Background: Although environmental exposure to Clostridium tetani spores is ubiquitous, tetanus is almost completely preventable through immunization. Routine immunization and wound care have resulted in a 95% decline in incidence since the 1940s.
Objectives: To describe surveillance and epidemiologic trends of tetanus in the
Methods: We analyzed data from the National Notifiable Diseases Surveillance System for tetanus cases reported to the CDC from 2001 through 2008.
Results: During 2001 through 2008, 233 tetanus cases were reported, a 35% decrease when compared to cases reported during 1991 through 1998 (n=357). The median age was 49 years (range 11 days-94 years) and 58.8% of cases were male. One neonatal case was reported. Thirty cases (12.9%) were reported as diabetic, and 27 (11.2%) as injecting drug users. Immunization data were available for 92(40%) cases; 29 received ≥3 doses tetanus toxoid, 26 received 1 dose, and 37 were unimmunized. One hundred and sixty seven (72%) cases identified an acute wound before onset, for which 61 (37%) sought medical care; 50% were puncture wounds to an extremity. Twenty six deaths occurred among 197 cases with reported outcome; case fatality rate (CFR) =13.2%. CFR was significantly higher in individuals age ≥65 years compared to those <65 (Attack Rate Ratio [ARR] =7.2, p<0.001), and in diabetics <65 years compared to nondiabetics <65 (ARR=6.5, p=0.03). None of the fatal cases had received more than 1 vaccine dose before onset; however vaccination history was unknown or missing in 14 of 26 fatal cases.
Conclusions: The number of tetanus cases continues to decrease in the
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