欧洲疾控中心-破伤风-2023年年度流行病学报告（英）-2025.9_10页_1mb

Tetanus Annual Epidemiological Report for 2023 Summary

Core Content

• Tetanus Overview: Tetanus is a severe disease caused by the neurotoxin of Clostridium tetani, which enters the body through wounds and thrives in low-oxygen environments. It is not contagious and can only be contracted through direct contamination with spores found in soil, dust, and faeces. The disease manifests in three forms: generalised, localised, and cephalic, with generalised being the most common.

• Case Trends: In 2023, 73 tetanus cases were reported in the EU/EEA, marking a slight increase compared to 2022 (53 cases). This follows a decline from 69 cases in 2019 to 32 in 2020. Italy accounted for 38% of all notified cases, while the Netherlands, Poland, and Romania accounted for 32%.

• Age and Gender Distribution: Adults aged 65 years and above were the most affected age group, with 50 cases (69%) reported in 2023. Among these, 38 cases were in women, representing a significantly higher notification rate for women (0.09 per 100,000) compared to men (0.04 per 100,000). Women made up 70% of all reported cases.

• Case Outcomes: Of the 63 tetanus cases with a known outcome, 13 (21%) were fatal. Most of these fatalities occurred in women over 79 years old, with Italy, Poland, Hungary, Romania, Spain, and Sweden reporting the most deaths.

• Vaccination Coverage: The population-weighted average DTP3 vaccination coverage among one-year-olds in the EU/EEA was 92.8% in 2023, slightly lower than in 2019 (94.3%). Three countries (Hungary, Luxembourg, and Portugal) reported 99% coverage. Some countries experienced a decrease in coverage, while others showed a slight increase. Despite this, overall coverage remains high.

Main Points

• Epidemiological Context: The increase in tetanus cases in 2023 may be attributed to lower vaccination coverage or waning immunity among older populations. The disease remains a concern in areas with inadequate immunisation, particularly affecting newborns and mothers.

• Surveillance and Data Collection: The report is based on data from EpiPulse Cases, which replaced TESSy in 2024. Data was reported by 26 EU/EEA countries, with some countries not reporting data (e.g., Germany, Austria, Belgium, Finland). Italy and other countries used different case definitions, which may affect comparability.

• Seasonality: Most tetanus cases in 2023 were reported between June and October, with a peak in August. An early peak in January was also observed, though the early April peak in 2022 was unique.

• Public Health Implications: Tetanus remains a severe disease, and maintaining high vaccination rates is essential, especially among the elderly and high-risk groups. Strategies should focus on improving adult immunisation and addressing gender-based immunity gaps.

Key Information

• Case Classification: In 2023, 13 cases were confirmed, 58 were probable, and one was classified as possible. One case from Italy had no classification.

• Vaccination Recommendations: A three-dose primary series is recommended for lifelong protection against tetanus, with booster doses at various ages depending on the country. The WHO recommends a six-dose series, including booster doses at 12–23 months, 4–7 years, and 9–15 years.

• Post-pandemic Impact: The number of tetanus cases dropped significantly in 2020 due to the pandemic but has since increased, surpassing pre-pandemic levels. This suggests possible disruptions in immunisation programs during the pandemic.

• Global Trends: Globally, DTP3 coverage decreased from 86% in 2019 to 81% in 2021, with coverage in 2023 still 2.7% below expected levels. About 17% of countries remained significantly below pre-pandemic levels.

• Immunisation Gaps: In some countries, such as Romania, Poland, and the Netherlands, tetanus cases were concentrated, highlighting the need for targeted immunisation strategies. In Italy, a significant proportion of cases occurred in older adults, likely due to lower vaccination rates or waning immunity.

• Gender Disparities: In the age group of 65 years and above, women had lower seroprotection rates than men, possibly due to fewer opportunities for vaccination compared to men who might have received the vaccine during compulsory military service in some countries.

Conclusion

The report underscores the importance of maintaining high vaccination coverage, especially among the elderly and high-risk groups, to prevent tetanus. While DTP3 coverage remains high in the EU/EEA, there are still concerns about immunity gaps and the potential for underreporting. Continued efforts to improve adult immunisation and address gender disparities in vaccine uptake are essential to reduce the burden of tetanus in Europe.