Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011-2019

Tetanus Cases in Mogadishu-Somalia: A Tragic Disease Despite the Existence of a Century-Old Safe and Efficient Tetanus Vaccine

Introduction

Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities.

Methods

This study includes tetanus patients who were admitted to the Recep Tayyip Erdoğan Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients' sociodemographic details.

Results

The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1-38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p<0.001), generalized/neonatal tetanus (p<0.001), high non-vaccination rate (p:0.011), antibiotic usage (p<0.001), and a positive blood culture (p<0.001). Almost all of the complications (p<0.001) and all of the deaths (p<0.001) were in the severe group.

Conclusion

In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine's low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.

Risk assessment of severe adult tetanus using the NLR and AST level and construction of a nomogram prediction model

We sought to examine high-risk factors for severe tetanus, construct a nomogram model, and predict the risk probability of severe tetanus in adult patients to provide a theoretical basis for clinical intervention. Methods: A retrospective analysis was employed in this study, which enrolled 65 adult patients with tetanus diagnosed at the Second Affiliated Hospital of Hainan Medical University from January 2017 to September 2022. Study participants were divided into severe and mild groups based on the Ablett classification. The general data and laboratory markers of both groups were compared, and logistic regression analysis was used to screen for independent risk factors for severe tetanus. A nomogram prediction model was constructed, and receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA) were constructed and used to assess discrimination, calibration, and net benefit. Results: Of the 65 adults patients with tetanus, 28 were placed in the severe group and 37 were placed in the mild group. Univariate logistic regression analysis showed that there were statistically significant differences in the incubation period, time from disease onset to treatment, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase level (LDH), myoglobin level (Mb), and aspartate aminotransferase (AST) level between the two groups (P < 0.05). while the differences in age; sex; and creatine kinase, creatine kinase isoenzyme, and alanine aminotransferase levels were not statistically significant (P > 0.05). Multivariate analysis showed that NLR (odds ratio [OR] = 4.998, 95 % confidence interval [CI] = 1.154-21.649, P = 0.031), AST (OR = 1.074, 95 % CI = 1.007-1.146, P = 0.031), PLT (OR = 1.055, 95 % CI = 1.006-1.106, P = 0.027), and incubation period (OR = 0.597, 95 % CI = 0.423-0.843, P = 0.003) are independent risk factor for severe tetanus. A Nomogram for predicting Severe Tetanus (N-ST) prediction model was constructed based on variables in the multivariate analysis with P < 0.05. The ROC curve showed that the optimal cutoff point was 108.044 points. At this point, the sensitivity was 86.5 %, the specificity was 89.3 %, the area under the ROC curve was 0.936, and model discrimination was good. The calibration curve overlapped with the ideal curve, and the DCA curve showed that the model can provide clinical benefits. Conclusion: NLR, AST, PLT, and incubation period are predictors of severe tetanus. The constructed N-ST model can provide a new, convenient, and rapid method to predict the risk probability of severe tetanus in adults and guide early clinical intervention.

Adult tetanus is not gone yet, but could be ready to leave: A case-series from central India

Introduction

Adult tetanus is a neurotoxin mediated infectious disease, that continues to be seen despite availability of a highly efficacious vaccine. In India population-based burden estimates for adult tetanus are not available. Elimination of neonatal and maternal tetanus from India was achieved in 2015 with DPT (diphtheria, pertusis, and tetanus) vaccine during childhood and tetanus toxoid (TT) during antenatal care. Vaccine coverage in adults is uneven. While pregnant women receive the vaccine as part of ante-natal care, booster dose coverage in all other non-pregnant women and men is poor.

Case report

We describe four cases of adult tetanus that presented to our tertiary care hospital in central India. Out of four cases, two were homemakers, one was a farmer, another was a student. Three of them were not aware regarding primary tetanus vaccination and none of the four received any booster dosages of tetanus vaccine.

Conclusions

These cases highlight complexity of disease management and reinforce the need for adult booster immunization against tetanus.

Understanding the Trajectory to a Diagnosis of Tetanus: A Descriptive Study

Background and objective Tetanus is a rare but potentially fatal disease in developed countries, including Japan. It is very difficult to diagnose this condition early because of its broad symptomatology and the lack of familiarity with tetanus among both physicians and patients. In this study, we aimed to describe the clinical manifestations of tetanus and to examine as to which departments/branches of medicine patients consult in order to provide helpful information for diagnosing this challenging condition. Materials and methods This was a descriptive, retrospective study conducted at a single tertiary hospital from January 2011 to December 2021. Patients with generalized tetanus, cephalic tetanus, and local tetanus presenting to our emergency department were included in the study. We examined the clinical manifestations and departments that patients with tetanus visited first. Additionally, the initial diagnosis and diagnostic evaluation before the diagnosis were examined. Results Of the total 10 patients included in the study, nine had generalized tetanus and one had cephalic tetanus; the common initial manifestations were neck stiffness (30%), dysarthria (20%), and trismus (20%). Of note, 80% of patients also complained of dysphagia before the diagnosis. Patients first visited various departments, including a dental clinic (30%) and the department of otorhinolaryngology (20%). Only two patients were accurately diagnosed with tetanus at the first department they visited. Physicians performed head imaging for all the patients. Conclusions Based on our findings, in Japan, patients with tetanus present with symptoms that physicians interpret or suspect to be associated with disorders of the central nervous system. Meanwhile, patients themselves tend to consider the symptoms as indicative of oral or dental issues. Further prospective studies involving a larger number of participants are needed to investigate the clinical course of tetanus until the establishment of a diagnosis.

The Role of Surgical Debridement in the Treatment of Systemic Tetanus: A Case Report

CASE

Tetanus is a potentially life-threatening infection of Clostridium tetani characterized by painful muscular spasms and hypertonia. Surgical debridement of infected tissue is intended to reduce the number of spores and limit the extent of the disease. We report a case of an unvaccinated 13-year-old adolescent boy who presented with systemic tetanus after stepping on a nail, and we describe the role that surgical debridement of infected tissue plays in optimizing outcomes.

CONCLUSION

Orthopaedic surgeons must remain aware of the role of surgical debridement of wounds potentially infected with C. tetani because it is an important component of proper management.

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.