Outbreak of tetanus cases following the tsunami in Aceh Province, Indonesia.

Aceh Province in Indonesia was the area most severely affected by the tsunami of 26 December 2004. Extensive loss of life, property, and livelihood left a large segment of the population without basic needs and vulnerable to epidemic-prone diseases. Following the tsunami, a surveillance/early warning and response system was implemented to detect, investigate, and respond to outbreaks of communicable diseases. Fixed and mobile clinics, hospitals, and laboratories, operating all over the affected areas, reported weekly figures and daily alerts. Over 1 month following the tsunami, 106 cases of clinically diagnosed tetanus were reported. Most cases occurred among adults. The case fatality ratio was 18.9%, higher among older patients and among those with short incubation periods. No other major outbreaks occurred in the acute phase of the emergency. This series of tetanus cases was the largest cluster reported following a natural disaster or mass casualty event, overtaken only by the recent earthquake in the Kashmir (139 cases reported), and reflects the high number of injuries which occurred during the tsunami and poor prior immunization status of the population. In the context of natural disasters, preventive measures against tetanus, including wound cleaning and active and passive immunization, should be routinely conducted. Immediate disaster relief should include supplies for the management of wounds and cases of tetanus.