By Alison McCook

NEW YORK (Reuters Health) - Three men contracted tetanus in Puerto Rico and two died of the disease within a 4-month period this year, according to a new report released by the US Centers for Disease Control and Prevention ( news - web sites) (CDC).

Until now, the last case of tetanus in Puerto Rico was reported in 1999, the authors note.

These cases highlight the need for people to be vaccinated against tetanus, the study lead author told Reuters Health, for vaccination would have prevented all of these infections.

"They key thing is to have everybody get the primary series (of vaccines), and receive boosters every 10 years," Dr. Francisco Alvarado-Ramy of the Puerto Rico Department of Health said.

Tetanus is an infection that occurs when a toxin found in soil and animal and human intestines enters the body through a wound. The disease, which is not contagious, leads to muscle spasms and may be fatal.

When a person receives a potentially tetanus-inducing wound, treatment approach depends on whether or not he has been vaccinated against the disease. According to current recommendations, doctors should administer a booster to anyone who has not had one within the last 10 years, as well as to anyone with a contaminated or deep wound who did not receive a booster shot within the last 5 years.

For patients who have never received the primary vaccine, Alvarado-Ramy said doctors should administer both the primary vaccine and a dose of tetanus immune globulin (TIG), which provides the patient with extra tetanus-fighting antibodies.

In the first case, an 86-year-old man contracted tetanus from a splinter he received while gardening. He visited the doctor to treat his wound, and did not receive a vaccine, even though his vaccination history was unclear. When he became seriously ill, he received a dose of the tetanus vaccine, but he died soon after.

In another case, a 68-year-old man requested the tetanus vaccine after stepping on a rusty nail, but was informed that no vaccine was available. He did not know if he had been vaccinated earlier in life. He died of tetanus one week after being wounded.

In the third case, a 76-year-old man contracted tetanus--but later recovered--after receiving a splinter. He was offered the vaccine when he began to experience symptoms of the disease, but refused it, Alvarado-Ramy and his team report in the July 19th issue of Morbidity and Mortality Weekly Report.

In an interview with Reuters Health, Alvarado-Ramy said that the two men who died should have been given both the tetanus vaccine and the TIG when they first began to show symptoms of the disease. However, tetanus occurs relatively infrequently, he noted, and some physicians may be less likely to offer a vaccine for a disease that they rarely encounter.

"People are just not prompted to provide these vaccines as opposed to illnesses that are more prominent in people's minds," he said, such as influenza.

Puerto Rico and the US are now recovering from a recent shortage of the tetanus vaccine, Alvarado-Ramy explained, which lasted from 2000 to 2002. He said that he believed none of the cases presented here resulted from the vaccine shortage, but that all doctors should now ensure that people get the booster shots they missed during the shortages. "Make sure they're fully protected against tetanus," he advised.

SOURCE: Morbidity and Mortality Weekly Report 2002;51:613-615.