In the bacterial world, the Clostridium family is a very large one comprising about a hundred species but only Clostridium tetani (Nicolaier’s bacillus) can cause tetanus, although it does not always secrete the toxin responsible for the disease.
Tetanus is a rather unusual disease because:
it is not the bacterium but its toxin which causes the symptoms;
it is not contagious;
it is not immunising.
It is not contagious so there is no risk of any tetanus epidemics. Besides, the vaccine is designed to deal with the toxin secreted by the bacillus and not with the bacillus itself so vaccination cannot eradicate the latter.
If you are unfortunate enough to have tetanus and lucky enough to survive the ordeal (about 2/3 of cases) your body will not have made antibodies against it once you have recovered. Antibodies have never been found in people who have been cured of tetanus. That raises the question: if the tetanus toxin cannot trigger a natural immunity, how can an attenuated toxin from the vaccine do so?
The reason why tetanus is not an immunising disease is a clue as to why the vaccination against it is inefficacious not to say useless.
Clostridium tetani is a strict anaerobe which means that oxygen, vital for us, is toxic to it – a deadly poison, even in small quantity. To survive in an aerobic environment, C. tetani uses a process called sporulation where it exists as a spore, a kind of seed that can ‘germinate’ into a tetanic bacterium only in the absence of oxygen. Without this strict anaerobic environment, the spores will stay in their vegetative form and no tetanus is possible. That’s why there are millions of septic wounds, even deep-puncture wounds which never give rise to tetanus. These spores are ubiquitous and are harmless inhabitants of the guts of many animals including human beings.
For a tetanus spore to develop into a bacillus which will secrete its toxin and cause tetanus it needs to be in non-vascularised, therefore non-oxygenated, tissues such as ischemic (without blood supply) or necrotic (dead) tissues.
Antibodies are transported to the tissues of the body only via the circulatory system (blood and lymph), that is in an aerobic environment since blood also carries oxygen. An anaerobic wound is not vascularised otherwise it would be oxygenated and therefore aerobic. In other words, tetanus antibodies (antitoxins, to be precise) and the tetanus toxin can never meet. The bacterium and its toxins are out of reach from the immune system. The antibodies produced by inactivated tetanus toxoid after a tetanus vaccination circulate in the blood and therefore cannot reach and ‘disable’ the tetanus toxin in an anaerobic wound since, by definition, it is not vascularised (provided with blood vessels). It is also the reason why antibiotics have no action against the tetanus bacterium but antibiotics can help prevent tetanus when there is the presence of a pyogenic flora (bacteria that consume oxygen) in a wound.
The tetanus toxin is a neurotoxin (which acts on the nervous system) with a strong attraction towards the nerve endings of motor neurons. At the level of the anaerobic wound, the nerve endings engulf, via invagination, the toxin which is then free to circulate towards the central nervous system and trigger the terrible symptoms of tetanus. Once the toxin is in the nerve, nothing can stop it.
Nervous tissues have their own autonomy and are weakly vascularised; this is why whatever circulates through the nerves such as microbes, toxins and viruses, is sheltered from antibodies. Nerves are pathways inaccessible to antibodies.
This why there has never been any correlation between tetanus antitoxin titers and tetanus protection. Most deaths from tetanus occur in people fully vaccinated, sometimes in people with titers way above officially established protective levels (3300 times higher in one reported case).
These facts also explain why:
Tetanus rarely affects children: they have a healthy circulatory system with good tissue oxygenation.
In the developed world, tetanus is rare and affects mainly the elderly population: in this group, circulatory problems resulting in badly irrigated tissues, varicose ulcers and phlebitis are common; this why the elderly are more prone to develop necrotic wounds after an injury. The elderly also often suffer from magnesium deficiency and there is a correlation between the severity of tetanus and a lack of magnesium. Intravenous injection of magnesium chloride can, in certain conditions, cure tetanus.
In developing countries, most tetanus deaths come from neonatal tetanus which accounts for about 60 to 90% of all tetanus cases worldwide: this is due to the lack of sanitary birthing practices where the umbilical cord may be cut with dirty tools and, in some tribes, a poultice made of cow dung is applied to it. The latter practice is like sowing the ‘seeds’ of tetanus on a fertile ‘soil’ because the dung and dirty instruments contain tetanus spores and the cut umbilical cord is by definition a necrotic tissue. Any existing tetanus antibodies would be in the proximal part (above the ligature) of the umbilical cord which is irrigated by the blood circulation of the baby (aerobic part). The tetanus bacterium and its toxins are in the distal part (just below the ligature) of the cord which is anaerobic. But the nerve endings are too small to be strangulated by the ligature and if the area is contaminated there is nothing to stop the toxins travelling, via the nerves, up to the head.
Vaccination by means of injection is akin to a deep-puncture wound, one that introduces highly noxious substances directly into the body. The tetanus vaccine, for example, contains two neurotoxins (mercury and aluminium) and residual formaldehyde. There is a large amount of scientific literature on tetanus toxoid vaccine adverse side-effects, some with severe complications that can be life-threatening. So much so that some medical professionals require that adrenalin is readily available when tetanus toxoid is administered. It has been shown that this vaccine provokes a strong immunosuppression.
Is it worth risking one’s health or even one’s life by an intervention which has never been proven to be efficacious, just to prevent a rare disease?
A deep-puncture wound from a rusty nail or other sharp object can at least be cleaned up, washed with Magnesium chloride and/or hydrogen peroxide, and kept open until it heals properly. As usual, what matters in the prevention of infectious diseases is hygiene, sanitation and good nutrition.
1. Vaccinations, je ne serai plus complice!, Dr Jean Meric, Marco Pietteur editeur, 2004.
2. Vaccine Safety Manual For Concerned Families and Health Practitioners, Neil Z. Miller, New Atlantean Press, 2012.
3. Vaccinations, les verities indesirables, Michel Georget, Editions Dangles, 2011.