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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 and Author 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
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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.

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