One in Three Hospitalised Adult Tetanus Patients Die: Meta-Analysis Finds

The study, conducted by Zhenlin Chen and colleagues from the Department of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, analysed data from 22 observational studies comprising 1,618 adult patients admitted with tetanus between January 2000 and February 2024.

The study revealed the following findings:

• The pooled analysis showed an overall mortality rate of 32% among hospitalised adult tetanus patients, highlighting the persistent threat of this preventable disease despite medical advancements.
• The findings emphasize the need for enhanced preventive strategies, including better adult vaccination coverage and timely wound care education, particularly for individuals over 40 years of age.
• Age ≥40 years was identified as a significant risk factor for mortality (RR = 1.89).
• An incubation period of less than seven days was linked to higher mortality risk (RR = 2.10).
• The onset of symptoms within two days increased the likelihood of death (RR = 2.06).
• Severe disease, indicated by the Ablett classification ≥III, was strongly associated with mortality (RR = 3.40).
• The presence of autonomic dysfunction was a major predictor of poor outcomes (RR = 4.84).
• The need for mechanical ventilation significantly increased the mortality risk (RR = 2.46).
• These identified factors can help clinicians in early risk assessment and implementing targeted management strategies to improve survival in hospitalised tetanus patients.

According to the authors, the meta-analysis is the first of its kind to systematically evaluate mortality and associated risk factors in hospitalised adults with tetanus. Data were extracted independently by two reviewers from four major databases—PubMed, Web of Science, The Cochrane Library, and Embase. Statistical heterogeneity was assessed using the I² statistic, with subgroup and meta-regression analyses performed to explore potential sources of variation among the studies.

While the study provides valuable insights, the authors acknowledged certain limitations. Only four databases were searched, which may have resulted in the exclusion of relevant studies. Additionally, both univariate and multivariate analyses were considered for risk factor extraction, and the small sample size for certain variables may have affected the robustness of the results. Differences in statistical methodologies across studies were also noted as a factor warranting cautious interpretation.

Despite these constraints, the findings carry significant clinical and public health implications. The high mortality rate reinforces the urgent need to strengthen tetanus control measures, particularly focusing on adult immunisation and early intervention for high-risk patients. The identification of specific risk factors provides a framework for targeted care, potentially reducing fatalities in hospitalised cases.

The researchers stress that further large-scale, multicentre prospective studies are necessary to validate these findings and provide more detailed clinical insights. Until then, prioritising vaccination coverage, improving awareness of wound care, and promptly identifying patients at elevated risk could serve as key strategies in reducing tetanus-related deaths among adults.

Reference:

Chen Z, Lin Z, Zhang W, et alMortality and risk factors in hospitalised adult patients with tetanus: a systematic review and meta-analysis. BMJ Open 2025;15:e101782. doi: 10.1136/bmjopen-2025-101782