Pascual F Brian, McGinley Emily L, Zanardi Lynn R, Cortese Margaret M, Murphy Trudy V
Epidemiology and Surveillance Division, National Immunization Program, USA.
MMWR Surveill Summ. 2003 Jun 20;52(3):1-8.
PROBLEM/CONDITION: Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s.
This report covers surveillance data for 1998--2000.
Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states.
During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis.
The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged >60 years were at highest risk for tetanus and tetanus-related death.
Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.
问题/状况：破伤风是一种严重且往往致命的感染。自20世纪40年代引入破伤风类毒素疫苗以来，美国报告病例的发病率稳步下降。
本报告涵盖1998 - 2000年的监测数据。
医生诊断的破伤风病例报告给美国疾病控制与预防中心（CDC）的国家法定传染病监测系统。各州提供补充临床和流行病学信息。
1998 - 2000年期间，每年平均报告43例破伤风病例；年均发病率为每百万人口0.16例。报告的破伤风年均发病率最高的是60岁以上人群（每百万人口0.35例）、西班牙裔人群（每百万人口0.37例）以及已知患有糖尿病的老年人（每百万人口0.70例）。15%的病例发生在注射吸毒者中。已知结局的113例患者的病死率为18%；75%的死亡病例发生在60岁以上患者中。破伤风类毒素疫苗接种及时的人群中无死亡病例。在可获取受伤信息的129例病例中，73%报告有急性损伤；其中，只有37%因急性损伤寻求医疗救治，且只有63%符合条件的人接受了破伤风类毒素进行伤口预防。
大多数破伤风病例发生在疫苗接种不足或接种史不明且遭受急性损伤的人群中。60岁以上成年人患破伤风及破伤风相关死亡的风险最高。
破伤风可通过常规接种疫苗（即基础免疫系列和每十年一次的加强免疫）及适当管理来预防。2000年开始的破伤风和白喉类毒素疫苗短缺于2002年结束。医疗保健提供者有必要努力为接种延迟或不完全的人群接种疫苗，重点是老年人和有高危状况的人群。
