Tetanus in the aftermath of the tsunami

© MSF Banda Aceh, Ulee Lhue area - Tutu, an Indonesian nurse who works in MSF mobile clinic, is treating a wounded person. Ulee Lhue area is one of the first places where MSF started to do tetanus prevention, providing medical consultation, dressings and distributing boots and gloves people digging in the mud. In one day MSF vaccinated 17 people against tetanus and distributed 30 pair of boots. One of the most dangerous diseases to be found in Aceh province, Indonesia, in the wake of the tsunami disaster is tetanus. Potentially life-threatening, tetanus transmission is facilitated by infected wounds and influenced by factors such as heat, humidity, and exposure to animals, soil, or other external elements. Over 60 cases of confirmed tetanus have been reported in health facilities in Aceh so far, with the majority of cases now being treated in the main hospital in Banda Aceh, and others in Meulaboh and Sigli hospitals. "Tetanus is a great concern here as it has a very high mortality rate of 25 percent and vaccination coverage against the disease in Aceh is very low," said Loris De Filippi, medical coordinator for Médecins Sans Frontières (MSF) in Aceh. "It is very important that people with open wounds have them properly cleaned and dressed. And we must do everything possible to prevent people who might be cut or injured while digging in the rubble left after the tsunami from developing it." After learning of the significant number of cases of tetanus in the city last week, MSF began tetanus prevention activities in Banda Aceh on Friday, 14 January. MSF is running a mobile medical clinic consisting of a doctor and two nurses offering medical consultations, dressings for wounds, and information on the disease in two of the most destroyed areas of Banda Aceh. The mobile team has also distributed over 500 pairs of boots and 1,500 pairs of gloves to people working in the vast amounts of debris in the city. A car equipped with megaphones has toured the destroyed area to inform people about tetanus and how to prevent it. At present, the confirmed cases of tetanus appear to be from injuries received during the tsunami rather than from wounds sustained by people doing clean up work in the rubble in the weeks since the disaster. Adequate vaccination against the disease requires an initial injection of vaccine, which the MSF mobile team is providing, followed by a second booster shot 28 days later. "The incubation period for tetanus is usually up to three weeks, so in the following days we hope to see a decrease in the number of cases appearing in Aceh," said De Filippi. "We started tetanus prevention activities as soon as we began to see that the disease was a potential problem and we will keep a close surveillance on it as we will also need to study it retrospectively to be prepared for future such emergencies."