In January 2005, a tetanus epidemic was discovered amongst survivors of the Boxing Day Tsunami in Aceh, Indonesia. Our aim was to describe the extent of the tetanus outbreak in tsunami survivors admitted and describe the case outcomes from one hospital. All clinicians were instructed to report suspected cases to a centralised organisation using a standardised data collection tool. Active case finding was carried out by a trained team that visited hospital wards in Aceh. Of the 106 cases, 79% was above 25 years old (the median age was 40 years) and 62% was male. The mortality rate in Aceh was 19% and that of in follow up cases was 17%. Fifteen of the follow-up cases were admitted with severe tetanus associated with superficial wounds, three of whom had a history of immersion. Supplies to treat the tetanus cases in this epidemic were initially limited as disaster relief agencies were not prepared for the resultant tetanus epidemic. The mortality rate of 17%, was significantly less than was usual for tetanus in adults (>50%) and children (80%) in underdeveloped countries. To reduce mortality and morbidity, rapid disaster relief organisations should include supplies for vaccination and treatment of tetanus cases and consider early tracheotomy for severe cases.