Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis
Objectives: This study identifies key risk factors for fatality among adult tetanus patients, assesses the impact of vaccination status and antibody levels on disease severity and outcomes in tetanus cases. Despite widespread vaccination, fatality rates remain high due to diagnostic and management c...
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| Language: | English |
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Elsevier
2025-04-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225000050 |
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| author | Selin Kolsuz Deniz Güllü Koçer Dilan Karahan Önder Ergönül |
| author_facet | Selin Kolsuz Deniz Güllü Koçer Dilan Karahan Önder Ergönül |
| author_sort | Selin Kolsuz |
| collection | DOAJ |
| description | Objectives: This study identifies key risk factors for fatality among adult tetanus patients, assesses the impact of vaccination status and antibody levels on disease severity and outcomes in tetanus cases. Despite widespread vaccination, fatality rates remain high due to diagnostic and management challenges. Design/Methods: A meta-analysis of 182 tetanus cases from 36 countries, published since 1990, was conducted. The analysis focused on risk factors such as autonomic dysfunction, opisthotonus, incubation time, diabetes mellitus, cardiovascular diseases, and dermatological conditions. Results: Key risk factors for fatality included autonomic dysfunction, opisthotonus, shorter incubation periods, diabetes mellitus, cardiovascular diseases, and ulcers and dermatological conditions. Interestingly, fatalities occurred in patients with antibody levels above the proposed protective threshold, showing that serological evidence of immunity is not absolute. Importantly, patients with a complete vaccination history experienced less severe disease, and no fatalities were observed among those who had received a full course of childhood vaccinations. Conclusions: The findings highlight the importance of maintaining up-to-date vaccination schedules to reduce the severity of disease and improve outcomes in tetanus cases. The results suggest that while immunity may not always prevent infection, prior vaccination significantly mitigates disease severity. Given that immunity may not be entirely protective and up-to-date vaccinations seem to improve the outcomes, prompt diagnosis and effective booster vaccinations are crucial to further reduce mortality in tetanus patients. |
| format | Article |
| id | doaj-art-ae75f279693a4c99a598376d916243bd |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-ae75f279693a4c99a598376d916243bd2025-01-26T05:03:32ZengElsevierInternational Journal of Infectious Diseases1201-97122025-04-01153107781Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysisSelin Kolsuz0Deniz Güllü1Koçer Dilan Karahan2Önder Ergönül3Koç University School of Medicine, Istanbul, TurkeyKoç University School of Medicine, Istanbul, Turkey; Koç University-Isbank Center for Infectious Diseases, Istanbul, Turkey; Koç University Graduate School of Health Sciences, Istanbul, TurkeyIstanbul University Cerrahpasa - Cerrahpasa School of Medicine, Istanbul, TurkeyKoç University-Isbank Center for Infectious Diseases, Istanbul, Turkey; Department of Infectious Diseases, Koç University School of Medicine, Istanbul, Turkey; Corresponding author: Önder Ergönül, Topkapı, Koç Üniversitesi Hastanesi, Davutpaşa Cd. No:4, 34010, Zeytinburnu/İstanbul, TurkeyObjectives: This study identifies key risk factors for fatality among adult tetanus patients, assesses the impact of vaccination status and antibody levels on disease severity and outcomes in tetanus cases. Despite widespread vaccination, fatality rates remain high due to diagnostic and management challenges. Design/Methods: A meta-analysis of 182 tetanus cases from 36 countries, published since 1990, was conducted. The analysis focused on risk factors such as autonomic dysfunction, opisthotonus, incubation time, diabetes mellitus, cardiovascular diseases, and dermatological conditions. Results: Key risk factors for fatality included autonomic dysfunction, opisthotonus, shorter incubation periods, diabetes mellitus, cardiovascular diseases, and ulcers and dermatological conditions. Interestingly, fatalities occurred in patients with antibody levels above the proposed protective threshold, showing that serological evidence of immunity is not absolute. Importantly, patients with a complete vaccination history experienced less severe disease, and no fatalities were observed among those who had received a full course of childhood vaccinations. Conclusions: The findings highlight the importance of maintaining up-to-date vaccination schedules to reduce the severity of disease and improve outcomes in tetanus cases. The results suggest that while immunity may not always prevent infection, prior vaccination significantly mitigates disease severity. Given that immunity may not be entirely protective and up-to-date vaccinations seem to improve the outcomes, prompt diagnosis and effective booster vaccinations are crucial to further reduce mortality in tetanus patients.http://www.sciencedirect.com/science/article/pii/S1201971225000050TetanusVaccinationTetanus antitoxinMortalityMeta-analysis |
| spellingShingle | Selin Kolsuz Deniz Güllü Koçer Dilan Karahan Önder Ergönül Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis International Journal of Infectious Diseases Tetanus Vaccination Tetanus antitoxin Mortality Meta-analysis |
| title | Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis |
| title_full | Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis |
| title_fullStr | Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis |
| title_full_unstemmed | Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis |
| title_short | Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis |
| title_sort | risk factors and preventive role of vaccination in adult tetanus fatality a systematic review of reported cases 1990 2024 and meta analysis |
| topic | Tetanus Vaccination Tetanus antitoxin Mortality Meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225000050 |
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