6084 Cases of Adult Tetanus from China: A Literature Analysis

Gou, Yi; Li, Sheng-Ming; Zhang, Junfei; Hei, Xiao-Ping; Lv, Bo-Hui; Feng, Ke

doi:10.2147/idr.s404747

Cited by 5 publications

(8 citation statements)

References 48 publications

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“…Although China eliminated maternal and neonatal tetanus by 2012 without using the vaccine as other countries typically have, this success is primarily due to improved birth hygiene and increased in-hospital delivery rates. These results may lead some to believe TT vaccination boosters are unnecessary, but adult tetanus cases have been frequently reported in Chinese literature ( Gou et al, 2023 ). Tetanus antibody levels tend to decrease with age, putting adults over 20 years old at high risk of tetanus infection.…”

Section: Discussionmentioning

confidence: 99%

“…There is a lack of epidemiological data on non-neonatal tetanus in China, but in some reports, certain hospitals admitted more than 30 tetanus patients in a year ( Gou et al, 2023 ). Furthermore, seroprevalence data found that low antibody levels are common in young adults and antibody levels tend to decrease with age ( Nazik et al, 2020 ; Zhang et al, 2022a ).…”

Section: Introductionmentioning

confidence: 99%

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Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study

Gao,

Yu,

Cao

et al. 2023

PeerJ

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Background Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. Methods From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. Results The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient’s TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Conclusions Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians’ knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians’ awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study

Gao,

Yu,

Cao

et al. 2023

PeerJ

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“…Autonomic disturbances mimicking "sympathetic storming" can frequently occur, so pancuronium should be avoided because of its potential to inhibit catecholamine reuptake. 21,64 Imperative to treatment are debridement of the wound and use of antibiotic therapy against C. tetani.…”

Section: Neuromuscular Complicationsmentioning

confidence: 99%

Neuroinfectious Emergencies

Reynolds

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article describes nervous system infections and complications that lead to neurologic emergencies. LATEST DEVELOPMENTS New research on the use of dexamethasone in viral and fungal infections is reviewed. The use of advanced MRI techniques to evaluate nervous system infections is discussed. ESSENTIAL POINTS Neurologic infections become emergencies when they lead to a rapid decline in a patient’s function. Emergent complications may result from neurologic infections that, if not identified promptly, can lead to permanent deficits or death. These complications include cerebral edema and herniation, spinal cord compression, hydrocephalus, vasculopathy resulting in ischemic stroke, venous thrombosis, intracerebral hemorrhage, status epilepticus, and neuromuscular respiratory weakness.

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“…This results in spasmodic motor muscle paralysis ( 1 ). Disease onset typically occurs within 3–20 days (average: 7 days) after infection, with a reported incubation period of up to 120 days ( 2 ). Following symptoms, including neck tension, tongue-twisting, and injured limb prodding, the patient progressively loses the ability to walk, causing general paralysis.…”

Section: Introductionmentioning

confidence: 99%

“…Following symptoms, including neck tension, tongue-twisting, and injured limb prodding, the patient progressively loses the ability to walk, causing general paralysis. In severe cases, respiratory muscle paralysis can lead to death ( 2 – 4 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative pathogenomic analysis reveals a highly tetanus toxin-producing clade of Clostridium tetani isolates in Japan

Shitada,

Sekizuka,

Yamamoto

et al. 2023

mSphere

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Clostridium tetani is the etiological agent of the disease tetanus, resulting in various symptoms, including neck tension, tongue-twisting, a decline in walking ability, and death in severe cases. To date, publicly available genome sequences of C. tetani are limited. C. tetani was isolated from soil in Kumamoto Prefecture, Japan, between 2020 and 2022. Subsequently, bacteriological, biochemical, genetic, and immunological tests were conducted. Among the 46 soil sampling sites, 151 C . tetani strains were isolated from 33 sites, with a 71.7% positivity rate. Comparative genomic analysis subdivided clade 1 into clades 1-1, 1-2, and 1-3. The enzyme-linked immunosorbent assay revealed that partial clade 1-3 strains produced over sevenfold more tetanus neurotoxin (TeNT) than the reference strain (first isolate of C. tetani KHSU-154301-001). RNA-Seq analysis supported this elevated tetanus toxin tetX gene expression. Additionally, tetX -negative strains were isolated from the clade, indicating that TeNT may not be essential for ensuring the survival of their offspring without its representative toxin-causing tetanus. Five strains acquired the tetracycline resistance gene tet (M) in the tetX plasmid, resulting in significantly reduced susceptibility to tetracycline. In conclusion, although we investigated C. tetani isolates from a specific region of the Kumamoto Prefecture, we demonstrated that these isolates exhibit variable genomic features, toxin productivity, and substantial acquired antimicrobial resistance. These findings indicate that multiple C. tetani lineages have successfully adapted to the soil in Japan, as evidenced by the additional genome information and toxin productivity assays in this study. IMPORTANCE C. tetani is a spore-forming, anaerobic bacterium that produces a toxin causing muscle stiffness and paralysis. Tetanus is preventable with the toxoid vaccine, but it remains a significant public health threat in regions with low vaccine coverage. However, there are relatively few isolates and limited genomic information available worldwide. In Japan, about 100 cases are reported each year, but there have been no nationwide surveys of isolates, and no genomic information from Japanese isolates has been published. In our study, we analyzed the genomes of 151 strains from a limited survey of soil in Kumamoto, Japan. Our findings revealed a high degree of genetic diversity, and we also identified a subset of strains that produced significantly more toxin, which provides new insights into the pathogenesis of tetanus. Our findings lay the foundation for future studies to investigate the distribution and evolution of C. tetani in Japan and neighboring countries.

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6084 Cases of Adult Tetanus from China: A Literature Analysis

Cited by 5 publications

References 48 publications

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study

Neuroinfectious Emergencies

Comparative pathogenomic analysis reveals a highly tetanus toxin-producing clade of Clostridium tetani isolates in Japan

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