Tetanus surveillance--United States, 1998--2000

Area of Science:

• Public Health Surveillance
• Infectious Disease Epidemiology
• Vaccinology

Background:

• Tetanus is a severe, potentially fatal infection with declining incidence due to widespread tetanus toxoid vaccination since the 1940s.
• Despite vaccination efforts, tetanus remains a public health concern, necessitating ongoing surveillance and targeted prevention strategies.

Purpose of the Study:

• To analyze reported tetanus cases in the United States during 1998--2000.
• To identify high-risk populations and assess vaccination status and wound management practices among tetanus patients.

Main Methods:

• Utilized data from the CDC's National Notifiable Disease Surveillance System (NNDSS) for physician-diagnosed tetanus cases.
• Incorporated supplemental clinical and epidemiological information provided by state health departments.
• Analyzed surveillance data covering the reporting period of 1998 to 2000.

Main Results:

• An average of 43 tetanus cases were reported annually, with an incidence of 0.16 cases per million population.
• Highest incidence rates were observed in individuals over 60 years old, those of Hispanic ethnicity, and older adults with diabetes.
• The case-fatality ratio was 18%, with 75% of deaths occurring in individuals over 60; no deaths were reported among fully vaccinated individuals.

Conclusions:

• Inadequate vaccination or unknown vaccination status, coupled with acute injury, significantly increases tetanus risk.
• Older adults are disproportionately affected by tetanus and its fatal outcomes.
• Tetanus is preventable through routine vaccination and prompt wound management; enhanced vaccination efforts are crucial for at-risk populations.