Up-to-date tetanus shots lessen disease severity, improve survival outcomes

Complete childhood vaccinations help reduce the risk of mortality in adult patients with tetanus, according to a study.

Researchers conducted a systematic review and meta-analysis of studies that involved adult patients with tetanus and had data on clinical presentation, underlying conditions, management, and outcomes. The studies also explored risk factors such as autonomic dysfunction, opisthotonus, incubation time, diabetes mellitus, cardiovascular diseases, and dermatological conditions.

The meta-analysis included a total of 154 case reports/series involving 182 eligible adult tetanus patients (mean age 55.4 years, 62.1 percent male). Of the tetanus cases reported, 150 were generalized (82.4 percent), 24 were cephalic (13.1 percent), and eight were localized (4.3 percent). Patients with incubation period over 9 days were less likely to require ICU admissions (odds ratio [OR], 0.154, 95 percent confidence interval [CI], 0.048–0.490; p=0.002) and were less likely to die (OR, 0.276, 95 percent CI, 0.113–0.674; p=0.005).

Fatalities occurred in patients with antibody levels above the proposed protective threshold. Notably, those with a complete vaccination history had less severe disease; none of them died.

In multivariate analysis, cardiovascular disease was associated with the increased case fatality (OR, 112.3, 95 percent CI, 1.41–106.81; p=0.023), whereas incubation longer than 9 days was associated with decreased case fatality (OR, 0.3, 95 percent CI, 0.09–0.74; p=0.012).