The Telegraph
Since 1st March, 1999
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Banda Aceh survivors struck down by tetanus

Banda Aceh, Jan. 13: Scores of survivors of the tsunami are dying of tetanus, a rare but often deadly disease whose outbreak has caught health officials completely off guard.

Deaths have been reported in Banda Aceh and Meulaboh, at either end of the Indonesian disaster zone in Sumatra. They are almost certainly being replicated in the cut-off towns and villages along the coast in between, say experts.

Tetanus, once better known as lockjaw, has been almost wiped out in the West through childhood immunisation and is now uncommon even in disaster areas. One doctor said this was the worst outbreak the world had seen in years.

'I might have expected to see one case in my career,' said Dr Charles Chan Johnson, from Singapore, who is working in Banda Aceh's general hospital, Zainal Abidin. 'Now I have 20 patients in one ward.'

Most had symptoms too far advanced to be treatable. 'I am afraid nearly all these patients will die,' he said.

Immunisation is regarded as the most important means of prevention because once symptoms appear the mortality rate is high. But in Sumatra primary health care was limited even before the tsunami which killed more than 100,000 Indonesians.

Medical workers say the disaster provided perfect conditions for tetanus, a form of blood poisoning.

Many people were injured by the debris the waves picked up, even if only with minor cuts, and ended up lying in the dirty water. Nevertheless, the number arriving at hospitals and field clinics with the classic rictus 'smile' of lockjaw has taken them by surprise. They had been on the lookout for cholera, dysentery and malaria, classic refugee-camp sicknesses, not tetanus.

There have been 40 confirmed cases and 20 deaths in Banda Aceh, and seven cases and five deaths in Meulaboh. But patients were still arriving at Zainal Abidin last night and Meulaboh hospital is seeing several suspected cases every day.

Officials have still not assessed the scale of the outbreak along the coast, where hundreds of thousands of survivors have fled. But workers there may not even know why people are falling sick, said Dr Tony Stewart, a consultant epidemiologist to the World Health Organisation in Banda Aceh.

'This is totally unprecedented,' he added. 'This is now a really rare disease.'

He had imported to Indonesia Australia's entire stock of immunoglobulin, which is used to treat tetanus intravenously. It amounted to 15 vials, a sign of how few cases the West now suffers.

Dr Johnson's ward is one of three which reopened on Tuesday in the hospital, which was inundated by mud in the disaster.

One young woman was writhing in pain there yesterday muttering 'Please let me wake up'. Patients on either side of her were also contorted in pain.

Siti Syarifah, 24, will almost certainly die of tetanus, with no relatives at her side. 'No one has found any family members,' said Dr Johnson.

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