Tetanus

Minor Injury Results in Tetanus Infection
In 2003, a Vermont woman in her 70s survived a serious case of tetanus, illustrating the danger of taking tetanus protection for granted. The woman, who lives on a farm, sought medical care after experiencing leg, back and jaw pain -- symptoms typical of a tetanus infection -- although she had no specific injury. Because the woman was also having difficulty breathing, doctors had to insert a breathing tube in her neck, and she was put on a respirator for two weeks. After two weeks in an intensive care unit, the patient faced weeks of physical rehabilitation. In all, the woman was hospitalized for six weeks of medical care.

Because the symptoms were recognized early on--and because the woman hadn't stopped breathing--she was able to make a complete recovery. The woman had not received a regular booster shot and the status of her primary vaccination was unknown.

Minor Injury Results in Tetanus Infection
In summer 2003, a 76-year-old Louisiana woman developed a tetanus infection from a fire ant bite while tending her garden. Within weeks of the bite, she had a severe rash, back pain and severe muscle spasms in her mouth and throat, commonly known as "lockjaw." By the time she visited her physician, the disease had become so painful and debilitating that she was unable to simply walk on her own. It took more than two weeks after symptoms began for the woman to be diagnosed with tetanus.

Following confirmation of tetanus, the woman was admitted to the hospital, where she spent several weeks receiving medical treatment, including the use of a respirator to assist breathing. Although this woman eventually recovered, nearly 20 percent of tetanus cases result in death. The woman's vaccination history was unknown.

Grazed Arm Leads to Second Tetanus Infection
The case of a 64-year-old English woman who contracted tetanus for a second time reinforces how a previous infection does not confer lifelong immunity from the disease. In addition, this case illustrates how even the smallest of injuries poses a real threat.

The woman was working in her garden when she grazed her arm. Within two days of this minor injury, symptoms, including lockjaw and painful muscle spasms, occurred. Shortly after arrival at the emergency department, the woman's muscle spasms became uncontrollable. She was hospitalized and required intubation for 17 days. The spasms continued for several more weeks.

Since the woman had tetanus 47 years earlier, she was able to assist the attending physicians in identifying the infection quickly, possibly avoiding a fatal outcome. The woman had received a tetanus toxoid booster following the first infection, but due to a local reaction at the injection site had not been further immunized. After the woman recovered from her second infection she was given two tetanus toxoid immunizations without incident.

A Case of Tetanus in a Man without an Apparent Wound
A case of tetanus in an otherwise healthy 58-year-old, New York man highlights that everyone is at risk for this disease.

The man arrived at the emergency room of an academic medical center in New York City complaining of severe stiffness in his jaw and difficulty swallowing. Following an exhaustive examination and attempts to alleviate his symptoms, a diagnosis of tetanus was made by the medical team -- despite the fact that he had no obvious wounds or cuts. He also could not recall the date of his last tetanus booster.

Once admitted to the hospital, the patient continued to have difficulty breathing. He was put on a ventilator, sedated and admitted to the intensive care unit. He was treated with tetanus immune globulin and tetanus toxoid, while kept unconscious for two weeks. The patient was discharged after spending nearly a month in the hospital, including his nearly three week stay in the ICU.

This case highlights the benefit and value of staying up to date on the preventive Td booster, rather than facing a medical emergency. Tetanus bacteria are everywhere in the environment, and can enter the body through the smallest of cuts, scrapes and wounds -- even those that might heal before the infection surfaces.

Diphtheria

Diphtheria Just a Plane Ride Away
In 2003, the Pennsylvania Department of Health issued an advisory to public health officers about a case of respiratory diphtheria in a 63-year-old Pennsylvania male. This man and several others traveled to Haiti, where diphtheria is still a common disease, to work in a rural village. Upon returning to Pennsylvania, the man was admitted to a hospital with a severe sore throat and respiratory distress; he was diagnosed with respiratory diphtheria and died 17 days after he was first exposed; the mortality rate for diphtheria can be as high as 20%. The clinical efficacy of the diphtheria vaccine is 97%, but the Pennsylvania man had never been immunized.

Importance of Herd-Immunity
Beginning in 1990, a major diphtheria epidemic occurred in the former Soviet Union after the government failed to keep its people up-to-date with vaccinations. By 1994, there were more than 157,000 cases and more than 5,000 deaths reported. This outbreak is a reminder that even a well-controlled infection can re-emerge when population immunity is not maintained. Currently, health officials in Latvia, a former Soviet state and now a popular destination on Baltic Sea cruises, are concerned that the diphtheria prevalence exceeds levels found in other parts of Northern Europe and are working to increase immunization rates.