Tetanus surveillance--United States, 1998--2000.

PROBLEM/CONDITION Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s. REPORTING PERIOD This report covers surveillance data for 1998--2000. DESCRIPTION OF SYSTEM Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states. RESULTS AND INTERPRETATION During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis. INTERPRETATION The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged >60 years were at highest risk for tetanus and tetanus-related death. PUBLIC HEALTH ACTIONS Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.