MMWR Morb Mortal Wkly Rep. 2011 Apr 1;60(12):365-9.
Tetanus is a life-threatening but preventable disease caused by the toxin of Clostridium tetani, a ubiquitous, spore-forming, gram-positive bacillus found in high concentrations in soil and animal excrement. Reported tetanus cases have declined >95%, and deaths from tetanus have declined >99% in the United States since 1947, when the disease became reportable nationally. To update a previous report and to determine the populations at greatest risk for the disease, CDC analyzed cases reported to the National Notifiable Diseases Surveillance System (NNDSS) during 2001--2008. This report summarizes the results of that analysis, which found that 233 tetanus cases were reported during 2001--2008; among the 197 cases with known outcomes, the case-fatality rate was 13.2%. Average annual incidence during that period was 0.10 per 1 million population overall and 0.23 among persons aged ≥65 years. Incidence among Hispanics was nearly twice that among non-Hispanics, a difference accounted for by 16 cases among Hispanic injection drug users (IDUs). Among the 92 patients for whom tetanus toxoid-containing (TT) vaccination status was available, 37 (40.2%) had received no doses of TT vaccine. Thirty (15.4%) of 195 patients had diabetes, and 27 (15.3%) of 176 were IDUs. Of 51 patients with an acute wound and a surveillance report complete enough to evaluate tetanus prophylaxis, 49 (96.1%) had not received appropriate prophylaxis. Tetanus remains a rare but life-threatening disease in the United States. Health-care providers should ensure up-to-date TT vaccination of all their patients, especially persons aged ≥65 years, persons with diabetes, and injection drug users.
破伤风是一种由破伤风梭菌（Clostridium tetani）毒素引起的危及生命但可预防的疾病，破伤风梭菌是一种普遍存在的、形成孢子的革兰氏阳性杆菌，在土壤和动物粪便中浓度很高。自 1947 年美国开始报告全国破伤风病例以来，报告的破伤风病例减少了>95%，破伤风死亡人数减少了>99%。为了更新以前的报告，并确定患该病风险最大的人群，CDC 分析了 2001-2008 年国家传染病监测系统（NNDSS）报告的病例。本报告总结了该分析的结果，发现 2001-2008 年期间报告了 233 例破伤风病例；在已知结局的 197 例病例中，病死率为 13.2%。该期间的年平均发病率为每 100 万人中有 0.10 例，65 岁及以上人群中为 0.23 例。西班牙裔的发病率几乎是非西班牙裔的两倍，这一差异归因于 16 例西班牙裔注射吸毒者（IDU）的病例。在 92 例可获得破伤风类毒素（TT）疫苗接种状况的患者中，37 例（40.2%）未接种 TT 疫苗。195 例患者中有 30 例（15.4%）患有糖尿病，176 例中有 27 例（15.3%）为 IDU。在 51 例有急性伤口和足够完整的监测报告以评估破伤风预防的患者中，49 例（96.1%）未接受适当的预防。在美国，破伤风仍然是一种罕见但危及生命的疾病。医疗保健提供者应确保所有患者，特别是 65 岁及以上人群、糖尿病患者和注射吸毒者，及时接种 TT 疫苗。
