Neonatal tetanus incidence in China, 1996-2001, and risk factors for neonatal tetanus, Guangxi Province, China

Background In China during 1995-1996 widespread tetanus toxoid (TT) mass vaccination of women of childbearing age in high-risk areas was conducted and neonatal tetanus (NT) surveillance was initiated as part of NT elimination efforts. Despite a subsequent decrease in the estimated rate of NT, the NT disease burden remains high in poorer areas of China. Methods To describe the recent epidemiology of NT in China and estimate its risk, we analysed national surveillance data in China 1996-2001 and conducted a case-control study in one high-risk county (Bobai): 60 hospitalized cases were sex- and calendar-birth year matched to 60 controls from the same or neighbouring villages. Results Reported national annual NT incidence decreased from 0.21/1000 live births (LB) in 1997 to 0.16/1000 LB in 2001. Case mothers were more likely to be aged >30 years (odds ratio [OR] = 6; 95% CI: 2.2, 20.2), unschooled (OR = 3.2; 95% CI: 1.1, 11.6), and with an annual income of <1000 yuan ($125 USD) (OR = 6.0; 95% CI: 1.9, 25.6). Only 28% of control mothers and 12% of case mothers reported any TT vaccination. In multivariate analysis, relative to hospital delivery, cases had a 64-fold increased odds of home delivery by a family member or neighbour (95% CI: 8.4, 982.2), and a 13-fold increased odds of home delivery by a traditional birth attendant (95% CI: 1.6, 322.6). Conclusions Improved access to clean deliveries in high-risk areas is critically needed in China. Nonetheless, targeted TT vaccination appears to have helped reduce NT incidence in China.