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Tetanus, a disease so ancient that even Hippocrates spoke of it. Has it ceased to be or does it still exist? Does it still present itself as a problem to modern medical practice, or is it just a mere curiosity, a footnote in some book? Perhaps the question we should ask ourselves, as doctors, is if we have been neglecting tetanus... and if we have, equally, neglected the aspects related to its prevention and treatment. Beyond medical practice, are we not neglecting the generation and communication of knowledge about this pathology which is of such great relevance in the Brazilian context? Let us begin from where medicine should always begin: the aspects pertaining to disease prevention and the promotion of health. Tetanus is an immuno-preventable disease, thus the mere occurrence of tetanus cases in the country demands reflection. Yes, there are cases of tetanus in Brazil and they are not few, as demonstrated by the data from the Brazilian Ministry of Health.(1) Let us remember that tetanus is a disease that must be duly reported so that its data is entered in the national epidemiologic alert system. Let’s begin with the morbidity data and then proceed to lethality data. If we take the absolute annual numbers of tetanus cases supplied by the Ministry(2) and group them into ten year periods, we will observe the following distribution: 1) 10,993 cases of accidental tetanus in the decade comprised between 1990 and 1999 (with an annual average of 1099 cases per year, varying from 705 cases per year in 1998 to 1548 cases per year in 1990); 2) 4560 cases of accidental tetanus in the decade comprised between 2000 and 2009 (with an annual average of 456 cases per year, varying from 315 cases per year in 2009 to 608 cases per year in 2002). Thus, over the years, one can see a decrease in the absolute number of accidental tetanus cases reported in the country. The more elaborate data from the state of Sao Paulo points towards the same trend. If we group the state’s annual numbers(4) into decades we have: 1) 1,540 cases of accidental tetanus in the period comprised between 1980 and 1989 (an annual average of 154 cases), with incidence coefficients (per 100,000 inhabitants) varying between 0.44 (133 cases) in 1989 and 0.70 (171 cases) in 1984; 2) 4,560 cases of accidental tetanus in the period between 1990 and 1999, (an annual average of 96.9 cases), with incidence coefficients between 0.16 (57 cases) in 1998 and 0.43 (133 cases) in 1990; 3) 328 cases of accidental tetanus in the period comprised between 2000 and 2010, (an annual average of 32.8 cases), with incidence coefficients between 0.12 (47 and 46 cases in 2001 and 2002 and 0.05 (20 cases) in 2007. Ricardo Tapajós1

Trismo, opistótono e riso sardônico: quem se lembra dessa doença?