Tetanus Alert


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.

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 12/08/22.