title: Tetanus: a case report, epidemiology review and recommendations for immunization compliance.
abstract: Tetanus is a forgotten disease in the United States since many practicing primary care physicians have not seen a case of the disease in their career. A 73-year-old woman presented with dysphagia two weeks after she obtained a superficial laceration while gardening. Within days, the jaw spasms and subsequent respiratory compromise that necessitated five weeks of ventilator support revealed the devastation that this disease can cause. Tetanus spores are found in high concentration in the soils of rural areas, especially where farm animals have grazed. Populations most at risk in the U.S. include under- or non-immunized elderly and immigrant populations. Barriers to immunization include patient and physician non-compliance, missed opportunity for immunization and concern over vaccine side effects. Targeting high-risk groups will enable primary care physicians to be more proactive in providing immunization, and thus in preventing prevention this disease.
authors.affiliation: Harpers Ferry Family Medicine, Harpers Ferry, West Virginia University School of Medicine, Harpers Ferry Branch, West Virginia University Family Practice Rural Residency Program, Harpers Ferry, USA.
authors.forename: R
authors.initials: R
authors.lastname: Cannarella
authors.forename: E
authors.initials: E
authors.lastname: Agbayani
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008795:Metronidazole / Q000008:administration & dosage; D010349:Patient Compliance; D018570:Risk Assessment; D013742:Tetanus / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D013743:Tetanus Antitoxin / Q000008:administration & dosage*; D013745:Tetanus Toxoid / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000592:standards* / Q000639:trends; D014903:West Virginia / Q000453:epidemiology
chemical_list: D013743:Tetanus Antitoxin; D013745:Tetanus Toxoid; D008795:Metronidazole