Tetanus in Romania-Trends and Challenges

Tetanus is a life-threatening, vaccine-preventable disease caused by tetanospasmin and tetanolysin, which are potent neurotoxins produced by Clostridium tetani, an anaerobic, spore-forming bacterium. Due to the widespread presence of spores in the environment, the disease cannot be eradicated. However, global tetanus prevention initiatives have contributed to a significant decline in tetanus incidence worldwide. Aiming to present the tetanus trends in Romania, we conducted a retrospective analysis of the tetanus surveillance data. During the study period (2010-2023), 97 cases of tetanus were reported in Romania (median: 6.5; IQR: 5-7) with an average incidence rate of 0.03 per 100,000 inhabitants (95% CI: 0.02-0.04; range: 0.01-0.09). The highest incidence rates were recorded among people aged 1 to 14 years old (0.09 per 100,000 inhabitants, 95% CI: 0.06-0.13; range: 0.00-0.20), male (0.05 per 100,000 inhabitants; 95% CI: 0.03-0.06; range: 0.03-0.12), and from rural areas (0.05 per 100,000 inhabitants; 95% CI: 0.03-0.08; range: 0.01-0.17). A decline in the number of tetanus cases of 7% by year was observed, which is supported by the statistical analysis showing a p-value of 0.005 (IRR: 0.93; 95% CI: 0.88-0.98). However, the same decline in tetanus incidence was not supported by the statistical analysis (IRR: 0.93; 95% CI: 0.44-1.98; p = 0.9). Forty-seven tetanus deaths were recorded, with an average case fatality ratio of 42% (95% CI: 25.62-57.92; range: 0-100), showing a decreasing trend of 9% by year (IRR: 0.91; 95% CI: 0.89-0.93). Although the annual number of tetanus cases in Romania has shown a slight downwards trend, its situation has remained relatively stable, as shown by the tetanus incidence. Moreover, the case fatality rate continues to be high. Therefore, our study emphasizes the importance of achieving high vaccination uptake among children and adolescents, raising awareness of the importance of booster doses in adults, and improving the management of tetanus-prone wounds.