title: Current epidemiology of tetanus in England, 2001-2014.
abstract: Public Health England conducts enhanced national surveillance of tetanus, a potentially life-threatening vaccine-preventable disease. A standardized questionnaire was used to ascertain clinical and demographic details of individuals reported with clinically suspected tetanus. The 96 cases identified between 2001 and 2014 were analysed. The average annual incidence was 0·13/million (95% confidence interval 0·10-0·16) of which 50·0% were male. Where reported, 70·3% of injuries occurred in the home/garden (45/64). Overall, 40·3% (31/77) cases were in people who inject drugs (PWID), including a cluster of 22 cases during 2003-2004. Where known (n = 68), only 8·8% were age-appropriately immunized. The overall case-fatality rate was 11·0% (9/82). All tetanus-associated deaths occurred in adults aged >45 years, none of whom were fully immunized. Due to the success of the childhood immunization programme, tetanus remains a rare disease in England with the majority of cases occurring in older unimmunized or partially immunized adults. Minor injuries in the home/garden were the most commonly reported likely sources of infection, although cases in PWID increased during this period. It is essential that high routine vaccine coverage is maintained and that susceptible individuals, particularly older adults, are protected through vaccination and are offered timely post-exposure management following a tetanus-prone wound.
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department (IHBSD),Public Health England,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Collins
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department (IHBSD),Public Health England,London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Amirthalingam
authors.affiliation: Tropical and Infectious Disease Unit,Royal Liverpool University Hospital;Clinical Science Group,Liverpool School of Tropical Medicine;and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections,University of Liverpool,Liverpool,UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Beeching
authors.affiliation: Microbiology Services,Public Health England,London,UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Chand
authors.affiliation: Microbiology Services,Public Health England,London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Godbole
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department (IHBSD),Public Health England,London,UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Ramsay
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit (RVPBRU),Public Health England,London,UK.
authors.forename: N K
authors.initials: NK
authors.lastname: Fry
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department (IHBSD),Public Health England,London,UK.
authors.forename: J M
authors.initials: JM
authors.lastname: White
keywords: Epidemiology; outcome; tetanus; vaccination