Intended for healthcare professionals

Rapid response to:


Tetanus in injecting drug users

BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:208

Rapid Response:

Prevention would be better

Tetanus in Injecting Drug Users


Nick Beeching’s timely warning about the danger of Tetanus and other
anaerobic infections in injecting drug addicts reminded me of many cases
of Tetanus I saw as a young doctor in the 60’s.

The first was in Middlesex in a man with a recent
history of open operation reduction and plating of a severely displaced
Colles (yes Colles!) fracture. He died.
I saw more cases during 2 years in Laos including several cases of
Neonatal Tetanus undoubtedly related to the practice of applying water
buffalo dung and earth to the umbilicus of the newborn. Many survived!
Others were in cases of wounds – two soldiers in the same ward who had
walked on the same land mine (left and a right below knee amputation) both
survived and a boy with poorly debrided compound fracture of the femur (my
fault - I saved the leg and lost the patient) – he died. I saw other
soldiers with Tetanus and one memorable case of Gas Gangrene (Clostridium

What I learned from all this is that we must always maintain
immunisation programs because you cannot eradicate Clostridia. I was
alarmed to hear a GP colleague recently state that in her view Tetanus
vaccination was a waste of time as you never saw it nowadays did you?

Nick Beeching urges early recognition and treatment of Tetanus in
order to reduce mortality from “100% to below 10%" but this seems to me to
be unlikely to be achievable. Surely the public health response to this
problem should be for all those treating drug addicts, including General
Practitioners, to ensure that all such people in their care are fully
vaccinated against such preventable diseases as Tetanus, Pneumonia,
Hepatitis A & B, and Influenza and allowed full access to clean
needles and syringes (particularly in our prisons where there is none but
lots of brown heroin.

In my view the ultimate remedy for the prevention of those diseases
which so devastatingly assail our drug addicts (AIDS, Hepatitis C,
Hepatitis B, accidental overdose, cellulitis, septicaemia etc) often
leading to early death is the provision of pure sterile heroin and water
for injection, to all who need (I use the word advisedly) it, to displace
filthy killer ‘brown’ heroin from our society for ever.

Dr Roger Weeks GP

Competing interests:
Dr Weeks and partners currently treat nearly 90 drug addicts in their PMS Plus General Practice and hope to recruit more through GP Commissioning.

Competing interests: No competing interests

31 January 2005
Roger L Weeks
2 Deanhill Road East Sheen London SW14 7DF