Two decades of global research on tetanus vaccines and tetanus immunoglobulins: a comprehensive bibliometric analysis and integrative review (2000-2025).

BACKGROUND

Tetanus is a severe but vaccine-preventable disease controlled by tetanus toxoid (TT) immunization and tetanus immunoglobulin (TIG) therapy. Although maternal-neonatal tetanus has been eliminated in many regions, coverage gaps and sporadic cases persist in low-resource settings. As a longstanding component of global immunization and a key conjugate carrier platform, tetanus research remains essential despite advances in novel vaccine technologies. However, the global research landscape on tetanus vaccines and immunoglobulins remains unmapped.

OBJECTIVE

This study aimed to conduct a comprehensive bibliometric analysis of publications on TT and TIG from 2000 to 2025, to characterize research dynamics, leading contributors, and thematic evolution.

METHODS

We retrieved publications from the Web of Science Core Collection (SCI-Expanded) for 2000-2025 using relevant keywords ("tetanus vaccine*" OR "tetanus toxoid*" OR "tetanus immunoglobulin*" OR "tetanus immune globulin*" OR "tetanus antitoxin*"). Following screening, 2,949 English-language articles and reviews were included. Bibliometric analyses (publication trends, funding agencies, co-authorship, co-citation, and keyword co-occurrence) were performed using VOSviewer, CiteSpace, and the bibliometrix R package.

RESULTS

A total of 2,949 publications were analyzed. Annual output remained stable (mean ≈ 113.4), with citations peaking in 2021 (n=7,291). The USA led in volume (1,130 papers), while Switzerland achieved the highest impact (88.41 citations/article). The Centers for Disease Control and Prevention (CDC) and University of Oxford emerged as central hubs, with GlaxoSmithKline (GSK) illustrating the role of industry-academic partnerships. A strategic funding shift occurred around 2010: while the National Institutes of Health (NIH) drives foundational research, the Bill & Melinda Gates Foundation (BMGF) has become the engine for translational equity. Evolutionary trends show a shift from early cellular mechanisms toward maternal immunization coverage, implementation determinants in low- and middle-income countries (LMICs), and the expanding utility of tetanus toxoid (TT) as a conjugate vaccine carrier.

CONCLUSION

Tetanus research has evolved into a dynamic model for modern vaccinology, bridging classical immunization and next-generation technology. Beyond maternal protection, the field is expanding toward conjugate platforms and recombinant biologics. Achieving global elimination requires aligning these biotechnological innovations with equitable implementation strategies in low-resource settings.