Litvoc J, Leite R M, Katz G
Departamento de Medicina Preventiva da Faculdade de Medicina, Universidade de São Paulo, Brasil.
Rev Inst Med Trop Sao Paulo. 1991 Nov-Dec;33(6):477-84.
Tetanus is a reportable disease in the State of São Paulo since 1978. The data from this source show a trend toward a decrease in the incidence of tetanus, although it is still higher than in the developed countries. There is a constantly high mortality rate. We have studied 133 cases of non-neonatal tetanus that had been reported to the Epidemiology Surveillance Center of the State of São Paulo in 1989. The data we analysed were obtained from the epidemiological report form routinely used during the investigation and confirmation of the cases. The incidence was 0.41 per 100.000 population and the mortality rate was 44.36%. It was possible to identify some groups under a higher risk like old-aged, those living in the western and north-western regions of the State and those classified occupationally as "domestic activities", "rural workers" and "pensioners". We propose that these groups deserve special attention, together with pregnant women and children. In 18.3% of the cases the incubation period could not be determined. The peak incidence occurred in May. We also compared the mortality rate in the group of patients in the Hospital das Clínicas da FMUSP (the only hospital in the State of São Paulo with an Intensive Unit Care designed exclusively to the treatment of the patients with tetanus) and the group of patients that were admitted to other hospitals. The mortality rate in the HC-FMUSP was 34.5% and in the other hospitals was 49.5%, but this was not statistically significant. The role of the medical facilities in the prognosis of the patient with tetanus specially the importance of considering at the same time the severity of the disease and the characteristics of the therapy deserve further study in order to contribute to the development of the medical assistance to the patients with tetanus.
自1978年以来，破伤风在圣保罗州属于应报告疾病。该来源的数据显示破伤风发病率呈下降趋势，尽管仍高于发达国家。死亡率一直居高不下。我们研究了1989年向圣保罗州流行病学监测中心报告的133例非新生儿破伤风病例。我们分析的数据来自病例调查和确诊过程中常规使用的流行病学报告表。发病率为每10万人口0.41例，死亡率为44.36%。有可能识别出一些高危人群，如老年人、居住在该州西部和西北部地区的人以及职业分类为“家务活动”、“农民工”和“退休人员”的人。我们建议这些人群以及孕妇和儿童应得到特别关注。在18.3%的病例中，潜伏期无法确定。发病高峰出现在5月。我们还比较了圣保罗大学医学院临床医院（圣保罗州唯一一家设有专门治疗破伤风患者的重症监护病房的医院）患者组和其他医院患者组的死亡率。圣保罗大学医学院临床医院的死亡率为34.5%，其他医院为49.5%，但这在统计学上无显著差异。医疗设施在破伤风患者预后中的作用，特别是同时考虑疾病严重程度和治疗特点的重要性，值得进一步研究，以便为破伤风患者的医疗救助发展做出贡献。
