Prevention and treatment of tetanus in China: a comparative review against international standards.

PURPOSE: Although China has successfully eliminated neonatal tetanus, non-neonatal tetanus, particularly among older adults, remains a persistent clinical and public health challenge. This narrative review synthesizes the current landscape of tetanus in China-covering epidemiology, pathophysiology, prevention, diagnosis, and treatment-and compares it with World Health Organization (WHO) guidance and practices in other countries to identify gaps and optimization strategies. METHODS: A comprehensive narrative review was conducted across five core domains: epidemiology, pathogen and pathophysiology, prevention strategies, diagnostic advances, and therapeutic interventions. Data were integrated from the WHO, the Chinese Center for Disease Control and Prevention, national guidelines, and relevant clinical studies, with comparative analysis against global best practices. RESULTS: Epidemiological trends show a clear shift in disease burden from neonates to older adults, predominantly in rural areas, with high case fatality rates (10-40%) despite low incidence. Advances in antibody detection include sensitive assays (e.g., quantum dot-based lateral flow tests), while treatment guidelines prioritize metronidazole over penicillin, with specific protocols for human tetanus immunoglobulin dosing and autonomic management. CONCLUSION: Adult tetanus highlights critical immunity gaps in China's aging population. Refining immunization policies with WHO guidance and standardizing management may help improve outcomes. China's experience offers a valuable reference for other low- and middle-income countries undergoing similar epidemiological transitions.