Haitian Earthquake Survivors At Risk: Tetanus

By Barbara Lock, MD
January 15, 2010

While most experts speak of the critical 72-hour window for the rescue and treatment of survivors following disasters, it appears that in Haiti, the vast majority of injured survivors will get delayed care, if anything. Communications, transport, supplies, and availability of medical perrsonel and shelter are still wholly inadequate to meet the demand, according to various sources.

There is a parallel 72 hour window; that is the window of time for preventative treatment of tetanus following an injury contaminated with soil.

Tetanus, also called lockjaw, is a terrible illness, in which Clostridium tetani bacterial spores, found in soil everywhere, grows unchecked in wounds with poor blood supply. Once tetanus has set in, patients suffer severe muscle rigidity, which can prevent normal breathing. Mortality from tetanus is upwards 18% in the United States, though nearer to 100% without medical attention.

It is hard to imagine a disaster as likely to produce as significant of a tetanus epidemic as an earthquake in an undeveloped nation in which tens of thousands, if not hundreds of thousands, of persons suffer deep wounds contaminated with soil, in the setting of limited or no clean water or medical care.

Outbreaks of tetanus were recorded after the 2004 Indian Ocean earthquake that spawned the massive Tsunami and after the North Pakistan (Kashmir) earthquake. In both cases, the setting included low rates of baseline immunization and medical services undersupplied and overwhelmed to manage countless survivors with contaminated wounds.

Usual management of tetanus is through prevention by routine immunization of children and adults ever five to ten years, and through early and frequent wound cleansing of deep and dirty wounds.

While routine wound management of earthquake victims may seem routine enough to be deferred until more critically injured patients are treated, there is a strong likelihood that many of these survivors who are currently relatively well will develop tetanus if their wounds are not addressed.

In nations with a robust health care system, persons who develop wounds likely to be contaminated with soil and who have not had a tetanus immunization in the last five years are given both a tetanus immunization and tetanus immune globulin to prevent tetanus. If a devastating earthquake were to occur in the United States, even if the healthcare system were similarly devastated, it is unlikely that as many people would be at risk for subsequent tetanus because of relatively high rates of baseline immunization.

It is unlikely that the population in Haiti has anything like a similar baseline rate of tetanus immunization. Haiti could not have been considered to have a robust health care system prior to the earthquake, and since the earthquake decimated the health care capacity of the nation, it is hard to imagine that injured survivors are getting propper wound care and reimmunization.

The antibiotic metronidazole (Flagyl) is effective at treating early stage tetanus infections.

We hope that relief supplies to Haiti include treatment for contaminated wounds, tetanus immunization and immune globulin, and effective antibiotics.

For information on how to help victims of the Haiti Earthquake, click here.

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