‘Lock jaw’ or tetanus – a looming threat after Hurricane Melissa

‘LOCK JAW’ or tetanus had stopped all the muscles, including breathing muscles, from working in a young athletic-looking male, cut down flat on his back with a breathing tube down his neck, a machine breathing for him. Witnessing this as a young medical student on rounds in the Intensive Care Unit, I imagined how afraid and helpless he might have felt.

Hurricane Melissa, a Category 5 hurricane with winds over 180 miles per hour, disrupted power supply to over 70 per cent of households and interrupted access to potable water after striking Jamaica. Torn-off roofs and scattered building materials have left mounds and trails of debris like zinc and lumber that now put people at increased risk for cuts and puncture wounds.

WHAT IS TETANUS OR ‘LOCK JAW’?

Tetanus, commonly referred to as ‘lock jaw’, is a combination of symptoms that include abnormal nerve and muscle function resulting from toxins released by a germ that gets into the body through cuts, punctures, bruises or burns. The germ is called Clostridium tetani and it lives in the form of spores in the soil and environment. Tetanus is not transmitted from person to person. Persons in certain jobs and hobbies like farming, gardening, mechanics, construction, and persons with a weakened immune system, like pregnant persons, the elderly, and persons with diabetes mellitus or ‘sugar’, are at increased risk. Poor infection control measures during childbirth or lack of proper care of the umbilical cord stump after birth contribute to tetanus in the newborn, but improvements in healthcare delivery have significantly reduced this risk.

According to the World Health Organization, there were over 25,000 deaths from tetanus in newborns in 2024, a significant reduction from the nearly 800,000 newborn deaths from tetanus in 2018. About one in every 10 persons with tetanus dies. Deaths from tetanus can be more in low-income countries that have fewer intensive care units and medical resources. According to the 2024 Annual Report of the National Epidemiology Branch, Ministry of Health and Wellness (MOHW), Jamaica, there were no cases of tetanus in babies in 2024, and there were two cases in adults for that year.

HOW TO PREVENT TETANUS

The vaccine against tetanus is given six times between a few weeks after birth to pre-teens, followed by a booster every 10 years for teenagers and adults. In Jamaica, the vaccine is given at ages six weeks, three months, six months to complete the primary series, and boosters given at 18 months, four-six years and 11-12 years of age. According to the MOHW, in 2024, 99 per cent of infants under one year of age had received the required three doses of the tetanus vaccine. However, as we get older, we forget or miss opportunities to obtain our tetanus booster vaccines every 10 years, and our protection from vaccines we received as children wanes over time. I encourage persons to check their immunisation records if they can find them or go for a medical check-up and discuss with your doctor or nurse whether you are at risk for tetanus and if you are protected. Adults who have not had a tetanus booster in the past five to 10 years, depending on their risk, should get vaccinated.

ACT AS QUICKLY AS POSSIBLE

Tetanus symptoms may take three to 21 days to appear and include stiffening of the jaw muscles (‘lock jaw’), difficulty swallowing, stiffening of the body in babies, changes in blood pressure and heart rate. The infection can spread to all muscles, making it difficult to breathe, and one could die without medical attention. Tetanus is a medical emergency. If one gets injured, clean the area with clean water and mild disinfectant like from a first-aid kit. Do not underestimate an injury. Seek medical attention. Certain types of wounds require tetanus immune globulins, which are pre-made antibodies that directly counter the toxins in a wound. It is required when there is not enough time for your body to make these protective antibodies after vaccination.

In areas directly affected by Hurricane Melissa, finding health records and even access to clean water and to health facilities will be difficult. As our public health facilities try their best to reopen, mobile medical volunteers should be vigilant and ask persons about such injuries and take appropriate measures to ensure access to the appropriate medical care.

As if the damage from Hurricane Melissa didn’t already seem like more than we could bear, we are now at risk for infectious diseases. Fortunately, some of these can be prevented by vaccines and proper hygiene. As soon as possible, you and your loved ones should get a check-up and update your vaccine status. Persons can contact the Ministry of Health and Wellness for information at 888-663-5683.

Dr Yohann White is a medical doctor with a focus on the immune system. Follow him on social media @CaribeWellness or email at yohann.white@caribewellness.com.