ACQUIRED TETANUS - CLINICAL AND EPIDEMIOL OGIC CHARACTERISTICS OF PATIENTS IN AN UNIVERSITY HOSPITAL

Introduction Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most d eveloping countries. Epidemiological transition is often cited as an e xplanation for this decline, the increase in vaccination coverage of c hildren being the most obvious cause. Few studies have looked carefull y at the current epidemiological patterns of acquired tetanus in devel oping countries. Methodology A descriptive, retrospective (series of c ases). An acute care 400 - bed university referral hospital situated i n a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. Results In the 57 m onth period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clin ical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were m ale and 18 (36%) female. Foul-teen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of t he rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were u nder 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a medi an of 54.5. Trismus was the most frequent (92.0%) clinical sign on adm ittance, followed by abdominal muscular rigidity (84.0%). Treatment me asures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare d epending on the intensity of spasms. In the second half of the study p eriod, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hosp italization exceeded 21 days in 56% (28) of the cases, only 10% (5) ha d a hospital stay of less than 7 days. Conclusions A high proportion o f patients were from rural nl eas, despite an urbanization rate of mor e than 90%. in the Campinas region there are two different epidemiolog ical patterns of acquired tetanus: a rural pattern, with a higher prop ortion of younger patients, determined by nit inadequate immunization rate and an urban pattern, similar to that found in industrialized cou ntries, with a higher proportion of older patients. Recommendations Th ere is an obvious need to immunize older individuals in urban areas an d young adults in rural areas. The elimination of acquired tetanus wil l only be achieved with a wider and more intensive adult vaccination p rogram.