Muhammad Khurram, Najia Mahmood.
Tetanus in post 2005 Pakistan earthquake scenario.
J Coll Physicians Surg Pak Jan ;17(9):577-8.

The study was conducted at three major public hospitals of Rawalpindi (Rawalpindi General Hospital, Holy Family Hospital, and District Headquarter Hospital). Study period extended from October to December 2005. All earthquake victims, suffering from tetanus, diagnosed on clinical basis, were included. Ablett classification, grade I to IV, was used for assessment of tetanus severity at presentation. Thirty-two patients were included. Of these 53.2% (n=17) were male and 46.8% (n=15) female. Mean patient age was 32 ± 25 years. None of the patients had received primary immunization against tetanus before the earthquake, while 68.8% (n=22) patients were administered tetanus toxoid after the earthquake. Mean incubation period was 13.16 ± 11.54 days. Mean duration of hospital stay was 12.9 ± 8.51 days. Lockjaw (53.1%, n=17) and fits (31.2%, n=10) were most frequently observed main presenting symptoms. Others included stiffness (6.2%, n=2), fever (3.1%, n=1), dysphagia (3.1%, n=1), and reflex spasm (3.1%, n=1). In majority (46.9%, n=15), grade II tetanus was noted. Grade I, III, and IV were noted in 18.7% (n=6), 18.7% (n=6), and 15.6% (n=5) patients respectively. Autonomic dysfunction (hypertension, tachycardia alternating with hypotension and bradycardia) were observed in 25% (n=8) patients, 46.9% (n=15) patients expired, while 53.1% (n=17) were discharged healthy to various medical camps. Sepsis, asphyxia, and dysrhythmias (autonomic dysfunction) were causes of death in 9, 4, and 2 patients respectively. Mortality in males was 41.17% (n=7), while in females it was 57.14% (n=8, p= 0.377), 56.11% (n=11) patients with incubation period <10 days died compared to 28.57% patients with incubation period >10 days, (p = 0.07). Grade II, and IV of tetanus at initial presentation were significantly associated with discharge (p= 0.03), and death (p = 0.0009) respectively. Mean incubation period, onset time, and duration of hospital stay with respect to outcome are shown in Table I 15.6% (n=5) patients received ventilatory support. Two of these patients had grade III, while of the rest one each had grade I, II, and IV tetanus. Sixty percent (n=3) patients, who received ventilatory support, expired (p = 0.64).

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