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Despite the wide availability of tetanus vaccines, US cases of the life-threatening disease continue to occur among people of all ages, especially those who are unvaccinated or undervaccinated, but at low levels, Centers for Disease Control and Prevention (CDC) researchers report.
The study, published today in Morbidity and Mortality Weekly Report, was based on case data from the National Notifiable Diseases Surveillance System from 2009 to 2023.
“Tetanus is a serious vaccine-preventable disease caused by the toxin produced by Clostridium tetani, a spore-forming bacterium that is ubiquitous in the environment,” the authors wrote. “Tetanus is not transmitted person-to-person; exposure usually occurs through a contaminated or deep wound,” causing symptoms such as muscle spasms, rigidity, difficulty swallowing or breathing, lockjaw, and seizures.
45% with wound sought care before disease onset
During the study period, 402 tetanus infections and 37 deaths were reported from 47 states and Washington, DC, for an average annual incidence of 0.08 cases and 0.008 deaths per 1 million people.
Tetanus is a serious vaccine-preventable disease caused by the toxin produced by Clostridium tetani, a spore-forming bacterium that is ubiquitous in the environment.
Over half (62.2%) of cases occurred in males, who had a higher incidence than women among patients older than 65 years, but rates were higher in women than men for those aged 80 and older (0.27 cases per 1 million people). The case-fatality rate among patients with known vital status was 12.4% (37 of 299), with deaths primarily in older adults.
In total, 45.0% of tetanus patients with a substantial wound sought care before symptom onset. Among those with wounds eligible for tetanus post-exposure prevention, only 2.3% received tetanus immune globulin (TIG), and 26% received tetanus toxoid–containing vaccine (TTCV). Among patients with known vaccination history, 43.9% hadn’t received any TTCV doses.
The researchers urged clinicians to evaluate for and offer routine tetanus vaccination for children, as well as 10-year boosters for adults. “In addition, persons with significant wounds should seek timely medical care, and clinicians should provide recommended wound care, including identifying tetanus-prone wounds and the need for and administration of TTCV and TIG.”
They called for continued surveillance and vaccination efforts to monitor trends, prevent tetanus, and reduce incidence.