I had a very minor injury from a broken door handle today. It was barely a little more than a scratch. I did not think much of it but my wife suggested that I get it checked by a doctor to see if I needed a tetanus shot. My last tetanus shot was more than 10 years ago. So I cancelled my meetings for the day and visited a doctor. The doctor indeed prescribed a tetanus shot despite the injury being very small, so I got the shot about an hour ago. Then came back home and sat down to read more about it on the web. That's when I came across this article and thought I might as well share it with the HN community.

Wait… does that imply people who work in their garage or on their vehicles (car, motorbike, pedal bike, etc., who routinely get nicks and cuts are putting themselves in elevated danger if they don’t get booster shots?

I can say I’ve gotten hundreds of nicks and cuts induced by metal objects since being a kid.

AFAIK the point is not about the cut or scrape being made by metal (or non metal) objects, tetanus (Clostridium tetani[0]) does not live on metals, it lives in the soil/earth, so - say - gardening tools are high risk - a gear taken out of a gearbox or a table knife are - still say - like 0% risk.

As anecdata I know someone that got it (but was treated in time and survived it just fine) while gardening because of a rose thorn prick.

A bite from an animal, even your own pet, might be risky because it may have ben eating earth or however something dirt and the tetanus is still in its mouth.

[0] https://en.wikipedia.org/wiki/Clostridium_tetani

That's interesting(!) because on the other hand there is the thought that kids should play with dirt and eat dirt to acquire immunity against some allergies later in life (which is typically has more sterile environs)

Well, hopefully kids don't have deep wounds inside their mouth/exofagus/stomach/etc.

And anyway a non-deep and well cleaned/sterilized wound (say with oxigen peroxide) has - I believe - very little risks of the bacteria to survive and germinate.

When I was a kid, my Dad was working making prosthetic legs for people. I won’t forget someone who lost their leg because they got fairly small cut going down a metal slide but didn’t get it treated. It resulted in their leg having to be amputated. I’d consider yourself lucky and probably go get a tetanus shot. It’s a really stupid way in modern society to lose a limb. Speaking of which I should probably go get my booster too!

Did the victim not have their tetanus shots at all? That would make sense. But if they did and they still got tetanus despite that, that would be concerning.

The article suggests that no, as long as you had the shot as part of your childhood vaccination series, you're not at higher risk at if you haven't had a booster:

A recent paper published in the journal Clinical Infectious Diseases suggested that tetanus and diphtheria booster vaccines are not necessary for adults who have completed their childhood vaccination series

It's a bacteria, which is typically found in moist soil.

This is often where rusty nails live, hence why people connect the two.

You can get tetanus from ground wasps too, for the same reason.

Who knows with a garage / cars in terms of risk level, realistically you can catch it from literally any cut.

I'd say a higher risk is gardening. Who notices every little cut, when weeding?

>This is often where rusty nails live, hence why people connect the two.

And rusty farm equipment, which gets dragged through manure and nutrient laden soil which is a perfect place for the bacteria. And people who hang around rusty farm equipment tend to have tons of exposure to soil and manure.

And in some places, naturally occurring anthrax, so more to worry about on the farm.

Gardening, especially if you have thorny bushes like roses. No way avoiding cuts even with gloves -but you also have fencing, trellises, frames, etc.

The bacterium is also anaerobic, so puncture wounds such as, again, from a nail are of greater general concern than bleeding cuts.

Tetanus is a nervous system disease caused by a bacteria. Rust has nothing to do with it.

Right, it's just that metal objects have high propensity to induce bruises, nicks, cuts and lacerations and it tends to be dirtier than the rest of the house.

if your tools and stuff you work on is rusty then there would be an increased risk

no, it doesn't imply it. A small nick is not a reason to get a tetanus shot.

What gets my hands in the garage is touching sawdust that's been sitting on the floor. Reliably causes a skin infection.

Sounds like a sawdust allergy.

Maybe it's associated with a particular type of tree/wood as well.

I think it kinda needs to be noted that the article linked (https://academic.oup.com/cid/article-abstract/72/2/285/57416...) does not consider cases like yours (a quickly administered booster shot after getting a cut), only the presence of a regular 10-20 year booster schedule. (They only use data of schedule exists/does not exist, and WHO data of tetanus & diphtheria cases, not whether booster was administered.)

In other words, if getting the irregular tetanus booster shot is a thing that saves people today, it wouldn't show in the data.

It is interesting how vague the timing for the booster shots is.

I had my last shot in 2010,and was told to get one in 10 years. When asking my MD, she told me that the rules changed and it is now a shot at 20, 40 and 65 yo. (and I think this is it).

you should have just washed your hands with soap and warm water.

A few months ago I had an incident with my dog where I was teasing her with a toy and she finally "got it" and also a bit of my hand in the process (my fault, the dog is not aggressive and immediately ran to hide when she realized she had broken skin). I went to the doctor and he recommended a tetanus shot "just to be safe". Coincidentally, I was scheduled to get my 2nd COVID shot that same day.

Apparently guidance right now is not to double stack vaccines like this, so it was an interesting back and forth with the pharmacist on whether or not it made sense to do it anyway. We did and I got both vaccines the same day (different arms), no issues in the end, but I did feel like a bit of a guinea pig!

The CDC has issued guidance that the COVID-19 vaccines and routine vaccines can be administered without regard for each other’s schedules including at the same time. As I understand it, there are a few reasons why this wasn’t always the case (including wanting to isolate COVID-19 vaccine symptoms and side effects from others at the start of the rollout).

Source: https://www.cdc.gov/vaccines/covid-19/hcp/faq.html

That's basically what the pharmacist said: it's probably not a hazard, more like your data point on side effects is not going to be useful because of the co-mingling. Good to know that they nailed it.

Oof, yeah, I wouldn't have gone for it myself. I had a pretty severe fever after my last tetanus booster shot; and my first CureVac shot (mRNA, https://www.curevac.com/en/covid-19/) gave me an atrocious 40 degree fever (that's 104F for the differently-scaled).

I'm sure they don't just …. add up, but I can't imagine having a good reaction to both at the same time.

My wife recently had her TDAP booster and had a stronger reaction to that than to her COVID shot -- she had a fever and body aches for a couple days.

How bad of a bite was this? I've been bitten during play with my dog more times than I can count and I've never once considered going to the doctor over it, let alone getting a vaccine for it...so strange to me.

Yeah fair question, it wasn't so much of a bite as the way my hand was angled it snagged on one of her canine teeth, and when I felt pain and pulled away, it drove her tooth even more deeply into the palm of my hand, causing a nice and deep tear/puncture wound in the process. That's why I said it wasn't the dogs fault, there wasn't really any pressure applied by her, and it wasn't like a classic "dog bite" injury with a bite-shaped pattern of bruising or anything. I was on my laptop and playing with her with my free hand, not really watching but still getting her really excited to grab the toy. So, my bad. Lesson learned.

I actually called and asked my family doc what to do and he recommended I come in strictly because it was somewhat deep and on my hand (apparently more prone to infection + bad outcomes). He even prescribed precautionary antibiotics due to the depth. I was lucky in that it didn't touch any tendons or anything, and healed without stitches with only a pinpoint scar.

fair enough!

I'm not diabetic and have a healthy lifestyle. I got a tiny injury on my foot during gardening with a iron rod scraping my skin. It didn't look threatening for a couple of days until my legs started swelling. I visited a doctor and gave medications and it went away. I got injured 2nd time after a few months on my leg and injury refused to heal. I visited another doctor again and the first thing he did was to give me a tetanus shot. I observed that it helps in healing and my overall immunity had improved. Lack of immunity shows up in the skin and the symptoms fade away once it improved.

So, periodic Tetanus shot is needed ( once every 3 years). If you are used to spending long hours in cubicles and not much life outside, its the cheapest way to be healthy.

“ There is no cure for tetanus, and no definitive proof that you will have lifelong immunity with childhood vaccinations alone. So for now, the CDC continues to recommend booster vaccines every 10 years to help your immune system protect against these infections.”

I'm guessing a lot of parents end up with boosters. My doctor recommended a TDAP booster as soon as he found out my wife was pregnant. It was more about the pertussis than tetanus, but still, it's all in the same shot.

Not if you regularly get one from your doc when you had another laceration. Although I am not sure if they still do that when they are unsure about your vaccination status. It is recommended to get a booster every 10 years.

Bacteria can be everywhere in the earth and if you do garden work I would heavily recommend that. A tiny cut you don't even notice is enough. I know someone who survived Tetanus. Barely and with lasting problems.

No, this is not an endorsement to get a booster shot for Covid and it isn't comparable.

I wish it was routine to do a blood test to determine the individuals characteristics before recommending an inoculation. In this day and age of big data there doesn't seem to be any sort of excuse except "its just cheaper and less liability arises by recommending the vaccine". I'm more concerned about my individual result not some actuarial assessment coming from a single dimension like time since last they paid for our shot.

This is just a rant about how vaccines in general are treated. Dogs are generally recommended to get rabies vaccines every 2 years even though there has never been any indication that the vaccine is needed again. Its only out of an abundance of caution in that single dimension without obvious long term outcome observation.

I'm not trying to totally refute your point, but it's worth noting that the desire for more testing is a common and somewhat naive perception amongst the public.

Doctors that practice medicine however are aware that it has been shown that in many different contexts, even despite the benefits of early detection of a number of different issues, that the risks of unnecessary tests and screening often outweigh the benefits.

>Wouldn't that depend on whether the test was harmful?

This is a huge topic, for which this forum is too small a place to properly expound on it, but the answer to your question here is a resounding NO! The risk of the test procedure itself is typically not actually the main concern.

The real risk has to do with inducing additional unnecessary testing, treatments, and side effects, costs, and psychological distress. In addition, you can cause profound nocebo effects, perceptions, and negative behavior changes in the "harmless" test-intervention group. You'd likely be surprised how negative an outcome this can actually be on average. The decision to add a screening test to routine procedures is NOT a light one.

I assume any test result would also result in some sort of "actuarial assessment" just like most medical treatments are.

ADDED: You're also now talking about getting lab work done, waiting for test results, then having to rush to the doctor if they determine you should get a shot. Sounds like a big hassle relative to just getting a booster for an utterly routine vaccination.

IMO, it's a cost/benefit analysis.

What's the damage caused by giving a booster that was unnecessary?

Compare that to the cost of regular testing to find if a vaccination is necessary when we already have an idea of what an average is for the duration of immunity/resistance given by a vaccine.

It'd probably cost me $50 to get my blood drawn and sent to a lab to determine if I needed a tetanus booster. Meanwhile, just giving me the damn booster is probably like $20.

Just give me the damn booster. If you've had reactions to vaccines in the past, then sure, by all means, do the blood work to determine the necessity of a booster first, but for the general population, it's probably better to just boost.

My vet also requested we did heart worm medicine in the middle of Indiana winter. You know, when it’s 30F out and 0 mosquitos. I think there is def some stretching of dangers in order to sell more foobobs.

(Same vet I asked for them to validate my RX for chewy so I could buy heartworm medicine, and they declined stating that they can’t validate the authenticity of online pharmacies so they wouldn’t do it. Pure cash grab)

Heart worm eggs can lay dormant in the bloodstream/muscles for up to 2 years, so the monthly pills ensure that no matter when they hatch they can’t develop into the worm.

Yes, your vet is only looking out for their own profit here. Find a new one.

Right, but if you take monthly pills all summer - there is nothing in your bloodstream to need to worry about in the winter.

And yes, we dumped that vet. Been through like 4 vets in as many years, it's wild.

> its just cheaper and less liability arises by recommending the vaccine

I wouldn't call these excuses, I'd call them very good reasons. I'd much rather have a quick cheap jab than bloodwork and weeks of back and forth. If I didn't need it, it was harmless. If I did, it may have been lifesaving.

The problem with rabies, is how it turns the animal wildly violent.

And how that change is designed to spread the virus.

IMHO getting blood drawn is more painful than any vaccination I've ever received.

Yes, but, I think this is where we need to go.

We can super-early detect some cancers now, via blood tests. vitamin deficiencies. A plethora of conditions and diseases, early on, too.

Why not test all these things at once, and improve health?

I had blood drawn for an antibody test literally 4 hours ago. I was utterly amazed that I didn't even feel the needle go in. I probably embarrassed myself by how loudly I complimented the nurse. Your mileage will vary.

I used to get a booster every 10 years because I was a hunter and went to places that might have wildlife and lots of junk to get cut on like bundles of old barbed wire.

According to the article, yes.

"Even though it happens rarely, people can still get tetanus and experience serious or deadly effects. There is no cure for tetanus, and no definitive proof that you will have lifelong immunity with childhood vaccinations alone. So for now, the CDC continues to recommend booster vaccines every 10 years to help your immune system protect against these infections. If you have questions about the tetanus and diphtheria vaccine, talk to your doctor."

No you are reading that wrong. The article says that new research suggests the answer is "no". In the conclusion you quote it is not answering the question "do adults need tetanus booster shots" but rather "what should you do?"

I think this is correct. The correct advice for an individual is not to plan their own vaccine regimen based on reading popular exposition of leading edge research. You are better off following the CDC guidelines as your general approach, EVEN IF new research is suggesting those guidelines might be flawed.

So, the CDC recommends one thing, the WHO something different. Where does the appeal to authority leave you at now? In the end, you'll have to make up your own mind.

I used to get really sick from tetanus shots but I don't have a reaction to the most recent versions. Even if they did lay me out for a day or three I would still prefer it to death by tetanus induced lockjaw.

I wonder sometimes what it means to have no reaction to vaccines. I've had lots of vaccinations. In the military I lost count of how many pneumatic shots I got, including ones for things like yellow fever, which have a reputation for making you sick. But I never have a reaction. Not to to the aforementioned yellow fever shot, not to the tetanus shot, nothing for either of my COVID shots (which were Pfizer). I hope they're all working :)

But I 100% agree that I'd rather get sick from a shot and know that it was just annoying, not serious, than to actually risk the real deal.

It could have been an allergy to one of the ingredients. They have been refining and simplifying vaccines over the years in light of new research. I have a mild allergy to neomycin, which is a common ingredient in the flu shot. The newer cell-based version typically does not contain it. The tech though I was vax-hesitant when I insisted on seeing the covid shot ingredient list.

I don't think it was an allergy, usually an allergy has a fast reaction and happens within 15m, I usually get an immune response though which is more similar to what happened with second shots of the mrna vax for covid. I get a high fever for 3 days and that's that. But the last time I had the shot was after I bludgeoned my foot with a rusty shovel that was about 4 years ago and I had no immune response this time which is more akin to what happens when I get a flu shot.

Fortunately (?) I’ve managed to slice myself often enough to be administered the booster at the same time I get stitches. I’d otherwise never remember to get it.

This is one of those things where there's virtually no good resources on: what vaccines one got as an infant to re-up on as an adult.

Yeah it's interesting, I got a booster for chicken pox when I was 20. I was given the vaccine the first year it was available, and it was my opinion that we didn't know enough to know what the titres looked like for adults in my cohort, so I talked my FNP into giving me one. (I was working as a paramedic at the time, and was dealing with a lot of shingles patients. While shingles is not a very contagious manifestation of the virus, I thought it prudent to protect myself since it can be a gnarly illness in an adult.)

For the diseases that are less severe for adults than children, I was less concerned. I do get my tetanus boosters since it also re-ups my immunity to pertussis (which wanes) and I have a lot of contact with babies and small children in my life.

Did you have chicken pox as a kid? My wife and I were 80s kids where you still got stuck in a room with other kids to intentionally get chicken pox. I had a mild case when I was 5 and have never been offered a shot, and was actually surprised to learn they were a thing when our kids were little.

I anxiously await becoming eligible for the shingles vaccine. I've heard it's a pretty nasty disease.

Coincidentally, I was chatting with a lady a couple days ago who told me she got shingles when she was a teenager. Not only that, it was a severe case, and on her face. She still has the scars.

10 years ago some docs were quite liberal with getting out shots. I think that has stabalized a bit.

There was one time in my life where I had an amazing comeback related to the tetanus shot. My coworker was complaining all day about how his arm was sore from his tetanus booster, so I finally asked him "Do you remember when I got my booster?" "No?" "Yeah that's right, because I wasn't whining about it all day!"

*the tetanus shot has a reputation for being somewhat painful

I'm sure it's much less painful than actual tetanus, given the horribly painful way in which that disease kill or maim people.

I completely agree! I am completely pro vaccine.