On February 26, 2013, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s first death from tetanus. The case was a 75-year-old female who resided in southern Taiwan. She had a history of diabetes and high blood pressure and suffered from an unstable blood sugar level. Before the Lunar New Year Holiday, she got a puncture wound to her foot while cleaning up coconut leaves around her residence. On the following day, she sought medical attention at a clinic where she received antibiotics and a dose of tetanus toxoid for treatment. One week later, her puncture wound became infected, red and swollen. Subsequently, when she developed swallowing difficulty, neck stiffness and opisthotonos, she was transferred to a hospital and diagnosed with tetanus. Immediately, she was transferred to a medical center and hospitalized in the intensive care unit. Despite the best efforts of medical personnel, the family requested the patient to be discharged from the hospital. Unfortunately, she passed away the next day.

Tetanus is a disease caused by a type of bacteria called Clostridium tetani (C. tetani) that can live in many different substances such as soil and animal and human waste. The incubation period ranges from 3 to 21 days. Infection generally occurs when the spores enter the body through an injury or wound and often involves a cut or deep puncture wound. As the infection progresses, abdomen rigidity, muscle spasms, specifically opisthotonos, and risus sardonicus develop. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. Death can occur in severe cases.

According to the surveillance data collected by Taiwan CDC, since the implementation of tetanus vaccination, the number of tetanus death has is merely 5 for the past decade and the average number of tetanus cases reported each year is about ten. One death from tetanus occurred in 2005, 2006, 2011, 2012 and 2013, respectively. In Taiwan, the existing routine childhood vaccination schedule recommends a dose of DTaP-Hib-IPV vaccine to children 2, 4, 6 and 18 months of age and an a dose of Td vaccine to children prior to elementary school entry. The vaccine efficacy can last more than ten years. Older children and adults can receive a booster dose (Tdap) every ten years after completion of the initial childhood series.

Taiwan CDC advises the public to take protective measures against tetanus when cleaning up after a disaster and seek prompt medical attention at a hospital when wound contamination is suspected. The doctor can determine if a patient needs tetanus toxoid based on whether the patient has previously received DTP or DT vaccine. If the risk of infection is high, the doctor can prescribe immune globulin (TIG) as further treatment. For any questions or further information, please call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-024582 if calling from a cell phone, or visit the Taiwan CDC’s website at http://www.cdc.gov.tw.