Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T14:15:04.967Z Has data issue: false hasContentIssue false
  • English
  • Français

Tetanus: A Potential Public Health Threat in Times of Disaster

Published online by Cambridge University Press:  20 February 2017

Paige Finkelstein ,
Laura Teisch ,
Casey J. Allen  and
Gabriel Ruiz
Paige Finkelstein
Affiliation:
Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
Laura Teisch
Affiliation:
Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
Casey J. Allen
Affiliation:
Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
Gabriel Ruiz*
Affiliation:
Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
*
Correspondence: Gabriel Ruiz, MD Division of Trauma and Surgical Critical Care Daughtry Family Department of Surgery University of Miami School of Medicine, Ryder Trauma Center, 1800 NW 10th Ave. Miami, Florida 33136 USA, E-mail: gruiz3@med.miami.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Tetanus is a potentially fatal condition that is rare in urban environments but is seen in developing countries and post-natural-disaster. Therefore, the purpose of this report was to review the epidemiology, pathogenesis, and management of tetanus in the trauma patient.

Methods:

A thorough literature review was conducted to look for the most current and thorough guidelines on the prophylaxis and treatment of tetanus. PUBMED (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), MEDLINE (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), and Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom) databases were searched for articles in English, published from 2005 to 2015, using the keywords “Tetanus,” “Trauma/Surgery,” and “Disaster.” Controlled trials, randomized controlled trials, trials of adult patients, published guidelines, expert opinions, and review articles were selected and extracted.

Results:

Current vaccination schedules in developed countries provide prophylaxis for tetanus. However, when severe natural disasters occur, many patients may not be able to provide a reliable vaccination history. In these situations, tetanus immune globulin (TIG) is indicated; if resources are not limited, both tetanus toxoid and TIG should be given to those with high-risk wounds. If resources are limited, TIG should be reserved for those that would benefit most or those least likely to have the protective antibodies.

Conclusions:

Although tetanus is a disease that has a low incidence in the developed world due to high rates of immunization, during large-scale natural disasters, compounding factors like the types of injuries, lack of medical services and supplies, and the delay in treatment associated with an already low immunization rate result in an increased incidence and outbreaks of the disease that has higher mortality in an underdeveloped society. It is important for the urban physician that cares for trauma and critical patients to become familiar with the protocols for treatment and immunization of patients that have tetanus-prone wounds, as well as recognize the potential for outbreaks in the settings of major natural disasters.

FinkelsteinP, TeischL, AllenCJ, RuizG. Tetanus: A Potential Public Health Threat in Times of Disaster. Prehosp Disaster Med. 2017;32(3):339–342.

Keywords

disasterpublic healthTetanus
Type
Brief Reports
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 3 , June 2017 , pp. 339 - 342
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: None of the authors have declared conflicts of interest.

References

1. Centers for Disease Control and Prevention (US). Tetanus. Epidemiology and Prevention of Vaccine-Preventable Diseases (2012). http://www.cdc.gov/vaccines/pubs/pinkbook/ downloads/tetanus.pdf. Accessed February 19, 2016.Google Scholar
2. Taylor, AM. Tetanus. Contin Educ Anaesthesia Crit Care Pain. 2006;6:101-104.CrossRefGoogle Scholar
3. Afshar, M, Raju, M, Ansell, D, Bleck, TP. Narrative review: tetanus-a health threat after natural disasters in developing countries. Ann Intern Med. 2011;154(4):329-335.Google Scholar
4. Centers for Disease Control and Prevention (US). Tetanus Causes and Transmission (2013). http://www.cdc.gov/tetanus/about/causes-transmission.html. Accessed February 19, 2016.Google Scholar
5. Cook, TM, Protheroe, RT, Handel, JM. Tetanus: a review of the literature. Br J Anaesth. 2001;87(3):477-487.CrossRefGoogle ScholarPubMed
6. Kouadio, IK, Aljunid, S, Kamigaki, T, Hammad, K, Oshitani, H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev Anti Infect Ther. 2012;10(1):95-104.Google Scholar
7. Centers for Disease Control and Prevention (US). Tetanus for Clinicians (2013). http://www.cdc.gov/tetanus/clinicians.html. Accessed February 19, 2016.Google Scholar
8. Vandelaer, J, Raza, A, Zulu, F, Yakubu, A, Khan, R. Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all. Int J Womens Health. 2015;7:171.CrossRefGoogle Scholar
9. World Health Organization. Maternal and Neonatal Tetanus (MNT) elimination (2016). http://www.who.int/immunization/diseases/MNTE_initiative/en. Accessed February 19, 2016.Google Scholar
10. Jagoda, A, Riggio, S, Burguieres, T. Cephalic tetanus: a case report and review of the literature. Am J Emerg Med. 1988;6(2):128-130.Google Scholar
11. World Health Organization. Global and Regional Immunization Profile (2015). http://www.who.int/immunization/monitoring_surveillance/data/gs_gloprofile.pdf. Accessed February 19, 2016.Google Scholar
12. Roper, MH, Vandelaer, JH, Çois, F, Gasse, L. Maternal and neonatal tetanus. Lancet. 2007;370(9603):1947-1959.CrossRefGoogle ScholarPubMed
13. Paul, Y. Herd immunity and herd protection. Vaccine. 2004;22(3-4):301-302.Google Scholar
14. Greene, CE. Infectious Diseases of the Dog and Cat 4th edition. Philadelphia USA: Elsevier/Saunders; 2012.Google Scholar
15. Edlich, RF. Management and prevention of tetanus. J Long Term Eff Med Implants. 2003;13(3):139-154.Google Scholar
16. Farrar, JJ, Yen, LM, Cook, T, et al. Tetanus. J Neurol Neurosurg Psychiatry. 2000;69(3):292-301.Google Scholar
17. Linnenbrink, T, McMichael, M. Tetanus: pathophysiology, clinical signs, diagnosis, and update on new treatment modalities. J Vet Emerg Crit Care. 2006;16(3):199-207.CrossRefGoogle Scholar
18. González-Forero, D, Morcuende, S, Alvarez, FJ, de la Cruz, RR, Pastor, AM. Transynaptic effects of tetanus neurotoxin in the oculomotor system. Brain. 2005;128(pt9):2175-2188.Google Scholar
19. Ahnert-Hilger, G, Bigalke, H. Molecular aspects of tetanus and botulinum neurotoxin poisoning. Prog Neurobiol. 1995;46(1):83-96.Google Scholar
20. Humeau, Y, Doussau, F, Gran, NJ, Poulain, B. How botulinum and tetanus neurotoxins block neurotransmitter release. Biochimie. 2000;82(5):427-446.CrossRefGoogle ScholarPubMed
21. Montecucco, C, Schiavo, G. Structure and function of tetanus and botulinum neurotoxins. Q Rev Biophys. 1995;28(4):423-472.Google Scholar
22. Bleck, TP. Pharmacology of tetanus. Clin Neuropharmacol. 1986;9(2):103-120.Google Scholar
23. Hinfey, PB. Tetanus Clinical Presentation. MedScape (2016). http://emedicine.medscape.com/artivle/229594-clinical. Accessed February 19, 2016.Google Scholar
24. Centers for Disease Control and Prevention (US). Tetanus Questions and Answers: Information About the Diseases and Vaccines. Immunization Action Coalition. http://www.immunize.org/catg.d/p4220.pdf. Accessed February 19, 2016.Google Scholar
25. Quasim, S. Management of Tetanus. Anaesthesia UK (2006). http://www.anaesthesiauk.com/documents/tetanus.pdf. Accessed February 19, 2016.Google Scholar
26. Centers for Disease Control and Prevention (US). Information for Parents 2016 Recommended Immunizations for Children 7-18 Years Old. http://www.cdc.gov/vaccines/ who/teens/downloads/parent-version-schedule-7-18yrs.pdf. Accessed February 19, 2016.Google Scholar
27. Centers for Disease Control and Prevention (US). 2016 Recommended Immunizations for Adult: By Age and Health Condition (2015). http://www.cdc.gov/vaccines/who/teens/ downloads/parent-version-schedule-7-18yrs.pdf. Accessed February 19, 2016.Google Scholar
28. Centers for Disease Control and Prevention (US). Recommended Immunizations for Children from Birth Through 6 Years old. http://www.cdc.gov/vaccines/parents/downloads/ parent-ver-sch-0-6years.pdf. Accessed February 19, 2016.Google Scholar
29. Centers for Disease Control and Prevention (US). Vaccines and Immunizations (2013). http://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htM. Accessed February 19, 2016.Google Scholar
30. Minnesota Department of Health. Summary Guide to Tetanus Prophylaxis in Routine Wound Management. http://www.health.state.mn.us/divs/idepc/diseases/tetanus/hcp/tetwdmgmt.html. Accessed February 19, 2016.Google Scholar
31. Rodrigo, C, Fernando, D, Rajapakse, S. Pharmacological management of tetanus: an evidence-based review. Crit Care. 2014;18(2):217.Google Scholar
32. World Health Organization. Special Report: Update on the Health Response to the Earthquake in Haiti Summary of affected population by department in Haiti (2010). http://www.who.int/hac/crises/hti/haiti_special_report_16february2010.pdf. Accessed February 19, 2016.Google Scholar
33. Aceh Epidemiology Group. Outbreak of tetanus cases following the tsunami in Aceh Province, Indonesia. Glob Public Health. 2006;1(2):173-177.CrossRefGoogle Scholar
34. Trujillo, MH, Castillo, A, España, J, Manzo, A, Zerpa, R. Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases. Chest. 1987;92(1):63-65.Google Scholar
35. Broder, KR. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMW Recomm Rep. 2006;55(RR-3):1-34.Google Scholar