Characteristics and outcome of tetanus in adolescent and adult patients admitted to the Lagos University Teaching Hospital between 2000 and 2009

• DOI: 10.1016/j.jns.2012.09.017
• Publication Date: 2012-10-12T19:01:19Z
• Authors: Idowu A. Bankole; Mustapha A. Danesi; Oluwadamilola O. Ojo; Njideka U. Okubadejo; Frank I. Ojini
• Keywords: Adult; Male; Spasm; Neck Pain; Tetanus; Adolescent; Nigeria; Middle Aged; Occupational Injuries; 3. Good health; Survival Rate; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Autonomic Nervous System Diseases; Motorcycles; Tetanus Toxoid; Humans; Female; Child; Hospitals, Teaching; Aged; Retrospective Studies

This study was a case record review of adult patients with tetanus admitted into Lagos University Teaching Hospital between 2000 and 2009. Of 78,009 adults admitted, 190 had tetanus, constituting 0.25% of admission. Mean age was 30.4 ± 13.8 years. Male to female ratio was 3:1. The commonest occupation was commercial motorcyclists. 96% of the patients were unimmunized and 4% that had partial immunization had localized tetanus. Commonest presentation was trismus (83%). Twenty three patients had complications, 30% had autonomic dysfunction. Mean incubation period was 11.4 ± 4.8 days, and mean duration of onset was 72 ± 45.6h. 31 patients died, case fatality rate was 16.3%. Twelve percent of those with long period of onset died while 43% with short period of onset died (P=0.002). Patients with complications (78%) died of tetanus while only 8% of those without complication died (P<0.0001). Case fatality rate is still unacceptably high for a vaccine preventable disease. Attention to primary prevention of people at risk and active surveillance to prevent complications will further reduce mortality.