Adult Tetanus Research Articles

Adverse events following immunization with DTaP-IPV (Tetraxim) in school-aged children in Taiwan, 2017–2020

Vaccination has been an effective method to prevent and control diphtheria, tetanus, pertussis and polio diseases in infancy and adults for years. To maintain the protective effect, a DTaP-IPV vaccine, Tetraxim, was introduced into Taiwan’s national immunization program for children at 5 years of age after primary series vaccination in infancy in October 2017 replacing a Tdap-IPV. To survey the safety of this vaccine, data between 01 October 2017 and 31 December 2020 from two surveillance systems, the Vaccine Adverse Events Reporting System (VAERS) and Vaccine Injury Compensation Program (VICP), were reviewed. We analysed patient’s demographics, symptoms, time of onset, and outcome. A total of 667,497 doses of DTaP-IPV vaccine were administered during the study period. We combined data from VAERS and VICP and deleted duplicate subjects and reports. There was a total of 59 subjects with AEs and the reporting rate of AEs was 8.8 subjects per 100,000 doses. The most common AEs were injection site erythema and swelling. AEs occurred with a median 1 day after vaccination (range 0–3 days). Among the 59 subjects, eight (13.6 %) with serious AEs were hospitalized. These serious AEs included injection site erythema, swelling or extensive limb swelling after vaccination and hospitalization might have been due to ELS that was misdiagnosed as cellulitis. The national passive surveillance data support the safety profile of Tetraxim as a school-entry booster in children at 5 years old in Taiwan.

Nonclinical safety and immunogenicity assessment of a combined DTacP vaccine in animal models.

The (diphtheria, tetanus, and pertussis [acellular, component] [DTacP]) vaccine is a combined vaccine designed to prevent three potentially fatal diseases including pertussis, tetanus, and diphtheria in both children and adults. We utilized advanced technology to develop a novel DTacP vaccine that was previously unavailable in China. The nonclinical studies were performed to evaluate the immunogenicity, potential toxicity, and local tolerance of the vaccine in animal models. In the immunogenicity study, three batches of the vaccine were intraperitoneally administered to National Institutes of Health (NIH)mice, resulting in 100% seropositivity for all three batches. Additionally, antibody levels notably increased as the immunization dosage increased. In acute toxicity study, no mortality was observed among the animals during the 14-day observation period, and no abnormalities in clinical signs were reported. Active systemic anaphylaxis assessment in guinea pigs showed no evidence of serious allergic reactions in the vaccine groups. In the repeat-dose toxicity study, where five intramuscular doses were administered every 2weeks, gross autopsy and histopathological examination revealed no vaccine-related systemic pathological changes in rats, with dose site irritant reactions mostly recovered at the end of recovery period. In conclusion, the vaccine demonstrated good local and systemic tolerance, supporting its clinical development.

An Analytical Study of the Number of Communicable Diseases and Health Institutions in Iraq using Two-Way Analysis of Variance, Friedman and Scheffe Tests

In this research paper, data were analyzed from Environmental Statistics in Iraq (Health Indicators for 2019)/ Central Statistical Organization /Iraqi Ministry of Planning. The data represents the number of health institutions distributed across all governorates of Iraq (government hospitals, private hospitals, popular clinics, specialized health centers (dental, chest, allergy, asthma, other specialties), primary health care centers (main and subsidiary), other health institutions (insurance clinics). health care, health homes), training health center, family medicine health center, family planning center, central health laboratories, forensic medicine, blood bank). In addition to other data representing the number of infections with communicable diseases in Iraq (polio, acute flaccid paralysis, whooping cough, measles, German measles, mumps, congenital tetanus, adult tetanus, hydatid cysts, typhoid, malaria, schistosomiasis, bacillus dysentery, rabies, Diphtheria, chicken pox, hemorrhagic fever, Malta fever, pneumonia, cholera, scabies, cutaneous leishmaniasis, black fever, animal bites, meningitis of all kinds, bird flu, swine flu). It was determined whether there are significant differences in the number of health institutions in terms of their distribution across all governorates of Iraq, or not. Also, is there a significant difference in the number of infections with communicable diseases in all governorates of Iraq or not? If there is a significant difference in the number of health institutions or the number of infections with communicable diseases, whichever number is higher. The study included the total number of health institutions in Iraq, as well as the total number of communicable diseases of various types in all governorates of Iraq. The results were obtained by applying the Friedman test, in addition to two-way analysis of variance, as well as the Scheffé test.

Reminder of Persistent Public Health concerns: A suspected case of adult tetanus

Reminder of Persistent Public Health concerns: A suspected case of adult tetanus

Risk assessment of severe adult tetanus using the NLR and AST level and construction of a nomogram prediction model

ObjectiveWe sought to examine high-risk factors for severe tetanus, construct a nomogram model, and predict the risk probability of severe tetanus in adult patients to provide a theoretical basis for clinical intervention. Methods: A retrospective analysis was employed in this study, which enrolled 65 adult patients with tetanus diagnosed at the Second Affiliated Hospital of Hainan Medical University from January 2017 to September 2022. Study participants were divided into severe and mild groups based on the Ablett classification. The general data and laboratory markers of both groups were compared, and logistic regression analysis was used to screen for independent risk factors for severe tetanus. A nomogram prediction model was constructed, and receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA) were constructed and used to assess discrimination, calibration, and net benefit. Results: Of the 65 adults patients with tetanus, 28 were placed in the severe group and 37 were placed in the mild group. Univariate logistic regression analysis showed that there were statistically significant differences in the incubation period, time from disease onset to treatment, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase level (LDH), myoglobin level (Mb), and aspartate aminotransferase (AST) level between the two groups (P < 0.05). while the differences in age; sex; and creatine kinase, creatine kinase isoenzyme, and alanine aminotransferase levels were not statistically significant (P > 0.05). Multivariate analysis showed that NLR (odds ratio [OR] = 4.998, 95 % confidence interval [CI] = 1.154–21.649, P = 0.031), AST (OR = 1.074, 95 % CI = 1.007–1.146, P = 0.031), PLT (OR = 1.055, 95 % CI = 1.006–1.106, P = 0.027), and incubation period (OR = 0.597, 95 % CI = 0.423–0.843, P = 0.003) are independent risk factor for severe tetanus. A Nomogram for predicting Severe Tetanus (N-ST) prediction model was constructed based on variables in the multivariate analysis with P < 0.05. The ROC curve showed that the optimal cutoff point was 108.044 points. At this point, the sensitivity was 86.5 %, the specificity was 89.3 %, the area under the ROC curve was 0.936, and model discrimination was good. The calibration curve overlapped with the ideal curve, and the DCA curve showed that the model can provide clinical benefits. Conclusion: NLR, AST, PLT, and incubation period are predictors of severe tetanus. The constructed N-ST model can provide a new, convenient, and rapid method to predict the risk probability of severe tetanus in adults and guide early clinical intervention.

Tetanus patient profiles and factors affecting clinical outcomes at Dr. Soedono general hospital, Madiun in 2019-2020

Link of Video Abstract: https://youtu.be/VC3Gcd7oS5Y Introduction: Tetanus is a disease that can be diagnosed clinically. However, there is a lack of research data on tetanus patients and their clinical outcomes, especially in adult tetanus patients in Indonesia. This study aims to determine the factors that influence the outcome of tetanus patients. Method: A cross-sectional study was performed from May to June 2021 at Dr. Soedono Madiun General Hospital. Subjects were recruited by total sampling. The data that will be taken in this study are gender, age, immunization history, incubation period, onset, port of entry, Philips score, and clinical outcomes of patients. Result: Were 112 patients diagnosed with tetanus at Dr. Soedono General Hospital from January 2019 to December 2020. The male subjects outnumbered female subjects by 81.3%. The youngest subject was 19 years old, and the oldest was 81 years old. The tetanus immunization status showed that 2 patients were known to be fully immunized, 21 were not fully immunized, and 89 (79.5%) had unknown immunization status. This study showed that the port of entry of the wound is most often the entry point for tetanus in the inferior extremity of 72 patients (64.3%). Most onset occurred in 1-7 days, with a mean onset for generalized tetanus was 2.3 ± 1.8 days. The mean incubation period for the appearance of tetanus symptoms in this study was 9.4 ± 5.6 days. The most common comorbid disease in this study was diabetes mellitus (11.6%). This study's clinical outcome of tetanus showed that 74 patients (66.1%) had improved, while 38 patients (33.9%) died during treatment. Discussion: This study's most common port of entry was on the inferior extremities. This lower limb predominance as the port of entry could be explained by the fact that C. tetani exists in soil; hence, any lower limb injury would be open to contamination and infection by this organism. Based on the Dakar and Phillips score system, tetanus has a worse prognosis when there is a faster incubation period, faster onset, more proximal port of entry location, immunization status, comorbidities and signs of muscle spasm, fever, and tachycardia are obtained. Conclusion: In this study, tetanus still has a high mortality rate. Male gender, age over 45, a moderate to severe disease degree (considering a relatively short incubation time, short onset period, and unknown immunization status) are a few factors that may affect this high mortality rate.

Australian vaccine preventable disease epidemiological review series: tetanus 2003-2019.

Background We examined trends in tetanus notification, hospitalisation and death data from 2003-2019 to assess the impact of adult tetanus booster recommendations in Australia. Methods Tetanus notifications and deaths from the National Notifiable Diseases Surveillance System; hospitalisations from the Australian Institute of Health and Welfare National Hospital Morbidity Database; and deaths from the Australian Coordinating Registry were analysed by age group, sex, Aboriginal and Torres Strait Islander status and state/territory. Annual rates were calculated using Australian Bureau of Statistics mid-year estimated resident populations from 2003-2019 as denominators. To assess the impact of a recommended booster dose of reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine for adults aged ≥ 65 years, notification, hospitalisation and death rates of tetanus per 100,000 population were compared pre (2003-2012) and post (2013-2019) the recommendation's introduction. Results There were 63 notifications of tetanus from 2003-2019 with an average annual incidence rate of 0.02/100,000. Similar to previous studies, the burden of tetanus in the Australian population continues to disproportionately affect the elderly, with those aged ≥ 65 years encompassing 63% (40/63) of notifications and 100% (11/11) of the deaths observed in this timeframe. Following the introduction of a recommendation for those aged ≥ 65 years to receive a dTpa booster, average annual notification and hospitalisation rates in those aged ≥ 65 years were significantly lower (notifications: 0.11/100,000 in 2003-2012 and 0.05/100,000 in 2013-2019, p = 0.01; hospitalisations: 0.24/100,000 in 2003-2012 and 0.10/100,000 in 2013-2019, p = 0.01]). The average annual death rate was similar in the two periods (0.002/100,000), although based on small numbers. Conclusions The findings of this analysis suggest a positive impact from the 2013 recommendation. However, the burden is still disproportionately higher in those aged ≥ 65 years and strategies to improve vaccination coverage in older Australians are recommended.

The road towards protection of all against tetanus.

In low- and middle-income countries (LMICs), tetanus continues to be a major public health concern. Although vaccination campaigns have been effective in lowering the incidence of tetanus worldwide, some areas continue to experience a considerable number of cases and fatalities. Adult tetanus is frequently underreported because there is insufficient systematic surveillance and reporting. A high proportion of tetanus patients die because of a lack of adequate critical care services, particularly ventilator support, with limited access to existing facilities due to high costs. Hence, the case fatality rate of adult tetanus remains high. Women and children are protected because of regular and booster immunization strategies implemented around the world. However, men are disproportionately affected by tetanus. Booster dosage based on the World Health Organization (WHO)-recommended schedule should be given to eligible children and adolescent boys. In addition, tetanus vaccination needs to be promoted among adults in vulnerable jobs. Functional strategies could help pave the way toward the protection of all against tetanus.

In-Hospital Mortality among Patients of Severe Adult Tetanus Presenting with bad Prognostic Factors: A Tertiary Care Hospital Experience

Background: Tetanus caused by clostridium tetani, despite being a preventable disease, is still posing a significant health hazard to developing countries like Pakistan. Objective: To determine in-hospital mortality among patients of severe adult tetanus presenting with bad prognostic factors.Material and Methods: This cross-sectional study was conducted at the Department of Medicine, Medical Teaching Institution Lady Reading Hospital, Peshawar, Pakistan from July 13, 2017, to January 13, 2018, on 176 patients. All severe adult tetanus patients as per Ablett Classification with bad prognostic factors (incubation period &lt;7 days, persistent fever &gt;40o C, persistent tachycardia of &gt;120/min, and no history of post-exposure prophylaxis) were included in the study. Patients with compromised renal functions (urea &gt;108 mg/dl, reduced urine output &lt;50 ml/hr) and already diagnosed neuromuscular junction disorders were excluded from the study. Written informed consent was obtained and patients were enrolled in the study. All patients were immediately worked up with detailed history and clinical examinations and were managed as per ICU protocols and followed within the hospital for mortality.Results: Mean age of study participants was 47±10.27 years. The majority of study subjects were males (n=102, 58%), un-immunized (n=88, 50%) or partially immunized (n=26, 15%), socioeconomically poor (n=84, 48%), illiterate (n=82, 47%) and from urban areas (n=114, 65%). In-hospital mortality was recorded in 109 (62%) of the study subjects. In hospital mortality was recorded highest in patients with an age range of 41-65 years (n=70/109, 64.22%), males (n=63/109, 57.8%), unimmunized (n=55/109, 50.45%), poor (n=52/109, 47.7%), illiterate (n=51/109, 46.78%) and urban (n=71/109, 65.14%). Conclusion: In-hospital mortality was high in patients with severe adult tetanus presenting with bad prognostic factors.Keywords: Clostridium tetani, Hospital Mortality, Severe adult tetanus, Tetanus, Tetanus Antitoxin, Tetanus Toxoid, Trismus, Prognostic Factors.

The relationship between the character of the course of the disease, the level of tetanus and diphtheria antibodies, and indicators of general immunity in adults with infectious mononucleosis

ABSTRACT. EBV infection is one of the most common infections in the world. About 90 % of the world's population is infected with the Epstein-Barr virus. The Epstein-Barr virus is capable of affecting immunocompetent cells, causing lymphadenopathy, hepato- and splenomegaly, being stored forever in the body's lymphocytes, and causing an immunodeficient state. The aim of the study. The purpose of the study was to determine the relationships between the nature of the course of the disease for infectious mononucleosis (IM) in adults, the level of blood antibodies before tetanus and diphtheria, and general immunoreactivity. Materials and methods. In the first series of studies, blood antibodies was studied before diphtheria and tetanus in 79 adults. The control group consisted of 41 people. In the second series of studies, the immune status of 45 adults who became ill with IM was studied: 19 people who did not have a protective level of blood antibodies to diphtheria and tetanus (1st group) at the same time and 26 people (2nd group) who had a protective level of blood antibodies to these infections . In this work, the level of blood antibodies to diphtheria and tetanus toxin was studied by the ELISA method; population and subpopulation composition of blood lymphocytes using monoclonal antibodies: anti-CD3, CD4, CD8, CD22, CD16 (eBioscience, Beckman Coulter, R&amp;D System). The proliferative activity of blood lymphocytes in the reaction of lymphocyte blast transformation was studied and the level of IgA, IgM, IgG in blood serum and the phagocytic activity of leukocytes. The results of the research were processed by the method of variation and correlation statistics using the "Statistica 10.0 for Windows" program. Results. It was established that 34.2% and 54,5 % of adults who developed MI in a moderate form did not have a protective level of blood antibodies for tetanus and diphtheria at the same time. A protective level of blood antibodies simultaneously before diphtheria and tetanus was observed in 55.2% of those who fell ill with IM in a moderate form and in 45,4 % of those who fell ill in a severe form. In persons who had a mild form of IM, the blood antibodies did not drop below the protective level before diphtheria and tetanus.The study of the immune status proved that in adults who do not have a protective level of blood antibodies against diphtheria and tetanus, the level of leukocytes, lymphocytes, CD3+, CD4+ - cells and the blast-transforming ability of T cells, the level of IgA, IgM, IgG, and the phagocytic ability of blood leukocytes are probably lower than in adults who have had an IM and have the protective blood antibodies level before these infections. Conclusions. The lack of a protective level of blood antibodies against diphtheria and tetanus in adults who have had IM is associated with a general low immunoreactivity of the body. A low level of blood antibodies before diphtheria and tetanus in persons who have had IM is closely related to the course of the disease. The lowest level of blood antibodies before these infections was observed in patients who fell ill with a severe form of IM, in patients with a mild form of the disease, significant changes in the level of blood antibodies before diphtheria and tetanus were not observed, as well as in the immune status.

Tetanus, diphtheria, and acellular pertussis vaccine coverage in adults with chronic respiratory conditions

BackgroundPertussis is a highly contagious respiratory disease, and those with chronic respiratory illnesses may be at higher risk of infection and severe pertussis. Acellular pertussis–containing vaccines (Tdap) are recommended in the United States for those with risk factors, such as asthma and chronic obstructive pulmonary disease (COPD). ObjectiveTo determine Tdap vaccination rates among people with asthma or COPD compared with matched controls with type 2 diabetes and the general population. MethodsThis observational database study identified adults with asthma or COPD, and their matched controls, from a large US administrative health claims system between January 2008 and December 2014. Vaccination with Tdap was identified using current procedural terminology and national drug codes, and vaccination rates per 1000 patient-years and adjusted rate ratios (RR) were calculated using a generalized linear model with a Poisson distribution and 95% confidence intervals (CI). ResultsVaccination rates were low overall; however, they were slightly higher in asthma than the general population cohort, with vaccination incidence RRs of 1.12 (95% CI, 1.08-1.17), 1.09 (95% CI, 1.06-1.11), and 1.11 (95% CI, 1.07-1.16) in those aged 18 to 44, 45 to 64, and 65 years and older, respectively. However, Tdap vaccination rates were lower in the COPD than in the general population cohort, with vaccination incidence RRs of 0.72 (95% CI, 0.60-0.86), 0.87 (95% CI, 0.83-0.91), and 0.94 (95% CI, 0.92-0.96), respectively. ConclusionPertussis vaccination rates were suboptimal among adults in general and adults with asthma or COPD. Work is needed to boost Tdap vaccination uptake among people with chronic respiratory conditions.

6084 Cases of Adult Tetanus from China: A Literature Analysis.

To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.

Immunogenicity and safety of reduced-antigen tetanus, diphtheria and acellular pertussis vaccination in adults treated for obstructive airway diseases

ABSTRACT Patients with obstructive airway diseases (OAD), like chronic obstructive pulmonary disease (COPD) and asthma, may be at increased risk of pertussis infection. Pertussis may also trigger COPD and asthma exacerbations. Vaccination against pertussis could help protect OAD patients from the additional burden of pertussis, but there may be hesitancy related to vaccine safety and immunogenicity in such patients. We performed a meta-analysis on 5 clinical trials in adults receiving reduced-antigen tetanus-diphtheria-acellular pertussis vaccine (Tdap, Boostrix, GSK), from which we selected participants on active OAD treatment. We compared immunogenicity and reactogenicity outcomes of the meta-analysis with data from the overall populations of Tdap-vaccinated adults from 6 Tdap trials (including the 5 in the meta-analysis). The meta-analysis comprised 222 adults on active standard OAD treatment. One month post-Tdap, 89.0% and 97.2% of these adults, respectively, achieved seroprotective anti-diphtheria and anti-tetanus antibody concentrations; 78.3%–96.1% showed booster responses across the 3 pertussis antigens. These rates were consistent with those in the comparator population. The most frequently reported solicited local and systemic adverse events within 4 days post-Tdap were injection site pain (47.7%) and fatigue (19.3%), with low rates of grade 3 intensity (0.9% and 2.8%). This was consistent with Tdap reactogenicity in the comparator population. Evaluation of unsolicited and serious adverse events within 1 month post-Tdap did not identify safety concerns. In conclusion, Tdap was immunogenic and well tolerated in adults under active standard OAD treatment, with immunogenicity and safety profiles consistent with those in a comparator population representing the general adult population.

NOVEL INTERVENTIONS AND TARGETS FOR THE PREVENTION OF DEMENTIA AND FRAILTY: 2021 EDITOR’S CHOICE ARTICLES FROM JGMS

Abstract This symposium will present four 2021 “Editor’s Choice” articles from the Journal of Gerontology Medical Sciences that focus on novel interventions and targets for the prevention of dementia and frailty. Jeffrey Scherrer and colleagues, in their article “Lower Risk for Dementia Following Adult Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination,” examine the links between adult vaccinations and decreased dementia risk. Katharine Brewster, Justin Golub (presenter), and colleagues, in “Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults,” investigate hearing loss and depression as independent risk factors for eventual conversion to dementia. By understanding these potentially reversible mechanisms for dementia, targets for early interventions could be identified. “Association Between Long-Term Aspirin Use and Frailty in Men: The Physicians’ Health Study,” written by Ariela Orkaby and colleagues, examines the association between long-term aspirin use and frailty, furthering our understanding of the benefits of anti-inflammatory medications even in older adults. Kristen George and coauthors, in their article, “Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans,” examine how cardiovascular risk factors early in life may affect late life cognition in Black Americans. Beverly Gwen Windham, the discussant, will highlight commonalities and lessons learned from these studies.

Clinical Features and Outcomes of Patients with Tetanus at Dr. Hasan Sadikin General Hospital Bandung 2015–2019

Background: Tetanus is a disease characterized by painful muscle spasms all over the body, which still becomes an important health issue worldwide, particularly in developing countries due to the high mortality rate. The clinical features also affect the mortality rate of adult tetanus patients. Tetanus severity score (TSS) is a prognostic scoring system developed in Vietnam that uses clinical features to predict the mortality rate in adult tetanus patients. The aim of this study was to describe the clinical features and outcomes of adult tetanus patients using TSS.Methods: A descriptive, cross-sectional study with a total sampling method was conducted between 2015 and 2019. A total of 71 medical records of adult generalized tetanus patients in the Department of Neurology Dr. Hasan Sadikin General Hospital Bandung were collected to analyze the clinical features and outcomes using TSS. Statistical analysis was performed using SPSS software ver. 25.0.Results: Among seventy-one tetanus patients, 62 (87.3%) were male, and the average age was 55.2±11.2 years. More than half of the patients (71%) were having grade III or worse and experienced dysautonomia complications (57.7%). The mortality rate was 38% and those who survived at discharge, 88.64% had TSS score &lt;8, whereas 37.04% who died had TSS score ≥8.Conclusions: Tetanus in Bandung has a high mortality rate. Those who have died have high TSS scores, while the survivors have low TSS scores, suggesting that the TSS is a prospective scoring to predict the mortality rate in patients with tetanus in Indonesia.

Is Adult Tetanus an Endemic in India?

Background: Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked. Methods: An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tetanus, clinical features and the outcome of tetanus. Results: Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status. Conclusion: An early diagnosis, a proper wound management immediately after the injury, health education programs to create awareness among the public not to neglect even trivial injuries would definitely lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immunization beyond the age of 10 years.

The progress on post-exposure prophylaxis of tetanus immunological preparation in adults

The tetanus has been eliminated in the pregnancy women and newborns in China. However, there is a gap for adult tetanus immunization, and the risk of tetanus infection cannot be ignored. In order to clearly understand the effect of the tetanus to human beings and the current use of tetanus immunological preparation for adult post-exposure prophylaxis, the incidence of the tetanus, the use status of tetanus immunological preparation and recommendations for post-exposure prophylaxis at home and abroad were reviewed and summarized, which may provide academic evidence for post-exposure prophylaxis procedures and use of tetanus immunological preparation.

Factors associated with in-hospital mortality of adult tetanus patients-a multicenter study from Bangladesh.

Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh. This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26). A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07-15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05-10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications. Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.

Clinical profile of adult tetanus patients and the impact of early tracheostomy on the outcome; a retrospective observational study

Clinical profile of adult tetanus patients and the impact of early tracheostomy on the outcome; a retrospective observational study

The management of tetanus in adults in an intensive care unit in Southern Vietnam.

Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.