Background
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
- IM and SC 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