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Objectives <p>Non-neonatal tetanus continues to pose a public health challenge in low- and middle-income regions. This study aimed to describe the decade-long profile of non-neonatal tetanus in Guangdong, China, from 2011 to 2021—a period marked by rapid economic development and healthcare system strengthening.</p> Design <p>Multicenter, retrospective study.</p> Setting <p>The study was conducted across 159 hospitals in Guangdong, China.</p> Patients <p>We included patients with a clinical diagnosis of tetanus admitted between 2011 and 2021. A total of 2,567 cases (median age 53&#xa0;years; 62.1% male) were analyzed.</p> Interventions <p>None.</p> Measurements and main results <p>Data on demographics, vaccination status, clinical severity (Ablett classification), etiology, seasonal trends, critical care utilization, outcomes, and costs were collected. Farmers constituted the largest occupational group (43.7%), and only 2.2% had documented tetanus vaccination. Hospitalizations fluctuated but showed an overall increase, with a rising proportion of severe cases (Ablett grade III/IV). A seasonal peak was observed in August–September. The most common etiology was post-traumatic injury (43.4%). Critical care was frequently required: 25.1% of patients were admitted to the ICU, and 23.8% received mechanical ventilation. Multivariable analysis identified higher Ablett grade, injection drug use, unknown etiology, and comorbidities as independent risk factors for mortality; ICU admission was protective. Case fatality declined significantly from 11.8% in 2012 to 3.5% in 2021, while median hospitalization costs rose substantially.</p> Conclusions <p>This large-scale study reveals a substantial burden of severe non-neonatal tetanus among under-vaccinated adults, persisting despite the region’s economic transition. Case fatality decreased over the study period, likely reflecting improvements in both the accessibility and quality of critical care, albeit with increasing healthcare costs. The association between injection drug use or unknown etiology and mortality warrants heightened clinical vigilance.</p>

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10 years trends and hospitalization outcomes of non-neonatal tetanus: a large-scale multicenter retrospective study in China

  • 期刊论文

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  • 发表日期：

    2026年3月19日

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  • Chunxin Liu,
  • Minli Lei,
  • Jingjing Chen,
  • Miaoting Huang,
  • Yaxin Lu,
  • Yueming Chen,
  • Dengfeng Wu,
  • Xingcai Tan,
  • Yuqiang Liang,
  • Xianwu Zhao,
  • Guowei He,
  • Long Yu,
  • Mingming Huang,
  • Tianrong He,
  • Chi Yang,
  • Gengwei Zhang,
  • Jing Xu,
  • Renfeng Liao,
  • Shaoyun Lu,
  • Shufa He,
  • Huizhong Qiu,
  • Yingjie Chen,
  • Zhong Zhao,
  • Jinrong Liang,
  • Fuxing Xu,
  • Shuyan Liu,
  • Yongxiang He,
  • Yuanjun Lv,
  • Zeqiang Yuan,
  • Huangyang He,
  • Hong Deng,
  • Yingbo Jiang,
  • Weibing Huang,
  • Xianrui Zhuang,
  • Xiaoxin Qiu,
  • Qinhai Liu,
  • Rui Huang,
  • Ke Yang,
  • Yuntao Peng,
  • Yi Ye,
  • Jiajie Ke,
  • Qingli Dou,
  • Wenlong Deng,
  • Haobo Zhang,
  • Xiuqun Kang,
  • Nan Liu,
  • Jun Chen,
  • Wenjian Zhu,
  • Fengqing Song,
  • Yang Liu,
  • Shengnan Xie,
  • Haiyu Gu,
  • Wenming Shao,
  • Licheng Luo,
  • Yaowen Huang,
  • Zenglong Wu,
  • Ping Liu,
  • Maoxiang Liao,
  • Shusen Ye,
  • Xusheng Tu,
  • Jianan Wu,
  • Mufu Wu,
  • Yingquan Chen,
  • Wei Zhang,
  • Haiming Fu,
  • Huarong Ding,
  • Xiao Shao,
  • Anni Lou,
  • Yulin Chen,
  • Zhao Fan,
  • Zengliang Lei,
  • Jianhui Yan,
  • Xian Chen,
  • Na Peng,
  • Wen Lv,
  • Ying Feng,
  • Qing Liang,
  • Mingliang He,
  • Zhilin Huang,
  • Tao Li,
  • Jun Li,
  • Wenfeng Fan,
  • Zhiquan Lai,
  • Yusheng He,
  • Yewen Zhang,
  • Hanzhong Qiu,
  • Yang Yu,
  • Yongguang Huang,
  • Dongjian Liu,
  • Weixin Quan,
  • Huanyao Zhang,
  • Jifeng Li,
  • Liping Wu,
  • Tao Yi,
  • Wensheng Wu,
  • Sheng Xie,
  • Wenhui Huang,
  • Yue Yang,
  • Guangshao Wen,
  • Yan He,
  • Jian Wu,
  • Qunlin Chen,
  • Chuming Liu,
  • Zhixue Hua,
  • Xiaoyan Yang,
  • Keke Wang,
  • Jiasong Hu,
  • Changqing Mao,
  • Jianfei Li,
  • Ping Song,
  • Chunfa Jiang,
  • Weiqin Zhong,
  • Xiaoyue Li,
  • Jialuan Zhang,
  • Bei Hu,
  • Youqing Tang,
  • Zhiming Lian,
  • Li Liu,
  • Wenyue Liu,
  • Qihua Wu,
  • Yaling Chai,
  • Xiaoming Lai,
  • Yong Zheng,
  • Yuanwen Lu,
  • Dianhong Li,
  • Zhipeng Zhou,
  • Qiutian Lin,
  • Guangda Liang,
  • Huayuan Zhu,
  • Feng Zhong,
  • Minjun Du,
  • Yue Huang,
  • Xingdong Zeng,
  • Huaqing Zhan,
  • Fengxi Wang,
  • Wenzhong Yu,
  • Pengcheng Wu,
  • Ruiquan Wang,
  • Bo Liu,
  • Lintao Yu,
  • Chao Chen,
  • Haidong Wu,
  • Zhenggeng Wu,
  • Lanxiang Wang,
  • Linfeng Zhang,
  • Tengfei Guo,
  • Wenliang Xiao,
  • Guoyan Li,
  • Shaoyi Lin,
  • Huafu Yan,
  • Yufeng Gao,
  • Yukun Chen,
  • Haixia Wang,
  • Ruiju Chen,
  • Donghua Gu,
  • Weicong Zheng,
  • Cong Liang,
  • Yuetao Zhang,
  • Yanli Wang,
  • Xu Feng,
  • Fuquan Xiao,
  • Xuemin Huang,
  • Guisheng Liao,
  • Yaogen Yuan,
  • Shaofeng Deng,
  • Quanle Liu,
  • Zhenliang Zheng,
  • Yongbiao Zhang

摘要

Objectives

Non-neonatal tetanus continues to pose a public health challenge in low- and middle-income regions. This study aimed to describe the decade-long profile of non-neonatal tetanus in Guangdong, China, from 2011 to 2021—a period marked by rapid economic development and healthcare system strengthening.

Design

Multicenter, retrospective study.

Setting

The study was conducted across 159 hospitals in Guangdong, China.

Patients

We included patients with a clinical diagnosis of tetanus admitted between 2011 and 2021. A total of 2,567 cases (median age 53 years; 62.1% male) were analyzed.

Interventions

None.

Measurements and main results

Data on demographics, vaccination status, clinical severity (Ablett classification), etiology, seasonal trends, critical care utilization, outcomes, and costs were collected. Farmers constituted the largest occupational group (43.7%), and only 2.2% had documented tetanus vaccination. Hospitalizations fluctuated but showed an overall increase, with a rising proportion of severe cases (Ablett grade III/IV). A seasonal peak was observed in August–September. The most common etiology was post-traumatic injury (43.4%). Critical care was frequently required: 25.1% of patients were admitted to the ICU, and 23.8% received mechanical ventilation. Multivariable analysis identified higher Ablett grade, injection drug use, unknown etiology, and comorbidities as independent risk factors for mortality; ICU admission was protective. Case fatality declined significantly from 11.8% in 2012 to 3.5% in 2021, while median hospitalization costs rose substantially.

Conclusions

This large-scale study reveals a substantial burden of severe non-neonatal tetanus among under-vaccinated adults, persisting despite the region’s economic transition. Case fatality decreased over the study period, likely reflecting improvements in both the accessibility and quality of critical care, albeit with increasing healthcare costs. The association between injection drug use or unknown etiology and mortality warrants heightened clinical vigilance.