title: Narrative review: tetanus-a health threat after natural disasters in developing countries.
abstract: 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.
authors.affiliation: Rush University Medical Center, Chicago, Illinois 60612, USA.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.forename: Mahesh
authors.initials: M
authors.lastname: Raju
authors.forename: David
authors.initials: D
authors.lastname: Ansell
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D003017:Clostridium tetani; D003906:Developing Countries; D004190:Disasters; D004196:Disease Outbreaks; D019353:Endemic Diseases; D006801:Humans; D007116:Immunization, Passive; D008795:Metronidazole / Q000627:therapeutic use; D013742:Tetanus / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013745:Tetanus Toxoid / Q000627:therapeutic use; D014611:Vaccination; D014950:Wounds, Penetrating / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D013745:Tetanus Toxoid; D008795:Metronidazole