Tetanus Alert
Alert from the UK Director
of Public Health 21/11/2003 - Cluster of cases of tetanus in injecting
drug users in
England (MSWord version)
- Five cases of tetanus have been reported in injecting drug users (IDUs) since July 2003
- Four of the five cases were in females between 20 and 26 years of age. All cases survived.
- A sixth female IDU with trismus on admission to the ED was reported with onset in week 46. This last patient died of a respiratory arrest, and so far no microbiological confirmation of tetanus is available.
- Most tetanus cases are, however, clinically diagnosed.
- Potential sources for tetanus infection in IDUs are contaminated drugs, paraphernalia, and contaminated skin.
- Intramuscular and subcutaneous drug use in particular are associated with tetanus infections in IDUs
Diagnosis and vaccination
- Vaccination coverage in Ireland and the UK is relatively good.
- But even fully vaccinated individuals require additional protection through tetanus immunoglobulin for wounds that are especially tetanus prone because they are heavily contaminated, or are puncture wounds.
- In 2000, an outbreak (108 cases and 44 deaths) of serious illness and death among IDUs in Scotland, Ireland , and England, associated with Clostridium novyi infection.
- Diagnoses of tetanus are made on clinical grounds alone.
Early recognition and treatment with wound debridement, metronidazole, and tetanus immunoglobulin, can be life saving
- Common early signs of tetanus in adults are abdominal rigidity and stiffening in the jaw until it is locked in position (trismus).
- Frequent and painful spasms, progressing in severity
- Accompanied by dysphagia, increasing respiratory embarrassment andIn the most severe cases, autonomic neurological dysfunction.
- Overall case fatality ratio in the most recent UK series was 29%.
- Early treatment with tetanus immunoglobulin may be life saving
Primary prevention through changing drug practises are suggested at (http://www.iduoutbreak.abelgratis.com/ or http://www.hpa.org.uk/infections/topics_az/injectingdrugusers/advice.htm)
Advice and Immunoglobulin
Advice on microbiological diagnosis of tetanus may be obtained from a local microbiology department
- Tetanus immunoglobulin is available from Bio Products Laboratory
- Tetanus is a notifiable disease
