Abstract
BackgroundAlthough preventable, tetanus still claims tens of thousands of deaths each year. The patterns and distribution of mortality from tetanus have not been well characterized. We identified the global, regional, and national levels and trends of mortality from neonatal and non-neonatal tetanus based on the results from the Global Burden of Disease Study 2015.MethodsData from vital registration, verbal autopsy studies and mortality surveillance data covering 12,534 site-years from 1980 to 2014 were used. Mortality from tetanus was estimated using the Cause of Death Ensemble modeling strategy.ResultsThere were 56,743 (95% uncertainty interval (UI): 48,199 to 80,042) deaths due to tetanus in 2015; 19,937 (UI: 17,021 to 23,467) deaths occurred in neonates; and 36,806 (UI: 29,452 to 61,481) deaths occurred in older children and adults. Of the 19,937 neonatal tetanus deaths, 45% of deaths occurred in South Asia, and 44% in Sub-Saharan Africa. Of the 36,806 deaths after the neonatal period, 47% of deaths occurred in South Asia, 36% in sub-Saharan Africa, and 12% in Southeast Asia. Between 1990 and 2015, the global mortality rate due to neonatal tetanus dropped by 90% and that due to non-neonatal tetanus dropped by 81%. However, tetanus mortality rates were still high in a number of countries in 2015. The highest rates of neonatal tetanus mortality (more than 1,000 deaths per 100,000 population) were observed in Somalia, South Sudan, Afghanistan, and Kenya. The highest rates of mortality from tetanus after the neonatal period (more than 5 deaths per 100,000 population) were observed in Somalia, South Sudan, and Kenya.ConclusionsThough there have been tremendous strides globally in reducing the burden of tetanus, tens of thousands of unnecessary deaths from tetanus could be prevented each year by an already available inexpensive and effective vaccine. Availability of more high quality data could help narrow the uncertainty of tetanus mortality estimates.
Highlights
Preventable, tetanus still claims tens of thousands of deaths each year
We identify the global, regional and national levels and trends of neonatal and non-neonatal tetanus mortality between 1990 and 2015, based on the findings from the Global Burden of Disease Study 2015
We used the Cause of Death Ensemble model (CODEm) strategy [7,8,9,10], which has been widely used for generating global estimates of cause-specific mortality
Summary
The patterns and distribution of mortality from tetanus have not been well characterized. Commonly referred to as “lockjaw”, is a serious infection caused by Clostridium tetani. Neonatal tetanus is more likely to occur in low and middle income countries especially in places such as urban slums and rural areas; in those places unhygienic deliveries at home are common, and coverage of antenatal care services and maternal tetanus toxoid immunization are usually inadequate [2,3,4]. During the past two decades, there has been a dramatic decline in tetanus cases and deaths due to the scale up of immunization programs [5, 6]. Despite the availability of an inexpensive and effective tetanus vaccine, many people in low and middle income countries
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