| BackgroundTetanus is an extremely serious acute infectious disease caused by C.tetanus invading the human body through skin or mucous membrane wounds,growing and multiplying in the wound and producing toxins.Tetanus can occur at any age,and the annual morbidity varies greatly in various parts of the world.Most of them occur in developing countries and become a serious public health problem.China currently lacks research on the incidence of tetanus in the general population.Adults in China rarely vaccinate against tetanus,and medical personnel have more misunderstandings in the prevention and treatment of post-traumatic tetanus.Clinicians in the treatment of patients with tetanus have different methods of using tetanus immune preparations,and there is a general problem of irregular use of tetanus immune preparations.ObjectInvestigate the incidence,economic burden and current status of post-traumatic tetanus disease in Shijiazhuang and Nanjing,analyze the epidemiological characteristics,conduct a survey on the awareness of tetanus prevention knowledge among primary medical staff,and enhance the medical staffs awareness of tetanus disease The degree of attention is paid to reduce misunderstandings in the prevention and treatment of tetanus,and provide a basis for formulating tetanus prevention and control strategies and standardizing the prevention of tetanus.MethodsThe data of tetanus cases comes from the cases of post-traumatic tetanus diagnosed by medical institutions in Shijiazhuang City and Nanjing City from January 1,2014 to December 31,2018.The knowledge of prevention and treatment of primary medical staff comes from May to June 2019 Survey questionnaires filled out among some serving primary medical staff in Hebei Province,Anhui Province,Chongqing City and Shandong Province.Using descriptive statistical epidemiological analysis methods,Excel 2010 and SPSS 22.0 were used for statistical analysis of tetanus incidence,distribution characteristics,economic burden,and current status of prevention and treatment,and awareness of tetanus-related prevention and treatment knowledge among medical staff at the basic level.ResultsThe average annual incidence rates of post-traumatic tetanus in Shijiazhuang City and Nanjing City from 2014 to 2018 were 0.42/100,000 and 0.17/100,000,respectively,and the incidence rates of people over 60 years old were 1.41/100,000 and 0.44/100,000;crude death rate They were 0.11/1 million and 0.05/1 million,respectively,and the mortality was 2.70%and 2.86%,respectively.The cause of death was asphyxia caused by convulsions,followed by respiratory failure,systemic multiple organ failure,75%The interval between death and death is≤7 days.The male to female ratio of cases was 2.70:1,and the incidence rates of males and females were 0.44/100,000 and 0.17/100,000(2=55.978,P<0.05);the cases were mainly agricultural,forestry,animal husbandry and fishery workers,accounting for the total number of cases 86.64%.The trauma site of the cases mainly occurred in the extremities,accounting for 80.82%.There were still 4.11%of cases with no obvious inducement;65.07%of the cases occurred within 1-2 weeks after injury.Of the cases,83.22%used tetanus antitoxin(TAT)and/or tetanus immunoglobulin(TIG),including cases of 4-year-old children.In this investigation,292 post-traumatic tetanus cases were incurred,and a total of 13 363 500.08 yuan in direct medical expenses were incurred,with an average cost of 45 765.41 yuan per case.The payment of medical expenses was mainly self-financed and rural cooperative medical insurance,accounting for 59.25%and 31.16%,respectively.Among the 344 primary medical personnel surveyed,the general latency of tetanus was 41.28%;the primary medical personnel who knew that perianal abscess and colon perforation could cause tetanus infection were 52.91%and 37.79%,respectively;they were fully aware of the three The name of the immune preparation accounted for 50.58%,of which the awareness rate of tetanus toxoid(TT)was 57.85%;17.44%of the medical staff confused the concept of TT and TAT;66.57%thought that inoculation of the immune preparation within 24 hours was effective.After single factor analysis and multivariate analysis Logistic regression analysis,age is a significant factor influencing the knowledge level of primary medical staff(OR=1.423,95%CI:1.068-1.896).Conclusion1.The average annual incidence of post-traumatic tetanus in Shijiazhuang and Nanjing in 2014-2018 was 0.42/100,000 and 0.17/100,000,respectively.There was a significant difference in the incidence of tetanus between the north and the south.2.The incidence of post-traumatic tetanus is closely related to occupational exposure.The incidence rate is higher among males,60-year-olds and above,and employees in agriculture,forestry,animal husbandry and fishery.3.The per capita direct medical expenses of post-traumatic tetanus patients in Shijiazhuang and Nanjing from 2014 to 2018 ranged from RMB 4.48±0.31 million to 4.89±0.83 million accounting for a relatively high proportion of the local GDP per capita and the burden of medical treatment.4.In the treatment of post-traumatic tetanus patients in Shijiazhuang and Nanjing in 2014-2018,the passive immunization application of TAT and TIG was high,but the active TT immunity was extremely low.5.The medical staff at the grassroots level has a relatively low level of knowledge about tetanus.There is a misunderstanding about the concept and use of tetanus immune preparations,which is mainly affected by age. |
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