Are tetanus immunizations being given to the survivors with injuries?

Q: A lot has been said about the need to prevent diarrhoeal diseases and to immunize survivors. I would like to know if the need for tetanus immunization for survivors with injuries is also being taken into consideration.

- Nigeria

A: In emergency situations such as the South Asia tsunami where there are serious injuries, tetanus immunization has to be taken into consideration.

As tetanus is a complication of wounds and injuries, it is essential that injured people receive appropriate surgical and medical care of contaminated open wounds. Open wounds must be considered as contaminated and should not be closed. Debridement and removal of dead tissue and debris is essential, and depending on the size of the wound may necessitate a surgical procedure undertaken in appropriate conditions. Wounds should be dressed with sterile dressings and the patient scheduled for delayed primary closure.

Tetanus immunization is usually provided to victims of natural disasters on an as-needed basis for several reasons. First, it is not communicable from person to person. Second, in many parts of the world, most people have already some protection against tetanus through immunization. Third, people at risk for tetanus can be relatively easily identified among those people with lack of evidence of vaccination and who have dirty or infected wounds. A person without or with insufficient immunization is at risk of developing tetanus after a wound gets infected with tetanus spores. Similarly, mothers with no or insufficient tetanus vaccination and who deliver in unclean circumstances can develop tetanus themselves after the delivery, or their newborn can develop neonatal tetanus.

In most instances, this means that people with infected or dirty wounds will receive a booster dose of vaccine (if the previous dose was given long ago). Depending on the vaccination history and the seriousness of the wound infection, tetanus immunoglobulins may be required in addition to the tetanus vaccine to provide additional protection, and follow-up doses may also be required. If the patient had never received tetanus immunization in the past, tetanus immunization needs to be initiated as soon as possible.

In emergencies where prior tetanus toxoid immunization levels were low, special attention should be given to preventing maternal and neonatal tetanus, by immunizing women of childbearing age and by improving the hygienic conditions under which childbirths take place. Routine immunization of women and children should also be re-established as soon as possible.