Adult tetanus: unfinshed problem

ABSTRACT

As the immunization coverage of children and pregnant women widened, it is to be expected that neonatal and childhood tetanus will become rare. In Egypt, the recommendations for booster doses every 10 years in adults are poorly followed and no intervention takes place in persons above 9-10 years of age except for wound prophylaxis. The aim of this retrospective study was to describe epidemiological features of tetanus cases over the period from 1998 to 2004. Cases of non-neonatal tetanus were 238, mean annual frequency 34 +/- 3.3, most of the cases were adolescents and adults of both sexes except 4 children below 15 years, male to female ratio 4.41, 56.3% were farmers. Only 66% of the studied cases sustained an acute injury before onset of illness; 66.2% occurred after puncture wounds of whom 20.2% had stepped on a nail, 8.9% had an injury related to surgery or gluteal injection. Frequent sites for injury were the lower limb mainly the foot in 72.6% of cases, hand in 15.3%, head in 2.55% and teeth in 1 .3%. No data were available as regards the post-injury care of the wound, anti-tetanic prophylaxis, or the patients vaccination status. The incubation period ranged from 5-30 days and was related to severity of tetanus. Case-fatality rate was 18.9%; it increased at extremes of age and reached its maximum [62.1%] in patients =60 years. Case-fatality rate was significantly influenced by age, sex, site of injury, and duration of hospital stay but was not significantly influenced by type of tetanus or incubation period. All adult cases of tetanus were managed in the intensive care unit with assisted ventilation for 11 .8%. Thus considering expenses incurred in managing tetanus patients, it seems necessary to include booster doses in the Expanded Immunization Program, and to develop vaccination programs targeting adult males and elderly population of both sexes. Occupation may be an important consideration in the development of immunization policies