Investigation of the baseline tetanus antibody level and its persistence in a military unit

An unexpected case of tetanus in a fully immunized 20-year-old female: a case report

BACKGROUND

Widespread vaccinations have significantly decreased the number of tetanus cases in developed countries. Today, most cases of tetanus affect the elderly and those with inadequate immunization in developed countries such as Japan. As vaccinations were believed to be nearly 100% effective in preventing tetanus, tetanus in young, immunized individuals were considered unlikely. However, unexpected tetanus infection has been reported in young adequately immunized individuals.

CASE

We herein describe a 20-year-old immunized female who visited our emergency department with trismus and painful muscle spasms that started after receiving a puncture wound to her right foot. A physical examination revealed an elevated body temperature (38°C), trismus, muscle spasms in her right leg and neck, and a puncture wound at the sole of her right foot. Following the development of dyspnea after admission to the intensive care unit, the patient was intubated and mechanically ventilated. She fully recovered after six days in intensive care.

CONCLUSION

The present case serves as a stark reminder that tetanus may still occur in young, immunized individuals. Patients with a history of immunization may have a better prognosis than those with no immunizations.

Seroepidemiology of Tetanus among Healthy People Aged 1-59 Years Old in Shaanxi Province, China

The study aims to determine the seroprevalence of antibodies against tetanus among healthy people aged 1−59 years old in Shaanxi province. IgG against tetanus in serum samples were detected by ELISA. 6,439 subjects were enrolled. The positive rate (≥0.01 IU/mL) was 84.39% and GMC was 0.03 IU/mL. There were significant differences in positive rates (χ2 = 308.944, p < 0.01) and GMC (Z = 5,200,000, p < 0.01) among different age groups. The positive rates (χ2 = 304.3, p < 0.01) and GMCs (χ2 = 146.417, p < 0.01) showed regional differences. Both full protection rate (≥0.1 IU/mL) (χ2 = 36.834, p < 0.01) and GMC (Z = 688,000, p < 0.01) increased with the doses of tetanus-toxoid-containing vaccines (TTCVs) administered. The positive rate (χ2 = 54.136, p < 0.01) and GMC (Z = 140,200, p < 0.01) decreased gradually with the time interval after full immunization with TTCVs. The full protection rate (≥0.1 IU/mL) (χ2 = 176.201, p < 0.01) and GMC (Z = 629,900, p < 0.01) decreased with the interval (years) since the last dose of TTCVs. There were significant differences in the positive rates and GMCs for different ages, regions, immunization histories of TTCVs, and doses of TTCVs administered. The full protection rate and GMC decreased with the interval following full immunization with TTCVs and the interval since the last dose of TTCVs. The importance of using tetanus booster doses should be emphasized in adolescents and adults.

Tetanus in Uganda: clinical outcomes of adult patients hospitalized at a tertiary health facility between 2011 and 2020

Background

Tetanus is a vaccine-preventable infectious disease associated with high mortality rates. Increased vaccination coverage globally and locally has resulted in substantial declines in the number of individuals diagnosed with tetanus. We report annual trends in tetanus admissions and deaths over a decade at a national referral hospital in Uganda.

Methods

This was a retrospective cohort study, using data from an electronic database of patients admitted to medical wards at a national referral hospital between 2011 and 2020. Data were abstracted on demographic characteristics, that is, length of hospital stay and mortality outcome. Admission and mortality rate trends were analyzed using the Mann-Kendall’s trend test, whereas Kaplan-Meier survival curves were used to compare gender survival rates.

Results

During the study period, 459 individuals were admitted with tetanus. Of these, 85.8% (394 of 459) were males, and 26.1% (120 of 459) were aged 20 years or less. Overall, 48.8% (224 of 459) participants died, 85.3% (191 of 224) of whom were males (85.3%, n = 191), although females had a higher mortality rate (50.8%, 33 of 65 vs 48.5%, 191 of 394). Those aged 31–40 years accounted for 23.7% (53 of 224) of the deaths; and 88.7% (197 of 224) of the deaths occurred within the first 7 days of admission. The total number of tetanus admissions declined (Tau_A = −.6444, P = .0116). However, mortality rates remained stable (Tau_A = .0222, P > .999). The average length of hospital stay was 8.1 days (standard deviation, 7.5; range, 1–46).

Conclusions

Although tetanus admissions declined, mortality rate remained high. Males were disproportionately affected. We recommend quality-of-care audits for inpatient care improvement and more research on the determinants of infection and mortality to inform vaccination for at-risk men.