Jeremy Laurance: Tamed here, but still a fatal threat elsewhere

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I once sat with a boy who had severe tetanus in a mission hospital in rural Africa. It was not a pretty sight. He was a couple of years older than Rahmadullah, and every few minutes his back would arch in a spasm and he would cry out. There was nothing I or anyone else could do except try to comfort him – and hope that help would soon arrive.

It did, in the shape of the Piper Cherokee of the Flying Doctor service of East Africa, which landed that afternoon on the dusty airstrip in north-eastern Uganda. The pilot and his medical assistant took the boy to Nairobi where, I later learned, he was successfully treated and survived.

Although tetanus can be easily prevented by vaccination, it remains a worldwide problem, especially in sub-Saharan Africa and the Indian sub-continent. In the UK there are still a handful of cases and one or two deaths each year, usually among unvaccinated individuals, but most British-trained doctors never see one.

It is spread by spores in the earth, distributed widely in the dung of horses, sheep, cattle, cats and dogs, which can be introduced into the body through puncture wounds. It affects muscles used in voluntary movements, and the first sign is lockjaw and the facial spasms associated with it. Later it progresses to the arch of the back as the skeletal muscles contract, which in severe cases can be extreme. The incubation period is typically eight days, but may be up to several months.

Treatment is with powerful antibiotics and, in severe cases like Rahmadullah's, mechanical ventilation.