The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Narrative Review: Tetanus—A Health Threat After Natural Disasters in Developing Countries

Majid Afshar, MD; Mahesh Raju, MD; David Ansell, MD, MPH; and Thomas P. Bleck, MD
[+] Article, Author, and Disclosure Information

From Rush University Medical Center, Chicago, Illinois, and University of Maryland Medical Center, Baltimore, Maryland.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2446.

Requests for Single Reprints: Thomas P. Bleck, MD, Rush University Medical Center, 600 South Paulina Street, 544 AF, Chicago, IL 60612.

Current Author Addresses: Dr. Afshar: University of Maryland Medical Center, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201.

Dr. Raju: Rush University Medical Center, 1653 West Congress Parkway, Suite 1021 Jelke, Chicago, IL 60612.

Dr. Ansell: Rush University Medical Center, 1700 West Van Buren Street, 5th Floor, Chicago, IL 60612.

Dr. Bleck: Rush University Medical Center, 600 South Paulina Street, 544 AF, Chicago, IL 60612.

Author Contributions: Conception and design: M. Afshar, D. Ansell, T.P. Bleck.

Drafting of the article: M. Afshar, M. Raju.

Critical revision of the article for important intellectual content: M. Afshar, M. Raju, T.P. Bleck.

Final approval of the article: M. Afshar, D. Ansell, T.P. Bleck.

Administrative, technical, or logistic support: T.P. Bleck.

Collection of assembly of data: M. Afshar, M. Raju, D. Ansell, T.P. Bleck.

Ann Intern Med. 2011;154(5):329-335. doi:10.7326/0003-4819-154-5-201103010-00007
Text Size: A A A

Tetanus is an expected complication when disasters strike in developing countries, where tetanus immunization coverage is often low or nonexistent. Collapsing structures and swirling debris inflict numerous crush injuries, fractures, and serious wounds. Clostridium tetani infects wounds contaminated with dirt, feces, or saliva and releases neurotoxins that may cause fatal disease. Clusters of infections have recently occurred after tsunamis and earthquakes in Indonesia, Kashmir, and Haiti. The emergency response to clusters of tetanus infections in developing countries after a natural disaster requires a multidisciplinary approach in the absence of an intensive care unit, readily available resources, and a functioning cold-chain system. It is essential that injured people receive immediate surgical and medical care of contaminated, open wounds with immunization and immunoglobulin therapy. Successful treatment of tetanus depends on prompt diagnosis of clinical tetanus, treatment to ensure neutralization of circulating toxin and elimination of C. tetani infection, control of spasms and convulsions, maintenance of the airway, and management of respiratory failure and autonomic dysfunction.





CME Activities are only available to ACP members and Individual Annals subscribers. If you are a member or a subscriber please sign in. Otherwise please become a member or subscribe to Annals.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.