Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Expanded Programme on Immunization, Ministry of Health, Kampala, Uganda.
Int J Epidemiol. 2023 Aug;52(4):1150-1162. doi: 10.1093/ije/dyad005. Epub 2023 Feb 10.
Despite providing tetanus-toxoid-containing vaccine (TTCV) to infants and reproductive-age women, Uganda reports one of the highest incidences of non-neonatal tetanus (non-NT). Prompted by unusual epidemiologic trends among reported non-NT cases, we conducted a retrospective record review to see whether these data reflected true disease burden.
We analysed nationally reported non-NT cases during 2012-2017. We visited 26 facilities (14 hospitals, 12 health centres) reporting high numbers of non-NT cases (n = 20) or zero cases (n = 6). We identified non-NT cases in facility registers during 1 January 2016-30 June 2017; the identified case records were abstracted.
During 2012-2017, a total of 24 518 non-NT cases were reported and 74% were ≥5 years old. The average annual incidence was 3.43 per 100 000 population based on inpatient admissions. Among 482 non-NT inpatient cases reported during 1 January 2016-30 June 2017 from hospitals visited, 342 (71%) were identified in facility registers, despite missing register data (21%). Males comprised 283 (83%) of identified cases and 60% were ≥15 years old. Of 145 cases with detailed records, 134 (92%) were clinically confirmed tetanus; among these, the case-fatality ratio (CFR) was 54%. Fourteen cases were identified at two hospitals reporting zero cases. Among >4000 outpatient cases reported from health centres visited, only 3 cases were identified; the remainder were data errors.
A substantial number of non-NT cases and deaths occur in Uganda. The high CFR and high non-NT burden among men and older children indicate the need for TTCV booster doses across the life course to all individuals as well as improved coverage with the TTCV primary series. The observed data errors indicate the need for data quality improvement activities.
尽管乌干达为婴儿和育龄妇女提供了含破伤风类毒素的疫苗（TTCV），但仍是报告的非新生儿破伤风（non-NT）发病率最高的国家之一。由于报告的非新生儿破伤风病例出现了不同寻常的流行病学趋势，我们开展了一项回顾性病历回顾，以了解这些数据是否反映了真实的疾病负担。
我们分析了 2012-2017 年期间全国报告的非新生儿破伤风病例。我们走访了报告非新生儿破伤风病例较多的 26 家机构（14 家医院，12 家卫生中心）（高病例组 n=20，零病例组 n=6）。我们在 2016 年 1 月 1 日至 2017 年 6 月 30 日期间在机构登记册中确定非新生儿破伤风病例；并对确定的病例记录进行了摘录。
2012-2017 年期间，共报告了 24518 例非新生儿破伤风病例，74%的患者年龄≥5 岁。根据住院患者数据，年平均发病率为每 10 万人 3.43 例。在所走访的医院中，在 2016 年 1 月 1 日至 2017 年 6 月 30 日期间报告的 482 例非新生儿破伤风住院患者中，有 342 例（71%）在机构登记册中被发现，尽管登记册数据缺失（21%）。男性患者有 283 例（83%），60%的患者年龄≥15 岁。在 145 例有详细记录的患者中，有 134 例（92%）被临床确诊为破伤风，其中病死率（CFR）为 54%。在报告零病例的两家医院中发现了 14 例病例。在所走访的卫生中心中，报告了超过 4000 例的门诊病例，但仅发现了 3 例，其余的均为数据错误。
乌干达发生了大量的非新生儿破伤风病例和死亡。高病死率和高非新生儿破伤风负担在男性和较大儿童中表明，需要对所有人群在整个生命过程中加强破伤风类毒素加强剂的接种，并改善破伤风类毒素基础系列的覆盖率。观察到的数据错误表明需要开展数据质量改进活动。
