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Tuesday, March 22, 2005 - 9:25 AM

Trends in Tetanus Epidemiology in the United States, 1972-2001

Pamela Srivastava, Kristin Brown, Jufu (Jeff) Chen, Katrina Kretsinger, and Martha Roper. National Immunization Program/ESD, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-61, Atlanta, GA, USA

Tetanus is severe and often fatal. The introduction and widespread use of tetanus toxoid (TT) vaccine in the late 1940s accelerated reductions in both tetanus morbidity and mortality.

To describe the epidemiology of tetanus from 1972 to 2001 in the United States.

We analyzed all reports of tetanus cases submitted to the National Notifiable Diseases Surveillance System, CDC, from January 1972 through December 2001.

Between 1972 and 2001, 1842 cases of tetanus were reported. The average annual incidence per million decreased from 0.39 in 1972-1976 to 0.16 in 1997-2001; the case fatality rate (CFR) decreased from 45% to 16%. Among the 932 cases (51%) for whom TT vaccination history was reported: 644 (69%) were unvaccinated and had a CFR of 28%; 172 (18%) had received 1 or 2 TT doses (CFR of 17%), and 114 (12%) had received 3 or more doses (CFR of 4%). Only 4 of 520 persons dying from tetanus (0.7%) had a history of at least 3 TT doses. Tetanus incidence and mortality were highest throughout the study period among persons 60 and older, with an overall incidence of 0.78/million and CFR of 40%. Diabetics were at increased risk for fatal tetanus [age-adjusted relative risk 1.9 (95%CI 1.4-2.6)], compared to non-diabetics. Injection drug users (IDUs) accounted for 12% of tetanus cases in 1992-2001, an almost 3-fold increase compared with the previous decade.

Between 1972 and 2001, reported tetanus incidence decreased by 59% and CFR decreased by 64%. Receipt of > 3 TT doses protects against both disease and mortality. Older adults, diabetics, and IDUs are at particular risk for tetanus disease and death.

To understand the epidemiology of tetanus in the United States today so that immunization programs can target persons at increased risk.

See more of Epidemiology Track Workshop:Tetanus and Diphtheria: Not in My Backyard?
See more of The 39th National Immunization Conference (NIC)