booster shots may be needed.

A course of tetanus-containing vaccine is recommended for anyone who has never been vaccinated. Three doses are given at monthly intervals and two further booster doses are given 10 years apart.

Before tetanus immunisation

Before immunisation, make sure you tell your doctor/nurse if your child:

Side effects of the tetanus vaccine

Immunisations containing protection against diphtheria, tetanus, whooping cough and other infectious diseases are effective and safe. However, all medications can have unwanted side effects.

Side effects from these vaccines are uncommon and usually mild, but may include:

  • localised pain, redness and swelling at the injection site
  • an injection-site lump that may last many weeks. Treatment is not needed
  • low-grade temperature
  • children may be unsettled, irritable, tearful, generally unhappy, drowsy and tired.

Extremely rare side effects include:

  • severe pain in the shoulder and upper arm
  • severe allergic reaction.

Managing side effects after immunisation

  • give extra fluids to drink
  • do not overdress children or babies if they are hot
  • paracetamol may be given for any fever or soreness around injection site.
Last updated Monday 29th January 2024


This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024