Tetanus surveillance--United States, 1989-1990.

During the period 1989-1990, 117 cases of tetanus were reported from 34 states, for an average annual incidence of 0.02/100,000 population. Fifty-eight percent of patients were > or = 60 years of age, while seven (6%) were < 20 years of age, including one case of neonatal tetanus. Among adults, the risk of tetanus in those > 80 years of age was more than 10 times the risk in persons ages 20-29 years. The case-fatality rate increased with age, from 17% in persons 40-49 years of age to 50% in those > or = 80 years of age. Only 11% of patients reported having received a primary series of tetanus toxoid before disease onset, while 31% lacked a history of tetanus vaccination. Tetanus occurred following an acute injury in 78% of patients. Of patients who sought medical care, only 58% received tetanus toxoid as part of wound prophylaxis. Tetanus remains a severe disease that primarily affects unvaccinated or inadequately vaccinated older adults. Increased efforts are needed to reduce the risk of tetanus among the elderly. Health-care providers should take every opportunity to review the vaccination status of their patients and provide tetanus vaccine when indicated.