A deadly disease once thought to have been eradicated is resurging in the United States. Tetanus, a life-threatening bacterial infection, continues to affect individuals of all ages despite the availability of vaccines, according to a report from researchers at the Centers for Disease Control and Prevention (CDC). Once nearly eliminated, this infection is reemerging as a public health concern, with case counts reaching their highest levels in two decades. Experts worry that without immediate intervention, this condition could claim more lives in the years ahead.
What Is Tetanus?
Tetanus is a bacterial infection caused by Clostridium tetani (C. tetani). Naturally found in the environment, this bacterium enters the body, most often through a wound, and releases a toxin. According to the CDC, tetanus is an uncommon but very serious disease that requires immediate hospital treatment.
Symptoms
Once inside the body, tetanus toxins interfere with the release of neurotransmitters, leading to muscle contractions and intractable spasms. Symptoms typically occur between 3 and 21 days (average 8 days) after exposure. The early hallmark of tetanus is lockjaw, a painful condition in which the jaw cannot move or open properly. Other symptoms, according to the CDC, include:
- Trouble swallowing
- Sudden, involuntary muscle spasms — often in the stomach
- Painful muscle stiffness throughout the body
- Seizures (jerking or staring)
- Headache
- Fever and sweating
- Changes in blood pressure and heart rate
The disease can cause serious health problems such as laryngospasm (uncontrolled tightening of the vocal cords), fractures, pulmonary embolism (blockage in the lungs caused by a blood clot), aspiration pneumonia (lung infection from inhaling saliva or vomit), and breathing difficulties. In severe cases, tetanus can lead to death. In the US, one in 10 infected patients dies from tetanus.
Why Are the Numbers Rising?
Recent data from 2025 show 38 confirmed cases, an increase from 33 in 2024. This is the highest since 2006, when there were 41 cases. In a recent article published in JAMA, two paediatricians noted that it was striking that four children had tetanus in 2024, as the disease usually affects older people who were never vaccinated in childhood. They also emphasised that it is extremely concerning that in two of the paediatric cases, families refused tetanus treatment and vaccination, which can be given after a cut or injury to prevent infection.
“Both the lack of appreciation of the tetanus-prone wound status and the inadequate implementation of recommended post-exposure tetanus prophylaxis, due either to incomplete clinical care or refusal by the patient or parent, are extremely concerning,” they said.
According to the CDC, none of the four paediatric patients (aged 1–15) had been vaccinated against tetanus. Among those who sought care, only 2% received treatment and 26% received the vaccine when indicated. The doctors added that the latest data emphasise the serious nature of tetanus, with nearly all cases requiring hospitalisation and many requiring mechanical ventilation and tracheostomy to sustain life during recovery.
Why Is Vaccination Important?
Vaccination is the best way to protect against tetanus, according to the CDC, which recommends it for everyone. As tetanus does not spread from person to person, there is no scope for herd immunity. Therefore, Tdap vaccination is the only effective means of prevention. The childhood schedule includes five doses, followed by boosters in adolescence and every 10 years. Pregnant women are also advised to receive Tdap to protect their newborns.
Despite this, vaccination rates among kindergarteners have declined. In 2024–2025, the CDC reported a drop to 92% coverage. The rate has been falling since the 2019–2020 school year, when coverage stood at 95%.
“As paediatricians, we are particularly concerned about declining primary immunisation rates in children and the lack of tetanus vaccination in pregnant women to prevent infant disease,” the doctors said.
Despite its proven effectiveness, the post-pandemic landscape has seen a shift in public attitudes towards vaccines. “Although the report affirmed the remarkable effectiveness of the tetanus vaccine, it raised several concerns, particularly because the value of all vaccines is increasingly being questioned. Since the Covid-19 pandemic, vaccination rates have declined, particularly among children eligible for the Vaccines for Children programme, and the percentage of children with vaccine exemptions has increased,” they added.
The doctors emphasised that tetanus is a frightful disease that can cause incredible suffering and even death in some cases. “If vaccine hesitancy increases and mandatory school-entry vaccination requirements are weakened, increases in vaccine-preventable diseases (including tetanus) would be expected,” they said.
