Burden of tetanus in China: trends from 1990 to 2021 and projections to 2050_West China Medical Journal

Authors：

LIU Menglong , LONG Xu , WANG Guixia , LI Siqi , SUN Tianjing , ZHOU Dandan , JIANG Xuheng , YU Anyong ,  DUAN Haizhen

Department of Emergency Medicine, the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P. R. China;

Corresponding?author：

DUAN Haizhen, Email: haizhenduan@126.com

Keywords：

Tetanus; disease burden; joinpoint regression analysis; age-period-cohort analysis; epidemiological study; Bayesian age-period-cohort model

DOI：

10.7507/1002-0179.202509266

Video：

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Objective To explore the long-term trends and epidemiological characteristics of the disease burden of tetanus in China over the past 30 years and to predict its disease burden in 2050, in order to comprehensively assess the overall disease burden of tetanus in China. Methods Leveraging the methods and findings of the Global Burden of Disease Study 2021, we provided a detailed description of the disease burden of tetanus in China based on key indicators such as prevalence, incidence, mortality, disability-adjusted life years, years lived with disability, and years of life lost due to premature mortality. Joinpoint regression analysis, age-period-cohort analysis, decomposition analysis, and Bayesian age-period-cohort models were employed to further elucidate the epidemiological characteristics of tetanus and predict its disease burden in China by 2050. Results From 1990 to 2021, the overall disease burden of tetanus in China exhibited a significant year-by-year decline. The primary demographic group bearing the burden of tetanus in China had gradually shifted from newborns to middle-aged and elderly individuals, with males being more affected than females. Decomposition analysis indicated that epidemiological change was a significant factor contributing to tetanus in China, while the impacts of population and aging were relatively minor. According to predictions from the Bayesian age-period-cohort model, by 2050, only the prevalence rate was expected to slightly increase, while all other indicators were projected to decline and remain at low levels. Conclusion The disease burden of tetanus in China decreased from 1990 to 2021. In subsequent prevention efforts, newborns and middle-aged and elderly individuals should be prioritized as targets for prevention and control to maintain the disease burden of tetanus at a low level.

Citation： LIU Menglong, LONG Xu, WANG Guixia, LI Siqi, SUN Tianjing, ZHOU Dandan, JIANG Xuheng, YU Anyong, DUAN Haizhen. Burden of tetanus in China: trends from 1990 to 2021 and projections to 2050. West China Medical Journal, 2025, 40(11): 1788-1793. doi: 10.7507/1002-0179.202509266 Copy

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24.	劉倩, 孔江南, 豐達星, 等. 2022-2023 年河南省健康人群破傷風抗體水平分析. 中華預防醫學雜志, 2025, 59(8): 1239-1245.

1. Cook TM, Protheroe RT, Handel JM. Tetanus: a review of the literature. Br J Anaesth, 2001, 87(3): 477-487.
2. Wilkins CA, Richter MB, Hobbs WB, et al. Occurrence of Clostridium tetani in soil and horses. S Afr Med J, 1988, 73(12): 718-720.
3. Galazka A, Gasse F. The present status of tetanus and tetanus vaccination. Curr Top Microbiol Immunol, 1995, 195: 31-53.
4. Gergen PJ, McQuillan GM, Kiely M, et al. A population-based serologic survey of immunity to tetanus in the United States. N Engl J Med, 1995, 332(12): 761-766.
5. Yen LM, Thwaites CL. Tetanus. Lancet, 2019, 393(10181): 1657-1668.
6. Fauveau V, Mamdani M, Steinglass R, et al. Maternal tetanus: magnitude, epidemiology and potential control measures. Int J Gynaecol Obstet, 1993, 40(1): 3-12.
7. Thwaites CL, Beeching NJ, Newton CR. Maternal and neonatal tetanus. Lancet, 2015, 385(9965): 362-370.
8. GBD 2019 Risk Factors Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
9. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countriesand territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
10. Carstensen B. Age-period-cohort models for the Lexis diagram. Stat Med, 2007, 26(15): 3018-3045.
11. Svensson J, Carstensen B, M?lbak A, et al. Increased risk of childhood type 1 diabetes in children born after 1985. Diabetes Care, 2002, 25(12): 2197-2201.
12. Lalli G, Gschmeissner S, Schiavo G. Myosin Va and microtubule-based motors are required for fast axonal retrograde transport of tetanus toxin in motor neurons. J Cell Sci, 2003, 116(Pt 22): 4639-4650.
13. Schiavo G, Benfenati F, Poulain B, et al. Tetanus and botulinum-B neurotoxins block neurotransmitter release by proteolytic cleavage of synaptobrevin. Nature, 1992, 359(6398): 832-835.
14. Caccin P, Rossetto O, Rigoni M, et al. VAMP/synaptobrevin cleavage by tetanus and botulinum neurotoxins is strongly enhanced by acidic liposomes. FEBS Lett, 2003, 542(1-3): 132-136.
15. World Health Organization. Electronic address: sageexecsec@who. int. Tetanus vaccines: WHO position paper, February 2017 - Recommendations. Vaccine, 2018, 36(25): 3573-3575.
16. Cernuschi T, Gaglione S, Bozzani F. Challenges to sustainable immunization systems in Gavi transitioning countries. Vaccine, 2018, 36(45): 6858-6866.
17. Demicheli V, Barale A, Rivetti A. Vaccines for women for preventing neonatal tetanus. Cochrane Database Syst Rev, 2015, 2015(7): CD002959.
18. Messeret ES, Masresha B, Yakubu A, et al. Maternal and neonatal tetanus elimination (MNTE) in the WHO African Region. J Immunol Sci, 2018, Suppl(15): 103-107.
19. Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
20. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am, 2023, 25: 100561.
21. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
22. IHME Pathogen Core Group. Global burden associated with 85 pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Infect Dis, 2024, 24(8): 868-895.
23. GBD 2019 Antimicrobial Resistance Collaborators. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2022, 400(10369): 2221-2248.
24. 劉倩, 孔江南, 豐達星, 等. 2022-2023 年河南省健康人群破傷風抗體水平分析. 中華預防醫學雜志, 2025, 59(8): 1239-1245.

West China Medical Journal

Burden of tetanus in China: trends from 1990 to 2021 and projections to 2050

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