Post-Flood Tetanus, Reconsidered

I noted with interest a Tweet in GHN last week linking to a STAT article labeling the risk of tetanus following Houston’s flooding an “old wives’ tale.” Helen Branswell quoted experts—even the CDC—as saying, essentially, that exposure to flood waters does not increase the risk of tetanus.

Old wives’ tales are superstitions regarded as unscientific or incorrect. In this case, though, there is evidence that such exposure can, in fact, lead to a sizeable increase in tetanus cases—as seen after the 2004 East Asian tsunami. Several peer-reviewed articles (Asia Pacific Journal of Public Health and Global Public Health, among them) document over 100 cases in the weeks that followed. The Annals of Internal Medicine in March 2011 published a review of the tetanus threat following natural disasters (albeit in developing countries).

This is not at all to say that critical, scant resources should be diverted to a mass tetanus vaccination campaign. But the public should be made aware of the risk and health care providers should be knowledgeable about the clinical presentation and treatment of tetanus. Early diagnosis is critical and potentially life-saving for a disease with such a high case-fatality rate. All patients presenting with an open wound (and no proof of recent vaccination) should receive the tetanus toxoid booster and adequate stores of tetanus immune globulin should be maintained for treatment.

Old wives’ tales should, of course, be debunked—but on the basis of scientific evidence. Otherwise, the expected will continue to take public health officials by surprise.

—Ron Waldman, Milken Institute School of Public Health, George Washington University

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