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[Epidemiologic features of tetanus in adults form Yucatan, Mexico].

OBJECTIVE
To describe epidemiologic features from tetanus in adult patients (TIAP) treated at hospital general O'Horan in Merida, Yucatan, Mexico and compare them with another Mexican series analyzed 25 years ago.


MATERIAL AND METHODS
From 1985 to 1999, 121 TIAP cases aged 13 years or older were identified from which 112 were analyzed. Diagnosis of TIAP was made just in a clinical basis. To analyze information inferencial statistics were used.


RESULTS
People affected by tetanus averaged 43 +/- 21, 95% CI 39 to 47. A 3:1 male to female ratio was documented. Eighty two (73%) patients come from the rural area; 43 (38%) did work as peasants. Sixty two cases (55%) were diagnosed during the Fall and Winter seasons. In 91 patients (81%) no anti-tetanus vaccination was documented. In 89 cases (79%) incubation period averaged 5.4 +/- 4 days, 95% CI 5 to 6. According to this 89 cases (79%) with incubation period < 10 days were graded as severe tetanus and 23 (21%) with incubation period > or = 10 days were graded as non-severe tetanus. Tetanus-prone wounds were documented in 95 (85%) cases, 59 (62%) of which (62%) were localized in the lower extremities. Final outcome dichotomized either as death patient (group one) or surviving patient (group two) was documented in 103 cases of whom 67 (65%) were in group one and 36 (35%) were in group two. By comparing them, differences were seen in mean age (P = 0.004, 95% CI 3.9 to 19.8), age categories (< 50 vs. > or = 50) (chi 2 P = 0.001, 95% CI 0.6 to 0.60), severity of tetanus (Fisher exact test P = 0.0009, 95% CI 2 to 53) and mean hospitalization time (mean difference 14.8, P = 0.0001, 95% CI 11 to 18) but not in sex (chi 2 0.69, P = 0.40).


CONCLUSIONS
In the State of Yucatan, Peninsula de Yucatan, Mexico, TIAP is still an endemic process with high mortality rate specially among young productive people. Secondary preventive measures as routinely tetanus toxoid booster vaccination are still not enough, at least in adulthood.