10 years trends and hospitalization outcomes of non-neonatal tetanus: a large-scale multicenter retrospective study in China

Non-neonatal tetanus continues to pose a public health challenge in low- and middle-income regions. This study aimed to describe the decade-long profile of non-neonatal tetanus in Guangdong, China, from 2011 to 2021—a period marked by rapid economic development and healthcare system strengthening. Multicenter, retrospective study. The study was conducted across 159 hospitals in Guangdong, China. We included patients with a clinical diagnosis of tetanus admitted between 2011 and 2021. A total of 2,567 cases (median age 53 years; 62.1% male) were analyzed. None. Data on demographics, vaccination status, clinical severity (Ablett classification), etiology, seasonal trends, critical care utilization, outcomes, and costs were collected. Farmers constituted the largest occupational group (43.7%), and only 2.2% had documented tetanus vaccination. Hospitalizations fluctuated but showed an overall increase, with a rising proportion of severe cases (Ablett grade III/IV). A seasonal peak was observed in August–September. The most common etiology was post-traumatic injury (43.4%). Critical care was frequently required: 25.1% of patients were admitted to the ICU, and 23.8% received mechanical ventilation. Multivariable analysis identified higher Ablett grade, injection drug use, unknown etiology, and comorbidities as independent risk factors for mortality; ICU admission was protective. Case fatality declined significantly from 11.8% in 2012 to 3.5% in 2021, while median hospitalization costs rose substantially. This large-scale study reveals a substantial burden of severe non-neonatal tetanus among under-vaccinated adults, persisting despite the region’s economic transition. Case fatality decreased over the study period, likely reflecting improvements in both the accessibility and quality of critical care, albeit with increasing healthcare costs. The association between injection drug use or unknown etiology and mortality warrants heightened clinical vigilance.