Impact of improved vaccination programme and intensive care facilities on incidence and outcome of tetanus in southern Vietnam, 1993-2002.
Unvaccinated individuals throughout the world are vulnerable to tetanus, but there are few data regarding the impact of focused vaccination programmes and modern intensive care facilities on the disease, particularly in the developing world. The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam admitted 2422 patients with tetanus aged > or =1 year between April 1993 and December 2002, during which time vaccine coverage and treatment facilities improved. The proportion of children < or =10 years old admitted with tetanus fell from 11.1 to 5.6% over the 10 year period (P = 0.002). The proportion of women aged 20-40 years fell from 10.1 to 1.2% (P < 0.001). Mortality rates fell from a maximum of 27.81% in 1994 to 10.04% in 2002 (P < 0.001). Thus, a marked reduction in tetanus incidence has occurred in age groups specifically targeted by the national vaccination programme. However, tetanus continues to be a major cause of morbidity and mortality in individuals outside the target population. Improved intensive care facilities, such as mechanical ventilation and low-cost infection control procedures are associated with a significant reduction in mortality.
Thwaites
C Louise
CL
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Ho Chi Minh City, Vietnam. lthwaites@hcm.vnn.vn
Yen
Lam M
LM
Nga
Nguyen T N
NT
Parry
Janet
J
Binh
Nguyen T
NT
Loan
Huynh T
HT
Thuy
Tran T D
TT
Bethell
Delia
D
Parry
Christopher M
CM
White
Nicholas J
NJ
Day
Nicholas P J
NP
Farrar
Jeremy J
JJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000592:standards*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D017678:Sex Distribution; D013742:Tetanus / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D014139:Tracheostomy; D016896:Treatment Outcome; D014611:Vaccination; D014744:Vietnam / Q000453:epidemiology