TETANUS IN SWITZERLAND 1980-1989

Tetanus cases that occurred in Switzerland between 1980 and 1989 have been reviewed with the help of three data surveillance systems: a) mor bidity data from the Federal Office of Public Health (FOPH), b) mortal ity data from the Swiss Federal Statistical Office (SFSO), and c) data from the Association of Swiss Hospitals and Clinics (VESKA), complete d by a written enquiry to clinics which did not (or only partly) parti cipate in the VESKA system during the study period. For every case, a questionnaire was sent to the clinic to verify the diagnosis and to ob tain additional information on the circumstances of occurrence. Ninety -one cases were identified. This corresponds to a yearly incidence of 1.93 per million population between 1980-84 and 0.88 for the 1985-89 p eriod (p < 0.01). Eighty-one percent of the cases were older than 50 y ears of age and women were significantly more frequently affected than men. None of the cases identified had a documented primary immunizati on series. Data available at the FOPH and SFSO level have been compare d to data obtained through the VESKA system using the Chandra Sekhar a nd Deming method. It is estimated that 134 tetanus cases (95% CI: 91-1 97) have occurred in Switzerland between 1980 and 1989, together with 28 deaths (95% CI: 27-31). Based on these estimates, FOPH appears to d etect only 6-13% of tetanus cases occurring in Switzerland. By contras t, SFSO had fairly consistent data for 81-100% of tetanus associated d eaths. The low rate of tetanus reported by physicians necessitates a s ustained effort to increase the understanding of epidemiological surve illance by Swiss practitioners.