Overview

• Introduction to tetanus and natural disaster
• Briefly discuss the causative agent/ mechanism of infection/ symptom and progression/prevention and treatment of tetanus. 
• Discuss natural disasters/their type/ impact on the community
• Discuss how the risk of tetanus infection increases after natural disaster
• What are the ways of preventing tetanus infection
• Look at the faqs
• Summarize the topic

What is tetanus?

Tetanus is an infectious disease requiring emergency treatment. It is caused by a spore of bacteria named Clostridium tetani. The most common symptom is muscle spasm.¹ the bacteria is found mainly in soils, rusty material, the upper surface of the skin, the intestinal tract of humans and animals and more.² It is an important health issue, particularly in elderly people, newborns, pregnant women and those who are unvaccinated or immune deficient.¹ However, newborn and pregnant women are more prone to disease. 

       “As per WHO report, nearly 25000 newborn babies died from tetanus in 2018.”²

What are natural disasters?

Natural disaster is defined as any sudden or terrible event that has a dreadful impact on societies and the natural environment. It has the potential to cause severe damage to nature, human lives or even thousands of deaths.³ Different types of natural disasters such as earthquakes, thunderstorms, floods, landslides, tsunamis, volcanos, drought, and wildfires. Every single disaster harms livelihood, services, socio-economic conditions, and environment or even after several years, people continue to suffer as a result of the disaster.³

This article aims to study the risk of tetanus following natural disasters because natural disasters may increase the chances of tetanus due to injuries or wounds. Moreover, lack of medical equipment or delay in treatment makes the disease more vulnerable.

Tetanus

Causative agent (clostridium tetani):

The causative agent of tetanus is clostridium tetani, it is an obligatory, rod-shaped spore-forming bacillus, motile, anaerobic in nature, gram-positive in new culture and gram-negative in old culture. It is found almost everywhere on the earth but mainly in soil, rusting needles, objects, skin surface and GI tract. It is resilient to extreme temperatures and moisture.⁴

According to research,” In the U.S. nearly 80% tetanus cases occur as a result of acute injuries, 20% from chronic injuries and 7-21% are cryptogenic tetanus (site of organism’ entry is unknown)”.⁴

Pathophysiology

The bacterium Clostridium tetani enters the human body through a wound and releases tetanus toxin into the bloodstream. The tetanus toxin is produced in the anaerobic environment which is a favorable condition for bacteria to generate toxin.⁵ After entering into the bloodstream it reaches the central nervous system and inhibits the release of inhibitory neurotransmitters i.e. glycine and GABA, inhibition may lead to uncontrolled muscle spasm.⁵ Symptoms may occur about 10-14 days after inoculation lasting up to weeks to months or in severe cases death may occur. The mortality rate for tetanus is about 10%.⁶

Symptoms 

The most common signs and symptoms of tetanus are as follows:

• Painful muscular contraction 
• Headache
• Seizures 
• Stiffness of jaw, back muscle and abdomen
• Facial muscle contraction
• Difficulty in swallowing
• Fever
• Increase pulse rate and blood pressure⁷

Treatment /management

The treatment of tetanus depends on the severity of the illness. However, there are some steps which have to be followed during the treatment/ management. It includes:

• Early wound healing
• Supportive/ symptomatic treatment
• Antibiotics therapy
• Frequent administration of HTIG (human tetanus immune globulin)
• Medicines to treat muscle contraction
• Manage further complications

Furthermore, immunization is necessary for patients because tetanus infection may not give future immunity.¹

Natural disasters and their impact on health:

Types of natural disasters

• Earthquake: A sudden or intense shaking of the earth’s surface due to disruption in the tectonic plates of the earth's crust
• Flood: The most common type of natural disaster in which water overflows cover the land area. It happens as a result of heavy rainfall, snow melt and tsunami
• Landslides: A movement of stone, debris, earth or vegetation either slowly or quickly down the slope due to gravity. It occurs as a result of extreme rain, earthquakes, and volcanoes
• Drought: A condition during which the land surface becomes extremely drier than normal due to lack of precipitation
• Wildfire: An uncontrolled fire in the forest and vegetation that spreads rapidly, easily damaging large areas
• Volcano: An eruption of lava, ash, and gasses through the earth's surface
• Tsunami: It is a series of giant waves caused by the displacement of water. Earthquakes, landslides, and volcanoes have the potential to generate tsunamis⁸

Impact of natural disaster on society

Natural disasters like earthquakes and floods to wildfires all have a dreadful impact on societies, hundreds to thousands of people die as a result of these disasters. Large numbers of people become homeless, and unemployed, and lose infrastructure, environmental destruction, economic downfall, and health-related issues arise.⁹ Individuals may suffer from mental trauma and physical, psychological, and emotional issues. Friends and families were divided, and people were more prone to chronic diseases. Due to loss of livelihood and resources poverty increases. Thus, All these problems will lead to self-harm, drug abuse, increased anxiety and depression, violence and suicide attempts.⁹

Risks of tetanus infection following natural disaster

Natural disasters including earthquakes, floods, tsunamis, and wildfires do not increase the prevalence of tetanus infection but getting open wounds after a disaster makes it more susceptible to 

Develop tetanus infection. However, the risk of tetanus infection is based on two things including the type and condition of the wound and how well the patient's immunity works.

Furthermore, immediately ask a physician whether a person needs a vaccine or not. The schedule of vaccines is as follows:¹⁰

• For children: 2 and 18 months children require 4 doses of vaccination and booster doses at 4-6 years and 11-12 years of age
• For adults: adults receive booster doses of tetanus after every 10 years
• Patient having wound: the person receives the last dose of tetanus vaccine 5 or more than 5 years before he/she should get a booster dose¹⁰

Case studies and historical data

According to a study, in 2004 when Indonesia was affected by the earthquake and tsunami, it showed 106 cases of tetanus infection after the disaster. Other hand, Yogyakarta was affected by the earthquake in 2006 and it shows 71 cases of tetanus. Both results indicated that the prevalence of tetanus infection after a disaster increases due to an increased number of injuries.¹¹

In another study, when Pakistan was affected by the earthquake in 2005, as per reports there were 139 cases of tetanus infection after a disaster.¹¹

How to prevent tetanus infection after a disaster?

Tetanus infection after a natural disaster can be prevented in the following ways:

• Properly treat wounds, cuts, punctures, and lacerations as soon as possible after exposure
• Immunization with a vaccine containing tetanus toxoid¹¹
• Proper disaster management and immediate care and treatment are provided to survivors
• Conduct an awareness program to decrease the chances of tetanus infection
• Provide TIG (Tetanus immune globulin) to those patients who are unable to provide vaccination history during the time of natural disaster¹¹

FAQs

What is another word for tetanus? 

Another word for tetanus is lockjaw. It is called lockjaw because tetanus toxins cause severe muscle spasms which makes it hard for the jaw or mouth to open.

How is tetanus diagnosed?

Tetanus is diagnosed by physical examination, medical or vaccination history, blood test if needed and signs and symptoms of the patient like wound, muscle spasm, and headache.

Who is the most common victim of tetanus?

The most common victims of tetanus are newborn babies and pregnant women.

Summary

Tetanus is an infectious disease caused by spores of bacteria named Clostridium tetani and requires emergency treatment. The most common symptom is muscle spasm. It is an anaerobic bacteria present in soil, rusty material, skin and more. Currently due to vaccination the chances of tetanus have decreased but still eagerly people, neonates, pregnant women and immuno-deficient are more prone to it. Moreover, the incidence of tetanus infection increases after natural disasters including earthquakes, floods, tsunamis, volcanoes, hurricanes etc and this is proved by different case studies. People catch wounds after the disaster or cleaning up the disaster and these wounds are the reason cause tetanus infection. Several preventive measures can be taken to reduce the disease like proper wound care, immunization, disaster management system, and awareness programs; all these measures contribute to decreasing the incidence of tetanus infection.