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[Trismus and tetanus vaccine]
Insights
Trismus, a rare side effect of tetanus immunization, can cause severe jaw spasms. While typically resolving favorably, awareness of this adverse event is crucial for physicians.
Area of Science:
- Immunology
- Neurology
- Vaccinology
Background:
- Tetanus immunization is standard, generally well-tolerated, with common side effects including fever and local reactions.
- This report details a rare adverse event associated with tetanus vaccination.
Observation:
- A 12-year-old boy experienced severe trismus (jaw muscle spasm) 22 hours post-tetanus polio vaccine booster.
- Symptoms included difficulty speaking and eating, moderate fever, and lower limb hypertonia.
- Trismus resolved rapidly after intravenous diazepam administration.
Findings:
- Trismus following tetanus toxoid immunization is rare, with 13 reported events in 12 years across millions of distributed vaccine doses.
- Adverse events appear more common in adults after booster doses, with symptom onset ranging from hours to 15 days.
- All reported cases, including this one, had a favorable outcome.
Implications:
- Physicians should be aware of trismus as a potential, albeit rare, adverse event following tetanus immunization.
- The exact mechanism remains unexplained, highlighting the need for continued vigilance and reporting.
- This emphasizes the importance of monitoring vaccine safety and reporting unusual side effects.
Background:
Tetanus immunization, mandatory in France before the age of 18 months, is usually well tolerated. Fever and local reaction at the site of injection are the most common side effects. We report a case of trismus associated with tetanus immunization.
Case Report:
A 12-year-old boy was hospitalized for a trimus which occurred 22 h after a booster dose of tetanus polio vaccine. The spasm of masticator muscles was so severe that the patient had difficulties in elocution and feeding. A moderate fever and a hypertonia of the lower limbs were associated. The trismus resolved itself within about 5 min after diazepam intravenous infusion. After examination of the buccal cavity, a local cause was discarded. The outcome was favorable and the clinical status of the boy was still normal six months later.
Discussion:
Although no similar cases have been published, 13 other comparable adverse events associated with four vaccines containing tetanus toxoid were reported to the manufacturer within a period of 12 years. During the same period, more than 66 millions doses of vaccines containing tetanus toxoid were distributed. Trisms appeared to be more likely reported in adults after booster doses. Onset of the symptoms was between a few hours to 15 days. Outcome was always favorable.
Conclusion:
Although trimus associated to tetanus toxoid immunization is rare and remains unexplained, physicians should be aware of this adverse event.