In a follow-up to a report last week, the final tally is in on the number of fireworks injuries and Philippines health officials put it at 929, including 33 amputations.

This is a slight increase compared to 2014; however, as Health Secretary Janette Garin said at the Kapihan sa Manila Bay forum, 2015-2016 figures were 41 cases less than the five-year period average.

Clostridium tetani /CDC
Clostridium tetani /CDC

The death toll is now at two as a 12-year-old boy tragically died from tetanus as a result of a firecracker wound.

According to Garin, the boy was taken to the hospital on Monday with “lockjaw” and difficulty in swallowing and died the following day.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, Clostridium tetani. The spores of this organism are very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail; however the rust has nothing to do with tetanus. At this point the spores germinate into the bacteria which multiply and produce toxin.

Depending on the extent of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks. The typical features of a tetanus spasm are the position ofopisthotonos and the facial expressions known as “risus sardonicus”. The death rate for this disease ranges from 10-80% depending on age and quality of care.

There are really no laboratory findings that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation.

This disease in not transmitted from person to person. Even if you had tetanus and recovered, this potent toxin produces no immunity.