Improving the management and prevention of tetanus in Vietnam

Tetanus is caused by a toxin that acts on nerves in the spinal cord causing severe muscle spasms. Treatment includes injections of antitoxin. Patients with severe tetanus have violent muscle spasms and muscle paralysis is needed to control them. Machine ventilation is also needed as the patient will not be able to breathe unaided. Patients with severe tetanus experience fluctuating heart rate and blood pressure which can be confused with infection. The disease remains common despite apparently good vaccination programmes.

I will examine whether an additional injection of antitoxin directly into the spine reduces the severity of disease. The study will involve randomly allocating 270 patients to normal treatment or additional spinal injection. I will see if spinal antitoxin can reduce the need for machine ventilation as well as reduce the length and cost of hospital stays and intensive care and other problems associated with tetanus such as hospital-acquired infections. I will also examine methods of predicting who is likely to be affected by tetanus. I will measure antibody levels from 4,000 Vietnamese people using already-stored blood samples to gauge how many people have protective levels of antibody.