Influence of Age on the Clinical and Prognostic Features of Tetanus in Mali

Abstract

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.