Epidemiological, Clinical and Prognostic Features of Tetanus in Dakar, Senegal

Abstract

The aim of this study was to describe the epidemiological, clinical and prognostic aspects of tetanus. Methodology: This is a retrospective, descriptive, cross-sectional study based on the records of patients hospitalized for tetanus in the infectious diseases and tropical department of the University Hospital of Fann and collected from 1 January 2015 to 31 December 2022. Results: Over an 8-year period, 517 cases of tetanus were selected, with an average age of 30.9 ± 21.7 years. The median age was 24 years, with extremes of 2 and 90 years. The distribution of cases according to sex revealed a clear male predominance, with a sex ratio of 4.94. The profession was not specified for 47% of patients. The population most affected was represented by students (20.9%) and manual workers (18.8%).  In terms of origin, 65.6% of the cases recorded came from suburban areas. The classic signs of tetanus were found: trismus (99.2%), dysphagia (84.5%) and tonic paroxysms (61.01%). The absence of a vaccination record was noted in 99.4% of cases. The main the portal of entry, for tetanus was integumentary in 397 cases (76.8%), with tetanus presenting mainly in the generalized form in 98.1% of cases. The incubation period was greater than or equal to 7 days in 63.06% of cases, and the invasion period was greater than or equal to 48 hours in 39.8% of cases. With regard to serotherapy, 89.2% of cases were treated intrathecally, and the main complications were cardiovascular (19.5%), infectious (14.1%) and respiratory (10.3%). 19.9% of cases were fatal. Conclusion: Although tetanus has become an exception in developed countries, it continues to pose a real public health problem in countries with limited resources, despite the existence of a vaccine that is now accessible, effective and completely safe. In Senegal, despite the efforts of the Expanded Programme on Immunisation, the incidence of tetanus in hospitals remains high, hence the importance of booster vaccinations and raising public awareness, especially among young people and manual workers.