title: Tetanus in Italy 2001-2010: a continuing threat in older adults.
abstract: Despite being a completely preventable disease, tetanus cases continue to occur in Italy and notification and hospitalization rates have been reported to be higher with respect to European and other industrialized countries. We examined statutory notification, hospitalization, mortality and seroprevalence data to describe tetanus epidemiology in Italy from 2001 to 2010. A total of 594 tetanus cases were notified, with an average annual incidence of 1.0/1,000,000 population. Most cases were unvaccinated or incompletely vaccinated. Eighty percent of cases occurred in subjects aged >64 years and a higher proportion of females with respect to males were reported in this age group. The annual number of hospital admissions was 1.4-1.7 times greater than the number of notifications in the same year. The mean annual number of reported deaths was 21. Seroprevalence data show progressively higher susceptibility levels with increasing age. Over 50% of persons aged 45-64 years and over two thirds of subjects ≥65 years had tetanus antibody levels <0.01 IU/ml. Results show that tetanus is a continuing problem in Italy and, as in other countries, most cases occur in older adults, especially elderly women. The observed differences in notification and hospitalization rates suggest underreporting by physicians. In recent years, Italy has accounted for most cases reported annually in the European Union (EU) but different case definitions are used. In Italy, a confirmed case is one that meets the clinical case definition while the EU case definition classifies confirmed cases as those with laboratory confirmation of disease. The incidence of clinical tetanus in Italy is ten-fold higher than in other industrialized countries, like Australia and Canada, likely due to higher susceptibility levels in Italy. In view of the low prevalence of tetanus antibodies in adults ≥45 years, strategies to improve vaccine uptake in this population group need to be implemented.
authors.affiliation: Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. Electronic address: antonietta.filia@iss.it.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Filia
authors.affiliation: Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Bella
authors.affiliation: National Center for Research and Evaluation of Immunobiologicals, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Christina
authors.initials: C
authors.lastname: von Hunolstein
authors.affiliation: National Center for Research and Evaluation of Immunobiologicals, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Alfarone
authors.affiliation: Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Declich
authors.affiliation: Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance e Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Rota
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D016036:Seroepidemiologic Studies; D013742:Tetanus / Q000453:epidemiology*; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adults; Epidemiology; Hospital admissions; Immunity; Mortality; Tetanus