Tetanus, a severe bacterial disease often referred to as "lockjaw," is experiencing a resurgence in the United States, with cases reaching their highest point in two decades, according to experts. Provisional data for 2025 indicates 38 cases, an increase from 33 in 2024 and nearing the 2006 high of 41 cases.
Tetanus is caused by the bacterium Clostridium tetani, found in soil and animal feces. It enters the body most commonly through wounds and releases a toxin that disrupts nerve signals, leading to painful muscle contractions and spasms. A hallmark symptom is lockjaw, difficulty opening the mouth. Severe cases can result in respiratory failure and other life-threatening complications. Approximately 10 percent of infected patients die from the disease.
Pediatric Cases Raise Alarm
Of particular concern to medical professionals are four pediatric tetanus cases reported in 2024, a striking number as many tetanus cases involve elderly individuals who may not have received early vaccinations. Two of these pediatric cases involved families refusing tetanus treatment and vaccination, a development described as "extremely concerning" by pediatricians writing in JAMA.
These four children, aged one to 15, were unvaccinated against tetanus. Overall, treatment was administered in only 2 percent of cases where patients sought care, and the tetanus vaccine was given prophylactically in only 26 percent of indicated instances. The doctors noted that nearly all tetanus patients require hospitalization, with many needing mechanical ventilation.
Vaccine Hesitancy and Declining Rates
Tetanus is not contagious between people, meaning herd immunity is not a factor in its prevention. The only preventative measure is vaccination, primarily through the Tdap vaccine, which also protects against diphtheria and pertussis (whooping cough). The Tdap vaccine has been recommended since 1948, with a different formulation, DTaP, used for young children.
Despite the vaccine's proven safety and efficacy, an increase in vaccine hesitancy has contributed to a decline in vaccination rates. The Centers for Disease Control and Prevention (CDC) reported a drop in DTaP vaccination coverage among kindergarteners to 92 percent for the 2024-2025 school year, down from 95 percent in 2019-2020.
"As pediatricians, we are particularly concerned about the declining primary immunization rates in children and the lack of vaccination with the tetanus vaccine in pregnant women to prevent infant disease," the doctors stated. Pregnant women are recommended to receive the Tdap vaccine during the third trimester to protect newborns.
Historical Context and Effectiveness
The CDC reports that tetanus mortality has decreased by over 99 percent since the early 1900s. Since the disease became reportable in 1947, incidence has also declined by 99 percent, with approximately two deaths annually since 2000.
However, a recent CDC report analyzing data from 2009 to 2023 found 402 tetanus cases and 37 deaths. Among patients with a known vaccine history, 44 percent had never received a tetanus vaccination, and 33 percent had only received one or two doses. For those who did receive the Tdap vaccine, 59 percent had their last shot more than a decade before infection.
Experts emphasize that if vaccine hesitancy continues to grow and school entry vaccination requirements are relaxed, increases in vaccine-preventable diseases, including tetanus, are likely. They stress the importance of vaccination and prompt medical attention for tetanus-prone wounds. The medical community has decades of experience with the tetanus vaccine, which has a strong record of safety and effectiveness.