Peer-reviewed article
Tetanus Surveillance - United States, 2009-2023.
Michelle M Hughes, Avnika B Amin, Amy B Rubis ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This surveillance report documents 402 tetanus cases and 37 deaths in the United States between 2009 and 2023, despite tetanus being vaccine-preventable. Tetanus occurred mainly in unvaccinated and undervaccinated people, with higher death rates among older adults. The report shows that many people with wounds did not receive recommended post-exposure prevention, and nearly 44% of those with known vaccination history had received no tetanus vaccine doses at all.
Key points
- 402 tetanus cases and 37 deaths occurred over 15 years, with a mean annual incidence of 0.08 cases per million population
- 43.9% of cases occurred in persons with no tetanus toxoid-containing vaccine doses
- Only 26% of patients with wounds eligible for post-exposure prophylaxis received the recommended tetanus vaccine
- Case-fatality rate was 12.4%, with highest mortality among older adults; women aged ≥80 years had the highest incidence
- 45% of persons with tetanus who had substantial wounds sought medical care before disease onset
Limitations
This is surveillance data that documents what happened rather than evaluates an intervention. It cannot show why vaccination gaps exist or what would most effectively increase vaccination rates.
Abstract
PROBLEM/CONDITION: Tetanus is a serious but vaccine-preventable disease caused by the toxin produced by germinated spores of Clostridium tetani bacteria. Despite substantial declines in incidence resulting from immunization, cases continue to occur, particularly among unvaccinated and undervaccinated populations. PERIOD COVERED: 2009-2023. DESCRIPTION OF SYSTEM: The National Notifiable Diseases Surveillance System uses national surveillance to identify cases of tetanus using the Council of State and Territorial Epidemiologists' tetanus case definition. Tetanus cases identified through clinical diagnosis are reported to CDC by state health departments. Detailed tetanus-specific case information is requested, which includes tetanus toxoid-containing vaccine (TTCV) vaccination history, wound history, medical care before tetanus disease onset, and the clinical course of illness, including death. RESULTS: During 2009-2023, a total of 402 tetanus cases and 37 associated deaths were reported from 47 states and the District of Columbia, with a mean annual tetanus incidence of 0.08 cases and 0.008 deaths per 1 million population. More than half (62.2%) of all reported tetanus cases occurred in males. Incidence was higher among males than females for all persons aged <65 years and higher among women than men for adults aged ≥80 years. Women aged ≥80 years had the highest overall tetanus incidence (0.27 cases per 1 million population). The overall case-fatality rate among persons with tetanus with known vital status was 12.4% (37 of 299), with deaths predominantly affecting older adults. A total of 45.0% of persons with tetanus who had a substantial wound sought medical care before disease onset. Among patients with wounds eligible for tetanus post-exposure prophylaxis, 2.3% received tetanus immune globulin (TIG) and 26% received TTCV per recommendations. Among persons whose vaccination history was known, a substantial proportion (43.9%) had not received any TTCV doses, highlighting substantial gaps in coverage. INTERPRETATION: Despite being preventable through vaccination, tetanus continues to occur among persons of all age groups in the United States. Overall, males have higher incidence compared with females; the highest incidence is among older women. Approximately 1 in 10 persons who develop tetanus will die, with the highest mortality and case-fatality rates among older adults. PUBLIC HEALTH ACTION: Multiple efforts might reduce the incidence of tetanus, including clinicians' assessing for and offering routine tetanus vaccination for children and decennial tetanus 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. Because C. tetani is ubiquitous in the environment, continued surveillance and vaccination efforts are crucial to monitor trends, identify opportunities to prevent tetanus cases, and reduce tetanus incidence in the United States.