KEYWORD1:
Tetanus, Surveillance, Injecting Drug Use

BACKGROUND:
The number of tetanus cases reported annually in California has increased steadily in the past 10 years. Since 1987, injecting drug users (IDUs) have emerged as a high risk group and now represent 1/3 to 1/2 of all tetanus cases reported each year.

OBJECTIVE:
To investigate the epidemiology and associated risk factors, especially among IDU, for tetanus disease.

METHOD:
Tetanus is a reportable condition in California. Detailed case histories collected during case investigations were analyzed to examine changes in disease epidemiology and risk factors for tetanus.

RESULT:
From 1987 to 2002 (first three quarters), 119 tetanus cases were reported, including 16 deaths. Sixty-nine percent of 48 cases with known vaccination history had not received a dose of tetanus during the past 10 years. Fifty-five percent of the cases were Hispanic, 36.7% were White, 6.7% were Asian/Pacific Islander and 3.3% were African American. Seventy-five percent of cases were 20-59 years of age, 19.3% were 60 years or older, and 5% were < 20 years. Forty-three percent of all cases were reported in IDUs. Of the 53 tetanus cases reporting injection drug use, 84.9% were Hispanic, 9.4% were white and 5.7% were African American; 81.1% were males. Eight cases reported among IDUs died, all were Hispanic.

CONCLUSION:
The disproportionate number of cases in the 20-59 year age group is in part due to an increased number of cases among Hispanic IDUs. The high risk among Hispanic IDUs may be related to low levels of immunity and exposure to contaminated heroin. Every effort should be made to ensure that all adults, especially IDUs, are up to date for tetanus vaccination.
LEARNINGOBJECTIVES:
To understand the epidemiology of tetanus in a large state. To demonstrate how tetanus surveillance data can be used to monitor changes in disease epidemiology and to identify high risk groups.