Incidence and Factors Associated with Death for Tetanus in Adults
Abstract
Introduction: Tetanus has a worldwide distribution and high lethality. The goal of this study was to characterize the tetanus cases confirmed in Pernambuco and identify factors associated with death in these patients.
Methods: Cross-sectional, with internal comparison groups. For data analysis we used the chi-square test and Pearson estimated the odds ratios and their respective confidence intervals at 95%. Multivariate analysis was applied to multiple logistic regression
Results: The incidence of tetanus ranged between 0.65 and 2.79 cases per 100,000 inhabitants with higher involvement of adults, male and city population. Only 13.8% had received the vaccine and 23.4% received it as prophylaxis. The average mortality rate was 20.4%. In multivariate analysis, presented neck stiffness as a symptom (p = 0.029), which was associated with increased mortality.
Conclusion: There is a need for greater investment in the prevention of the disease, both in immunization coverage and in the application of prophylaxis. Despite the hospitalization guarantee with proper care, there was an increase in tetanus mortality, suggesting that more specific studies should be conducted to investigate what may have influenced this change. Special attention should be offered to cases that presented neck stiffness as a symptom, because these groups have a higher chance of progressing to death.
References
Tétanos: ¡Todavía un problema de salud pública!. Iatreia. 2008
Apr./June; 21(2): 186-198.
2. Organização Mundial da Saúde. Vaccine-preventable diseases:
monitoring system. 2010 global summary.
3. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Guia de Vigilância em Saúde. Brasília: Ministério da Saúde,
2014. 812 p. Available from: www.saude.gov.br/bvs
4. Centers for Disease Control and Prevention. Tetanus Surveillance-
United States, 2001-2008. Morbidity and Mortality Weekly
Report (MMWR) 2011; 60.
5. Gouveia P.A.C., Silva C.E.F., Miranda-Filho D.B., Bernardino
S.N., Escarião A.G., Ximenes R.A.A. Tendência temporal do
tétano acidental no período de 1981 a 2004 em Pernambuco
com avaliação do impacto da assistência em unidade de terapia
intensiva sobre a letalidade. Rev. Soc. Bras. Med. Trop. 2009
Fev; 42(1): 54-57.
6. Armijo M.J., Soto-Aguilar B.F., Brito A.C. Tétanos generalizado:
caso clínico y revisión del tema. Rev. chil. neuro-psiquiatr. 2012
Dic.; 50(4): 229-233.
7. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Departamento de Análise de Situação em Saúde. Saúde
Brasil 2012: uma análise da situação de saúde e dos 40 anos
do Programa Nacional de Imunizações. Brasília: Ministério da
Saúde; 2013. 536.
8. Maeda S.T., Gryschek A.L.F.L.P., Duarte Y.A.O., Tomo T.T..
Tétano acidental no município de São Paulo: da perspectiva
epidemiológica à dimensão individual no processo de
atendimento. Saúde Coletiva. 2009; 6(31): 135-140.
9. Neves F.F., Faiolla R.C.L., Napoli E,M.G., Lima G.M.N., Muniz
R.Z.A., Pazin-Filho A. Perfil clínico-epidemiológico dos casos
de tétano acidental ocorridos em Ribeirão Preto, Estado de São
Paulo, no período de 1990 a 2009. Rev. Soc. Bras. Med. Trop.
2011 Aug; 44(4): 481-485.
10. Chalya, P. L., Mabula, J. B., Dass, R. M., Mbelenge, N., Mshana,
S. E., Gilyoma, J. M. Ten-year experiences with Tetanus at a
Tertiary hospital in Northwestern Tanzania: A retrospective
review of 102 cases. World Journal of Emergency Surgery. 2011
Jul 8; 6: 20.
11. Vieira L.J., Santos L.M.. Aspectos epidemiológicos do tétano
acidental no Estado de Minas Gerais, Brasil, 2001-2006.
Epidemiol. Serv. Saúde. 2009 Dez; 18(4): 357-364.
12. Feijão A.R., Brito D.M.S., Peres D.A., Galvão M.T.G. Tétano
acidental no Estado do Ceará, entre 2002 e 2005. Rev. Soc.
Bras. Med. Trop. 2007 Aug; 40(4): 426-430.
13. Pagliuca L. Marlena F., Feitoza A.R., Feijão A.R.. Tétano na
população geriátrica: problemática da saúde coletiva?. Rev.
Latino-Am. Enfermagem. 2001 Nov; 9(6): 69-75.
14. Vieira L.J., Santos G.P.. Tétano acidental no idoso: situação em
Minas Gerais. Rev APS. 2011 abr/jun; 14(2): 177-184.
15. Weckx L.Y., Divino-Goes K., Lihama D.M., Carraro E., Bellei N.,
Granato C.F., et al. Effect of a single tetanus-diphtheria vaccine
dose on the immunity of elderly people in São Paulo, Brazil.
Brazilian Journal of Medical and Biological Research. 2006 Apr;
39(4): 519-523.
16. Rapisarda V., Bracci M., Nunnari G., Ferrante M., Ledda C.
Tetanus immunity in construction workers in Italy. Occup Med
(Lond). 2014; 64(3): 217-219.
17. Karabay O., Ozkardes F., Tamer A., Karaarslan K. Tetanus
immunity in nursing home residents of Bolu, Turkey. BMC Public
Health 2005 Jan 12; 5: 5.
18. Divino-Goes K.G., Moraes-Pinto M.I. de, Dinelli M.I.S.,
Casagrande S.T., Bonetti T.C.S., Andrade P.R. et al . Prevalence
of diphtheria and tetanus antibodies and circulation of
Corynebacterium diphtheriae in São Paulo, Brazil. Braz J Med
Biol Res. 2007 Dec; 40(12): 1681-1687.
19. MacDougall D.M., Halperin B.A., MacKinnon-Cameron D., Li L.,
McNeil S.A., Langley J.M., et al. The challenge of vaccinating
adults: attitudes and beliefs of the Canadian public and
healthcare providers. BMJ Open. 2015 Sep 29; 5 (9): e009062.
20. De Mattos A.C., Júnior C.G., Fuentefria A. Tetanus epidemiology
in Santa Catarina, Brazil from 1998 to 2008. Infectio. 2010;
14(2): 112-119.
21. Miranda-Filho D.B., Ximenes R.A.A., Bernardino S.N., Escarião
A.G.. Identification of risk factors for death from tetanus in
Pernambuco, Brazil: a case-control study. Rev. Inst. Med. trop.
S. Paulo. 2000 Dec; 42(6): 333-339.
22. Brauner J., Vieira R.S., Bleck T. Changes in severe accidental
tetanus mortality in the ICU during two decades in Brazil.
Intensive Care Med. 2002 July; 28(7): 930-935.
23. Saltoglu N., Tasova Y., Midikli D., Burgut R., Dündar I.H.
Prognostic factors affecting deaths from adult tetanus. Clinical
Microbiology and Infection. 2004 March;10(3): 229- 233.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright policies & self-archiving
We are a RoMEO green journal.
Author's Pre-print: author can archive pre-print (ie pre-refereeing)
Author's Post-print: author can archive post-print (ie final draft post-refereeing)
Publisher's Version/PDF: author can archive publisher's version/PDF
Copyright ownership
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 4.0 License ©