With all those crimson and pumpkin-coloured leaves falling to the ground, hard-core gardeners know there's still plenty of work to be done before winter settles in. Now is the time to plant spring bulbs, harvest herbs, and grow hardy vegetables like cabbage and kale.

Along with all that digging around in the dirt, though, comes a potential menace. Tetanus is a bacterial organism that lives in soil, and, if it enters the body, it can release a potent, sometimes deadly, neurotoxin. Last year, B.C. had four cases-three of them fatal-and infectious-disease specialists are urging people to get vaccinated.

Granted, tetanus is rare. The average number of cases in Canada is four per year, according to the Public Health Agency of Canada. British Columbia hasn't had any reported cases so far this year, nor were there any between 2002 and 2006. In 2001, five people came down with the illness.

But just because the disease is uncommon doesn't mean people shouldn't get vaccinated, said Monika Naus, director of the British Columbia Centre for Disease Control's immunization program.

"Tetanus is in the environment; it's an environmental organism. It's always there," Naus told the Georgia Straight in a phone interview. "It's important for individuals to be vaccinated."

Naus explained that "herd immunity"-in which the risk of transmission of communicable diseases, such as respiratory illnesses, is low because so many people are vaccinated-doesn't apply to tetanus. Spores of the tetanus bacteria, Clostridium tetani, are found not only in soil but can occur almost anywhere, even in household dust and animal poop, according to the Minnesota-based Mayo Clinic. If the bacteria enter a wound, they can produce a toxin called tetanospasmin that interferes with the nerves that control muscles. Hence the term lockjaw as another name for tetanus; the toxin can cause stiffness in the muscles of the jaw or neck, or even in the chest, abdomen, and back. Other symptoms, which can show up any time from a few days to many weeks after exposure, include muscular spasms, trouble breathing, and fever.

Tetanus makes up one-third of the "Tdap" vaccine, which also protects against diphtheria and pertussis. It's given as part of the "primary series" of vaccinations recommended for babies aged two, four, and six months old; then again at 18 months. They are resumed when children enter elementary school and again when they finish high school. From there, boosters are recommended every 10 years.

Because so many people don't even have family doctors to remind them about booster shots, let alone administer them, Naus recommended contacting your local public-health office to set up an appointment or going to a walk-in clinic for the free vaccine. "If you have no clue when your last tetanus shot was, go ahead and get it," Naus said, adding that an easy way to remember when to get a booster is to go by mid-decade: when you're 25, 35, 45, and so on.

The fact that the tetanus vaccine is only given in conjunction with those for diphtheria and pertussis, however, concerns Edda West, the coordinator of the Vaccination Risk Awareness Network.

"The public has no say what vaccine combinations are available to them," West said on the line from the Slocan Valley village of Winlaw. "A lot of people are extremely annoyed that they can't get a single tetanus vaccine. It removes decision-making from the public. The fact that they are making a formula that forces other vaccines on people in unconscionable."

West emphasized that VRAN does not make recommendations regarding vaccinations but is a resource for people wanting to make informed decisions. However, she said that doctors often fail to mention that vaccinations such as the one for tetanus do not guarantee immunity. Plus, she said, the best way to protect against tetanus is to take proper care of wounds, by letting them bleed to wash away spores, cleaning the area well with soap and water or hydrogen peroxide, and changing dressings regularly.

"Wound care is the number-one preventative method of tetanus," West said.

Although VRAN does not tell people whether they should or should not be vaccinated, other organizations take a more hard-line stance. Vaccination Liberation, for instance, an Idaho-based Web site, calls the tetanus vaccine not only "ineffective" but also "toxic". Among the ingredients in Sanofi Pasteur's Pentacel vaccine (which is given to children up to age six), for instance, are aluminum phosphate, residual formaldehyde, residual glutaraldehyde, and residual bovine serum albumin. (The Vaccination Liberation site has links to drug companies' products' package inserts.)

Health experts like Naus, however, reject arguments of those who are opposed to vaccines.

"It's really dumb to be against vaccinations," Naus said. "They've saved countless lives. The risks of vaccinations are minuscule.”¦It's foolish to take those kinds of chances. Even in Canada, tetanus is always there. You don't have to leave Canada to get it. You can get it in your own back yard."

Vancouver doctor Bonnie Henry, chair of the Canadian Coalition for Immunization Awareness and Promotion, explained that although tetanus can be treated in some cases, other times there's nothing doctors can do to counteract the tissue-attacking toxin. She, too, said that the disease's obscurity is no reason not to be vaccinated.

"Tetanus is something that's everywhere," Henry told the Straight. "We can't guarantee you aren't going to come into contact with tetanus. People need to understand that the vaccines we have are very safe and will give you protection."

Other ways to prevent against becoming infected, Henry said, are to use gloves when working in the garden and to wash any cuts carefully with soap and water. If a wound is particularly deep and dirty, see a doctor right away.

According to CCIAP, 42 percent of Canadians say they have discussed immunizations with their doctor in the past five years. Another six in 10 say they do not feel knowledgeable about which vaccines are recommended for adults.