Jiangtao Yu,1,* Benfeng Zheng,2,* Na Liu,2,3 Yiheng Zhu,4 Fen Hui,5 Jin Zhang,5 Lin Luan1,2 

1Department of Epidemiology, School of Public Health, National Vaccine Innovation Platform, Nanjing Medical University, Nanjing, 210000, People’s Republic of China; 2Department of Immunization Program, Suzhou Center for Disease Control and Prevention, Suzhou, 215000, People’s Republic of China; 3Center for Immunization Planning, Chinese Center for Disease Control and Prevention, Beijing, 100050, People’s Republic of China; 4Suzhou Municipal Health Commission, Suzhou, 215000, People’s Republic of China; 5The Fifth People’s Hospital of Suzhou, Suzhou, 215000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lin Luan, Email szluanlin@163.com

Objective: To investigate the epidemiology, and hospitalization of tetanus in Suzhou, Jiangsu Province, China, focusing on the severity of the disease, treatment, outcomes and hospitalization costs, and to explore the risk factors for severe tetanus.
Methods: This retrospective, multicenter observational study analyzed tetanus patients admitted to various medical institutions between 2013 and 2023. Patients were classified into two groups as severe or non-severe, using the Ablett classification. Differences between the two groups were compared using the Chi-squared test, Fisher’s exact test and Mann–Whitney U-test. Binary logistic regression analysis was used to evaluate potential risk factors for severe disease.
Results: A total of 63 patients with tetanus were included in this study. The median age of the patients was 57.0 (48.0– 74.0) years, with a predominance of males (65.1%). There was an overall increasing trend in the rate of severe illness in tetanus patients from 2013– 2023 (P< 0.001). The proportion of patients admitted to the hospital was highest (39.7%) in summer (June–August) (P=0.001). The rate of severe tetanus was significantly higher in patients aged ≥ 65 years than in those aged 0– 40 years and 41– 64 years (P=0.019). The incubation period was 8.0(5.0– 11.0) days for severe tetanus patients and 11.0 (8.0– 18.0) days for non-severe patients (P=0.005). Compared to the non-severe group, the severe group shouldered a higher hospitalization cost, with total costs amounting to US $19062.8(4675.4– 29,385.4) and US $4291.1(1356.6– 19,635.4), respectively. Binary logistic regression analysis revealed that patients aged 65 years and above significantly increased the risk of developing severe disease (OR = 3.345, 95% CI: 1.039– 10.770).
Conclusion: Tetanus occurs primarily in the summer in Suzhou City, Jiangsu Province, China. The incubation period is shorter in patients with severe tetanus. The elderly are the main affected population, with the risk of developing severe disease escalating with advancing age. Knowledge of tetanus immunoprophylaxis should be strengthened to further reduce morbidity and mortality.

Keywords: tetanus, severe, hospitalization, risk factors