title: Tetanus after a minor injury leading to death in a previously non-immunized, elderly, Norwegian woman.
abstract: Tetanus vaccination is part of the Norwegian childhood vaccination program. An elderly woman injured her arm and leg after a minor fall on her outdoor stairs. Two weeks later she presented with trismus. This developed into tetanic spasms, obstructed airways and the need for a tracheostomy. She died 14 days later due to pneumonia and multi-organ failure. ELISA for tetanus toxoid IgG was negative, probably because the patient was born before the introduction of tetanus vaccination in the Norwegian childhood vaccination program. Lack of adherence to the vaccination programs should be considered in patients presenting with symptoms resembling diseases they normally would be protected from. Although the patient presented with typical symptoms the diagnosis was not suspected initially, probably due to the rareness of this disease in Norway.
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital Ullevaal, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Brandsæter
authors.affiliation: Norwegian Institute of Public Health, Division of Infectious Disease Control, Oslo, Norway.
authors.forename: Ingeborg S
authors.initials: IS
authors.lastname: Aaberge
authors.affiliation: Department of Acute Medicine, Oslo University Hospital Ullevaal, Norway.
authors.forename: Oona
authors.initials: O
authors.lastname: Dunlop
keywords: Locked jaw; Minor wounds; Norway; Tetanus; Vaccination