High incidence of tetanus in the middle-aged and elderly

Tetanus is a disease which has a high mortality rate, caused by clostridium tetani. It presents with trismus, difficulty in swallowing, and more ominously difficulty in breathing, or opisthotonus. Included in this retrospective study are 23 cases of tetanus treated in Chang Gung Memorial Hospital between Jan. 1986 and Dec. 1989. Age ranged from 36 to 87, with the highest incidence in the middle-aged and elderly (91% older than 40 years of age). In 20 cases a wound was found as the source of infection, most of which were minor injuries. Of the nine patients who received no medical attention, three received herb drugs. Of the eleven patients who did seek medical attention at the time of injury, four received tetanus toxoid but none of them received human tetanus immunoglobulin. Tetanus is a totally preventable disease. Prevention includes three basic principles: local wound management, active immunization, and passive immunization. When treating injured patients, it is important to recall that many middle-aged and older adults are not adequately immunized against tetanus. Such patients should receive human tetanus immunoglobulin as well as tetanus toxoid.