National vaccination programmes recommend the influenza vaccine for older adults, but this population group has the greatest morbidity and mortality from other preventable vaccine diseases. The aim of this article is to estimate the vaccine coverage in adults aged 65 years and older and to analyse the factors that could increase or decrease vaccination uptake probability for the three listed vaccines in the national vaccination programme (influenza, tetanus and diphtheria, and pneumococcus) and the full scheme in Mexico. We conducted an analytical cross-sectional study with 2012, 2018, and 2021 rounds from the National Health and Nutrition Survey, in which we calculated the vaccine coverage estimations and performed multivariable logistic regression models to analyse the factors related to vaccine uptake. Tetanus and diphtheria vaccines had the greatest coverage estimation in all years (59–71%), whereas the pneumococcus vaccine had the lowest (32–53%). Full scheme vaccine coverage decreased from 37.80% to 24.77% in 2012 and 2021, respectively. The National Health Card property, morbidity, being a beneficiary of any health system institution, and use of preventive services increased the probability of vaccine uptake. In conclusion, vaccine coverage in older Mexican adults decreased over time, and the Mexican health system plays a strategic role in immunisation.

The aim of the present research is to verify the immune status against tetanus in students and workers exposed to risk and to ascertain whether a decennial booster is necessary. Antibodies against tetanus were measured in 1433 workers and students of Padua University (Italy). The enrolment criterion was the ability to provide a booklet of vaccinations released by a public health office. The influence of age, gender, the number of vaccine doses, and the interval since the last dose was determined. Ten years after the last dose, the majority of subjects (95·0%) displayed an antibody titre above the protective level (⩾0·10 IU/ml), and half of these (49·1%) had a long-term protective level (⩾1·0 IU/ml). According to our data, titre depends on both the number of vaccine doses and the interval since the last dose (P < 0·0001). Five vaccine doses and an interval of at least 10 years since the last dose are predictive of a long-term protective titre in absence of a booster (1·97 IU/ml). These data suggest that when primary series are completed, a decennial booster is unnecessary for up to 20 years. Furthermore, we recommend measuring the antibody level before a new booster is given to prevent problems related to over-immunisation.

Tetanus is a life-threatening clinical syndrome that commonly presents with muscular spasms, rigidity, and autonomic instability. It is considered rare in industrialized countries, and tetanus occurring secondary to dental abscesses, procedures, or infections has been infrequently reported. We describe the case of a patient inadequately immunized for tetanus, who presented to the emergency department with muscular spasms, rigidity, and autonomic instability in the setting of an odontogenic infection. A clinical diagnosis of tetanus was made and subsequently managed successfully.

Public Health England conducts enhanced national surveillance of tetanus, a potentially life-threatening vaccine-preventable disease. A standardized questionnaire was used to ascertain clinical and demographic details of individuals reported with clinically suspected tetanus. The 96 cases identified between 2001 and 2014 were analysed. The average annual incidence was 0·13/million (95% confidence interval 0·10–0·16) of which 50·0% were male. Where reported, 70·3% of injuries occurred in the home/garden (45/64). Overall, 40·3% (31/77) cases were in people who inject drugs (PWID), including a cluster of 22 cases during 2003–2004. Where known (n = 68), only 8·8% were age-appropriately immunized. The overall case-fatality rate was 11·0% (9/82). All tetanus-associated deaths occurred in adults aged >45 years, none of whom were fully immunized. Due to the success of the childhood immunization programme, tetanus remains a rare disease in England with the majority of cases occurring in older unimmunized or partially immunized adults. Minor injuries in the home/garden were the most commonly reported likely sources of infection, although cases in PWID increased during this period. It is essential that high routine vaccine coverage is maintained and that susceptible individuals, particularly older adults, are protected through vaccination and are offered timely post-exposure management following a tetanus-prone wound.

Susceptibility to vaccine-preventable diseases in Belgium in 2006 was estimated from a serum survey. Immunoglobulins against measles, mumps, rubella (MMR) and diphtheria at all available ages (1–65 years), and against tetanus in >40-year-olds, were measured by ELISA. Age-standardized overall seronegativity for MMR was low (3·9%, 8·0%, 10·4%, respectively). However, the World Health Organization's targets for measles elimination were not met in 5- to 24-year-olds and about 1 in 7 women at childbearing age (15–39 years) were seronegative for rubella. In adults >40 years, tetanus immunity (87·2%, >0·16 IU/ml) largely exceeded diphtheria immunity (20–45%, >0·1 IU/ml). Despite free universal vaccination against MMR for more than 20 years and against diphtheria and tetanus for almost 60 years, our study revealed specific age groups remaining at risk for infection with these pathogens.

Despite successful large-scale immunization programs in North America, there remains a significant population without active immunity to tetanus toxins because immunizations have been refused or delayed, and because of waning immunity. We report the case of a 7-year-old boy who presented to the emergency department with a chin laceration and a 7-day history of repeated falls of increasing frequency. We found this case to be associated with dysphagia and facial spasm, and we learned that the child had dropped a brick on his foot 2 weeks previously. The patient was subsequently diagnosed with tetanus and treated accordingly. Tetanus presentations to emergency departments may vary from mild muscular rigidity to advanced respiratory failure and thus clinicians should consider the diagnosis in various clinical presentations, especially in areas remote from advanced supportive care.

Tetanus kills approximately 500 000 people worldwide each year. Widespread immunization has ensured that it is rarely encountered in the United Kingdom. An increase in global travel may increase the likelihood of such encounters in the developed world in the future.

In the non-immunized patient, death from tetanus can be avoided by early recognition and timely intervention. The potential need for airway support and sedation should not be underestimated.

The authors’ case report should increase the awareness of the otolaryngologist when confronted with atypical cases of dysphagia and trismus and provides details of the recommended treatment regime.

A 6-months pregnant woman suffering from severe tetanus was successfully treated with intrathecal baclofen. She delivered a premature but healthy neo-nate, and was safely discharged home 40 days after the onset of symptoms of tetanus. Specific aspects of intrathecal baclofen therapy in the pregnant woman are discussed.

Tetanus is a life threatening infection that is rarely encountered in clinical practice. Knowledge of the condition is necessary to ensure optimal management. A 30-year-old male presented with classic signs and symptoms of the disease, including trismus, risus sardonicus, paroxysmal muscle spasms and autonomic instability. The pathophysiology and modern management of this condition are reviewed.

Three patients are presented with cephalic tetanus following injuries to the face. Two were adults and one a child. All three had bilateral VIIth cranial nerve involvement and one patient also presented with involvement of the IIIrd, IVth and VIth cranial nerves. The patients initially an ipsilateral VIIth cranial nerve weakness which later in the course of the illness developed into hyperactivity of the VIIth cranial nerve. The contralateral VIIth cranial nerve demonstrated a similar pattern. The stapedial reflex was tested serially. The stapedius muscle activity preceded that of the muscles of the face thus serving as an indicator of improvement or impending deterioration. Deflections measuring more than 1 cm, on stapedial reflex threshold testing, were indicative of stapedial reflex spasm. In the stapedial reflex decay test, both ill-sustained (intermittent) and sustained spasms of the stapedius muscle were seen.

Dysphagia is a common symptom presenting to ENT departments. Two cases of tetanus with dysphagia as a major symptom are discussed, together with a review of previously reported cases. Although tetanus is a rare disease in the United Kingdom, the possibility of this diagnosis should be borne in mind in patients presenting with progressive dysphagia, especially if there are other head and neck symptoms present.