J Varney1, B Watkins1, J Shah2
1American University of the Caribbean, School of Medicine, St Maarten, SXM
2Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
1417 14th Ter,
Palm Beach Gardens, FL
Copyright: This is an open-access article under the terms of the Creative Commons Attribution License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.
©2021 The Authors. Caribbean Medical Journal published by Trinidad & Tobago Medical Association
Tetanus disease is a deadly toxic condition that can potentially develop in individuals who sustain open wounds. The bacterium that results in tetanus is known as Clostridium tetani, a gram-positive bacillus that thrives in the soil. A significant source of bacterial infections is open wounds such as lacerations and punctures.1 Furthermore, it was shown that 70% of the patients presenting with tetanus have a history of injury sustained during natural disasters.2 One significant component of ensuring the safety of a population is appropriate documentation of vaccination and exposure to potentially lethal toxoids, like Clostridium tetani. Without proper record keeping in the incidence of an unforeseen event, like a weather emergency, the propensity for calamity is increased, resulting in the immediate halt in providing care to those in need.
Hurricanes are a natural disaster that Sint Maarten and many Caribbean countries know all too well. The citizens of these countries also are aware that lethal diseases, like tetanus, are a common result of unpreventable weather events, like hurricanes.3-5 When speaking with Collective Prevention Services (CPS), we were informed that once Hurricane IRMA made landfall, the island saw an immediate increase in the number of people seeking the tetanus vaccination. Sadly, the small island could not meet these demands immediately due to the short supply and poor record keeping. The recording of disease rates such as tetanus on the island is through the doctors of Sint Maarten. They are responsible for contacting CPS when disease in their patients occurs. When meeting with the CPS team of Sint Maarten, it was found that the island had zero reported cases of tetanus in its history. Reflecting on the history of Sint Martin, the countries were established free of disputes in the year 1817. With this knowledge, it is safe to presume that tetanus has happened within the island and has remained unrecorded rather than never happening at all.
Due to the high rates of disease incidence in disaster areas, health care workers on Sint Maarten should be educated to have a heightened awareness for tetanus symptoms in someone who presents with a wound possibly contaminated with dirt, feces, rust, and other unknown potentially contaminated particulate matter. Aside from there being no standardized electronic system for recording vaccinations, there is no standardized medical record system in Sint Maarten. We advise that regular tetanus vaccinations be distributed on the island, an electronic system for adult vaccination records being implemented, and information regarding tetanus be readily available to the public. With these steps being taken, we know Sint Maarten will remain ready for the next natural disaster.
Ethical Approval statement: Not Applicable
Conflict of Interest statement: Not Applicable
Informed Consent statement: Not Applicable
Funding statement: None
Author Contribution: Joseph Varney- Conceptualization, Investigation, Project Administration, Methodology Resources, Visualization, Writing, Original Draft Preparation, Review & Editing
Brandon Watkins- Methodology, Visualization, Writing, Review & Editing, Supervision, Validation
Jaffer Shah – Design, Administration, Review & Editing
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- Hedderson, S. O., T. Mody, and D. E. Groth. “The presentation of tetanus in an emergency department.” J Emerg Med 16 (1998): 705-708.
- Afshar, Majid, et al. “Narrative review: tetanus—a health threat after natural disasters in developing countries.” Annals of internal medicine 154.5 (2011): 329-335.
- Nufer, K. E., and M. E. Richards. “Different medical needs between hurricane and earthquake victims.” Annals of Emergency Medicine 44.4 (2004): S34.
- 5. “Tetanus in Areas.” IDSA Home, www.idsociety.org/public-health/hurricane-resources/hurricane-resources/tetanus-in-areas/.