Current Epidemic Situation on Tetanus, Status and Success of Vaccination
https://doi.org/10.31631/2073-3046-2025-24-3-103-113
Abstract
Tetanus, caused by the action of toxins produced by Clostridium tetani, remains a disease with high mortality.
Aims: based on publications and official sources, to present a description of the current epidemic situation with tetanus in the world, the organization of planned vaccination against the disease, its effectiveness and safety. The prevalence of C.tetani has a zonality determined by the climatic and geographical features of the areas, but the incidence rate of tetanus in the modern period is determined by the state of work on its vaccination. From 1980 to 2023, the number of tetanus cases in the world decreased by 5.3 times. In Russia in the middle of the last century, an average of about 800 cases were registered annually, in 2006-2023 - from 8 to 21 cases. The coverage of completed 3-doses vaccination of children in the world in 2018-2023 was 84-86 %, in our country it exceeded 96 %. The coverage of adults with vaccination in Russia exceeds 90 %, which is confirmed by the results of seromonitoring of collective immunity. National tetanus vaccination shchedule have some differences, not all countries carry out boosters doses of the adult population. Vaccines with different tetanus toxoid content are used to immunize children and adults, and post-vaccination complications after the use of vaccines containing tetanus toxoid are rarely recorded. Selective studies of tetanus seroprevalence in the population conducted in various countries, including some regions of Russia, have shown a high level of immune protection for children and adults. The proportion of people with a protective level of antitoxic antibodies to tetanus in different age groups was higher than to diphtheria. It was shown that antitoxic immunity to tetanus persists for over 10 years at a level higher than protective.
Conclusion: Decades of planned mass immunization of the world population against tetanus have shown its high epidemiological effectiveness and safety. Persons who have completed the vaccination course develop more intense and long-lasting antitoxic immunity than to diphtheria.
About the Author
L. V. RubisRussian Federation
Lyudmila V. Rubis – Cand. Sci. (Med.), Associate Professor, Associate Professor Medical Institute
33, pr. Lenina, Petrozavodsk, 185910
+7 (921) 469-20-78
References
1. Gill DM. Bacterial toxins: a table of lethal amounts. Microbiol Rev. 1982. 46 (1):86–94. doi: 10.1128/mr.46.1.86–94.1982.
2. WHO. Immunological basis for immunization series module 3: tetanus. Available at https://apps.who.int/iris/handle/10665/275340. Accessed: 10.11.2024
3. Komarovskaya EI, Perelygina OV. Current incidence of certain clostridial infections: gas gangrene and tetanus. BIOpreparaty. Profilaktika, diagnostika, lechenie. BIOpreparations. Prevention, Diagnosis, Treatment. 2021; 21(1):31–38. (In Russ.). doi.org/10.30895/2221-996X-2021-21-1-31-38
4. Jun L, Zicheng L, Chao Yu, еt al. Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. International Journal of Infectious Diseases. 2023; 132 :118–126 doi.org/10.1016/j.ijid.2023.04.402
5. . Rukovodstvo po epidemiologii infektsionnyih bolezney. Ed.: Pokrovskiy VI. M.: «Meditsina» 1993:432–440
6. Gonçalves G F, Italo BM, Meneses do Rêgo AC, et al. Postoperative tetanus in abdominal surgery: scope review. MOJ Surg. 2023;11(2):63–66 doi:23937/2378-3397/1410150
7. Pokrovskiy VI, Onischenko GG, Cherkasskiy BA. Evolyutsiya infektsionnyih bolezney v XX veke: rukovod. dlya vrachey. M.: «Meditsina». 2003: 551–567. (In Russ.).
8. European Centre for Disease Prevention and Control (ECDC). Tetanus. Annual epidemiological report for 2022. Stockholm: ECDC; 2024. Available at: https://www.ecdc.europa.eu/en/publications-data/tetanus-annual-epidemiological-report-2022. Accessed: 10.11.2024
9. Information collection of statistical and analytical materials “Infectious diseases in Russia (1913-2002) // Federal Center for State Sanitary and Epidemiological Surveillance. Moscow, 2003.: 45–46/ (In Russ.).
10. WHO. Vaccine-preventable diseases: monitoring system.2020 global summary. ncidence time series for Russian Federation. Available at: ttps://apps.who.int/immunization_monitoring/globalsummary/incidences?c=RUS. Accessed: 10.11.2024
11. Sergeeva TI, Marveev KI. Geografical distribuhion of Cl. Tetani in the soil of the USSR. Hygiene and sanitation. 1968;10:39–45. Available at: https://cyberleninka.ru/article/n/geograficheskoe-rasprostranenie-vozbuditelya-stolbnyaka-v-pochve-sssr (Accessed: 09.12.2024). (In Russ.).
12. Yastrebov V.V., Sergeeva T.I., Zarubina E.K. Contamination of soils of the Arkhangelsk region with the tetanus pathogen. Hygiene and sanitation. 1973; 1:43–45. Available at: https://cyberleninka.ru/article/n/obsemenennost-vozbuditelem-stolbnyaka-pochvy-arhangelskoy-oblasti (Accessed: 09.12.2024). (In Russ.).
13. Petlakh VI. Tetanus in children: a modern concept of infection management. Almanac of Clinical Medicine. 2018; 46 (2):160–70. doi: 10.18786/2072-0505-2018-46-2-160-170. (In Russ.).
14. Simovanyan EM, Goncharova E L, Denisenko VB. Tetanus is a difficult diagnosis in children. Children’s Infections. 2019;18(4):70–72 https://doi.org/10.22627/2072-8107-2019-18-4-70-72. (In Russ.).
15. Karachentseva DYa, Krylova DR, Topolyan AV. Tetanus is not forgotten. Kuban State Medical University. 2020; 23(6): 399–400. (In Russ.).
16. Kurmaeva, DYu, Melnikov VL, Shubina YuA. A case of post-traumatic tetanus in the Penza region. Bulletin of the Penza State University. 2020 Vol. 29, No. 1. P. 68–71. (In Russ.).
17. Kozlov AA, Shevchuk IV, Emelyanov AN, et al. Generalized tetanus in an 11-year-old boy: A case report. Russian Journal of Pediatric Surgery,Anesthesia and Intensive Care. 2021;11(1):69–75. DOI: https://doi.org/10.17816/psaic693 (In Russ.).
18. Ryumin AM, Sobolevskaya OL, Korochkina OV, et al. The case of mild tetanus: clinical tactics. Far Eastern medical Journal.2017; 3:98. https://cyberleninka.ru/article/n/sluchay-stolbnyaka-legkogo-techeniya-takticheskie-osobennosti-vedeniya. Accessed: 10.11.2024 (In Russ.).
19. Evans AS, Brachman PS. editors. Bacterial Infections of Humans. Epidemiology and Control. 3nd ed. New York and London. Plenum Medical Book Company. 1998: 741–754
20. CDC. Manual for the Surveillance of Vaccine-Preventable Diseases Chapter 16: Tetanus. Available at: https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-16-tetanus.html. Accessed: 10.11.2024
21. Okuda M, Morizane A, Asaba S, et al. An unexpected case of tetanus in a fully immunized 20-year-old female: a case report. Int J Emerg Med. 2024 Apr 24;17(1):59. doi: 10.1186/s12245-024-00633-1. PMID: 38658846; PMCID: PMC11040956.
22. Feldblum IV,. Subbotina KA, Nikolaeva AM, et al. Status of immunity against diphtheria, tetanus and pertussis in adults currently. Russian Journal of Immunology. 2017.20(1): 64–69. (In Russ.).
23. Tetanus vaccines: WHO position paper - February 2017. Wееkly Epidemiol Rec. 2017; 92(06). Cited 2024 Mar 30. Available at: https://iris.who.int/bitstream/handle/10665/254582/WER9206.pdf?sequence=1. Accessed: 10.11.2024
24. European Centre for Disease Prevention and Control. Vaccine Scheduler. Stockholm: ECDC; 2019. Available from: http://vaccine-schedule.ecdc.europa.eu. Accessed: 10.11.2024
25. CDC. Tetanus vaccination. Available at: https://www.cdc.gov/tetanus/vaccines/index.html. Accessed: 10.11.2024
26. Slifka AM, Park B, Gao L, et al. Incidence of tetanus and diphtheria in relation to adult vaccination schedules. Clin Infect Dis. 2020;72(2):285–92.
27. UK Health Security Agency Complete routine immunisation schedule from 1 September 2024. Available at: https://www.gov.uk/government/publications/the-completeroutine-immunisation-schedule/the-complete-routine-immunisation-schedule-from-february-2022. Accessed: 10.11.2024
28. Basov AA, Maksimova NM, Vysochanskaya SO, et al. Assessment of the State of Antidiphtheria Immunity in Different Age Groups of the Population of the Russian Federation Based on Seromonitoring Data for 2015-2021.Epidemiology and Vaccinal Prevention. 2023;22(5):63–73 (In Russ.). https://doi:10.31631/2073-3046-2023-22-5-63-73
29. Hammarlund E, Thomas A, Poore EA, et al. et al. Durability of Vaccine-Induced Immunity Against Tetanus and Diphtheria Toxins: A Cross-sectional Analysis. Clin Infect Dis. 2016 May 1;62(9):1111–1118. doi: 10.1093/cid/ciw066. Epub 2016 Mar 21. Erratum in: Clin Infect Dis. 2016 Jul 1;63(1):150. doi: 10.1093/cid/ciw269.
30. Olander RM, Auranen K, Härkänen T, et al. High tetanus and diphtheria antitoxin concentrations in Finnish adults--time for new booster recommendations? Vaccine. 2009;27(39):5295–8. doi: 10.1016/j.vaccine.2009.06.080. Epub 2009 Jul 9. PMID: 19596410.
31. Hopkins JP, Riddle C, Hollidge M, et al. A systematic review of tetanus in individuals with previous tetanus toxoid immunization. Can Commun Dis Rep. 2014;40(17):355–364. doi:10.14745/ccdr.v40i17a03..
32. Vollman KE, Acquisto NM, Bodkin RP. A case of tetanus infection in an adult with a protective tetanus antibody level. Am J Emerg Med. 2014;32(4):392.e3–4.
33. Ribak VO, Sudakevich VG., Nasalsky TV, et al. A case of tetanus in a previously immunized person. Child`s Health. 2023;18(5):391–397 doi: 10.22141/2224-0551.18.5.2023.1618 (In Ukr.)
34. Feldblum I.V, Subbotina KA, Markova NI, , et al. Combined vaccines Bubo-M and Bubo-Coc in the National vaccination schedule. Medical Council . 2017; 4: 94-98. doi:10.21518/2079-701X-2017-4-94-98. (In Russ.)
35. Namazova-Baranova LS, Kharit SM, Perminova OA, et al Safety and Immunogenicity of Fully Liquid Hexavalent DTaP-IPV-HepB-Hib Vaccine in Healthy Infants in Russian Federation. Epidemiology and Vaccinal Prevention. 2019;18(3):28–39. https://doi.org/10.31631/2073-3046-2019-18-3-28-39 (In Russ.).
36. Thierry-Carstensen B, Jordan K, Uhlving HH, et al. A randomised, double-blind, non-inferiority clinical trial on the safety and immunogenicity of a tetanus, diphtheria and monocomponent acellular pertussis(TdaP) vaccine in comparison to a tetanus and diphtheria (Td) vaccine when given as booster vaccinations to healthy adults vaccine. Vaccines. 2012 Aug 10;30(37):5464–71. doi: 10.1016/j.vaccine.2012.06.07
37. Halperin SA, Donovan C, Marshall GS, et al. Randomized controlled trial of the safety and immunogenicity of revaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) in adults 10 years after aprevious dose. J Pediatric Infect Dis Soc 2019;8:105–114. doi: 10.1093/jpids/pix113.
38. Niyazalieva MS, Toygombaeva VS, Djumalieva GA, et al. The state of post-vaccination immunity to diphtheria and tetanus in the population of the Kyrgyz Republic. Problems of social hygiene, health care and history of medicine. 2021; 29 (4):988–991 DOI: http://dx.doi.org/10.32687/0869-866X-2021-29-4-988-991 (In Russ.).
39. Kolodkina VL, Samoilovich EO, Martinov VS, et al. Population Immunity to Diphtheria and Tetanus in the Republic of Belarus Following Long-Standing Vaccination. Epidemiology and Vaccinal Prevention. 2018;17(3):19–26 (In Russ.) https://doi.org/10.31631/2073-3046-2018-17-3-19-26 (In Russ.).
40. Korotkova VA, Khomichuk VA. Serological monitoring of the state of collective immunity to infections controlled by specific prophylaxis among the population of Primorsky Region. Health. Medical ecology. Science. 2016; 3 (66): 102–7. (In Russ.). Available at: https://cyberleninka.ru/article/n/serologicheskiy-monitoring-sostoyaniya-kollektivnogo-immuniteta-k-infektsiyam-upravlyaemym-sredstvami-spetsificheskoy-profilaktiki. Accessed: 09.12.2024.
41. Chubirko MI, Degtjareva IM, Kholodova LA, et al. Monitoring the intensity of immunity against diphtheria and tetanus in the population of the Voronezh region. [abstract]. Russian Journal of Infection and Immunity. 2016; 6(3):124. (In Russ.) https://iimmun.ru/iimm/article/download/424/294. Accessed: 10.11.2024.
42. Zhang C, Hu W, Ma Y, et al. Seroepidemiology of Tetanus among Healthy People Aged 1–59 Years Old in Shaanxi Province, China. Vaccines. 2022. 10. 1806. https://doi.org/10.3390/vaccines10111806
43. Lot release volume of tetanus vaccines in China from 2017 to 2022, by producer. Available at: https://www.statista.com/statistics/1425544/china-lot-release-volume-oftetanus-vaccines (дата обращения: 10/11.2024)/ Lot release volume of tetanus vaccines in China from 2017 to 2022, by producer. Available at: https://www.statista.com/statistics/1425544/china-lot-release-volume-of-tetanus-vaccines Accessed: 10.11.2024
44. Alagappan K, Poland GA. Best practices for tetanus vaccination and treatment. Pharmacy Practice News. Special Report. 2019:1–8 Available at: https://www.tdvax.com/documents/3022863/0/Special_report.pdf/24651d69-afa0-4f7e-a9b8-5c46609c13df?t=1562773299136/Accessed: 10.11.2024
45. CDC. About diphtheria, tetanus and pertussis vaccines. From Pink book. Available at: https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/hcp/about-vaccine.html (дата обращения: 09.12.2024). /CDC. About diphtheria, tetanus and pertussis vaccines. From Pink book. https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/hcp/about-vaccine.html Accessed: 10.11.2024
46. Fedorov AM, Tatochenko VK, Wundtsettel NN, et al. Post-vaccination complications. Childhood infections. 2004.2:17–20. (In Russ.). Available at: https://cyberleninka.ru/article/n/postvaktsinalnye-oslozhneniya. Accessed: 12.11.2024
47. Jacobs RL, Lowe RS, Lanier BQ. Adverse reactions to tetanus toxoid. JAMA. 1982;247(1):40–2.
48. Merkulov VA, Bunyatyan ND, Lepakhin VK, et al. Evaluation of adverse reactions in the use of drugs in Russia in 2013. Safety and risk of pharmacotherapy. 2014. 1(2): 31–41 (In Russ.). Available at: https://cyberleninka.ru/article/n/otsenka-nezhelatelnyh-reaktsiy-pri-primenenii-lekarstvennyh-sredstv-v-rossii-v-2013-godu
49. Bakhmutskaya EV, Chernyavskaya OP, Volkova NA. Monitoring system for adverse events following immunization in Russia and the world. Modern aspects and problems. Epidemiology and Vaccinal Prevention. 2022;21(5): 4–13 (In Russ.). doi:10.31631/2073-3046-2022-21-5-4-13
50. Lakotkina EA, Kharit SM, Chernyaeva TV, et al. Post-vaccination complications (clinic, diagnostics, treatment, prevention). Handbook of a practical physician, St. Petersburg: St. Petersburg Medical Information and Analytical Center, 2004. – 79 p. (In Russ.).
51. Śmietańska K, Rastawicki W. Seroprevalence of Ig G antibodies against tetanus toxoid among different age groups in Poland. Ann Agric Environ Med. 2024; 31(3): 329–333. doi: 10.26444/aaem/182987
52. Mayansky NA, Mukozheva RA, Kulichenko TV, et al. Serological monitoring of levels of antibodies to pathogens of tetanus, diphtheria and pertusis in schoolchildren aged of 11-17 years of seven regions of the Russian Federation. Russian pediatric journal. 2019; 22(2): 81–87 (In Russ.). DOI: http://dx.doi.org/10.18821/1560-9561-2019-22-2-81-87
53. Karimov IZ, Gorovenko MV, Penkovskaya NA, et al. The level of intensity of immunity to diphtheria and tetanus among the population of the Republic of Crimea.Russian Journal of Infection and Immunity, 2015; 5(2): 165–170. doi: 10.15789/2220-7619-2015-2-165-170 (In Russ.).
54. Gao H, Lau E, Cowling BJ. Waning Immunity After Receipt of Pertussis, Diphtheria, Tetanus, and Polio-Related Vaccines: A Systematic Review and Meta-analysis. J Infect Dis. 2022 Feb 15;225(4):557–566. doi: 10.1093/infdis/jiab480.
55. Theeten H, Hutse V, Htns.N, et al. Are we hitting immunity targets? The 2006 age-specific seroprevalence of measles, mumps, rubella, diphtheria and tetanus in Belgium. Epidemiol. Infect. 2011; 139: 494–504. doi:10.1017/S0950268810001536
56. Papagiannis D, Thireos E, Mariolis A, et al. Diphtheria and Tetanus Immunity Status among Greek Adults: Results from a Nationwide Seroprevalence Study. Vaccines. 2024 Apr 2;12(4):378. doi: 10.3390/vaccines12040378.
57. Try Zasada AA, Rastawicki W, Rokosz N, et al. Seroprevalence of diphtheria toxoid IgG antibodies in children, adolescents and adults in Poland. BMC Infect Dis. 2013 Nov 19;13:551. doi: 10.1186/1471-2334-13-551
58. Angelidakis G, Chemaly RF, Sahasrabhojane PV, et al. Humoral Immunity and Antibody Responses against Diphtheria, Tetanus, and Pneumococcus after Immune Effector Cell Therapies: A Prospective Study. Vaccines. 2024;12(9):1070. doi: 10.3390/vaccines12091070.
59. Vasilyeva GV, Kostinov MP, Lyskina GA, et al. Anti-diphtheria and anti-tetanus immunity in children with systemic connective tissue diseases. Children’s infections. 2004; N3: 9–11. (In Russ.). Available at: https://cyberleninka.ru/article/n/protivodifteriynyy-i-protivostolbnyachnyy-immunitet-u-detey-s-sistemnymi-zabolevaniyami-soedinitelnoytkani Accessed: 09.12.2024
60. Trucchi C, Zoppi G. Decennial diphtheria-tetanus adult boosters: are they really necessary? J Prev Med Hyg. 2015 Jun 10;56(1):E44–8.
Review
For citations:
Rubis L.V. Current Epidemic Situation on Tetanus, Status and Success of Vaccination. Epidemiology and Vaccinal Prevention. 2025;24(3):103-113. (In Russ.) https://doi.org/10.31631/2073-3046-2025-24-3-103-113