Tetanus Surveillance in the United States 2009–2023: CDC Report

The Centers for Disease Control and Prevention (CDC) has released a surveillance summary detailing tetanus cases in the United States from 2009 through 2023. The report highlights that while tetanus is a vaccine-preventable disease and remains rare in the U.S., it continues to occur primarily among populations that are unvaccinated or undervaccinated.

Between 2009 and 2023, a total of 402 tetanus cases and 37 associated deaths were reported across 47 states and the District of Columbia. The mean annual incidence during this period was 0.08 cases and 0.008 deaths per 1 million population.

Demographic Trends and Risk Factors

The surveillance data indicates specific demographic patterns in the occurrence of the disease. More than half of all reported tetanus cases, specifically 62.2%, occurred in males.

Incidence rates varied by age and gender. For all persons under the age of 65, the incidence was higher among males than females. However, for adults aged 80 years and older, the trend reversed, with incidence being higher among women than men.

The highest overall tetanus incidence was observed among women aged 80 years and older, with a rate of 0.27 cases per 1 million population.

Surveillance Methodology

Tetanus is a nationally notifiable disease tracked by the National Notifiable Diseases Surveillance System (NNDSS). State health departments report cases identified through clinical diagnosis to the CDC using the case definition established by the Council of State and Territorial Epidemiologists (CSTE).

The CDC requests detailed case-specific information to better understand the disease burden. This data includes the clinical course of the illness, wound history, medical care received before the onset of the disease, and the patient’s vaccination history regarding tetanus toxoid–containing vaccines (TTCV).

Historical Context and Prevention

Tetanus is caused by the toxin produced by germinated spores of Clostridium tetani bacteria. The disease has seen a significant decline in the United States since the late 1940s.

Since 1947, reported tetanus cases have declined by more than 95%, and reported deaths have decreased by more than 99%. This decline is attributed to several public health factors:

• The development and use of tetanus immune globulin (TIG), which contributed to declining cases and deaths starting in the early 1900s.
• The integration of tetanus toxoid-containing vaccines into routine U.S. Childhood vaccination schedules during the 1940s.
• The continued use of tetanus vaccination and TIG for wound management.

Despite these advancements, sporadic cases continue to appear. The CDC identifies three primary groups at risk: those who never received a tetanus vaccine, those who did not complete the primary vaccine series, and those who did not remain up to date with their 10-year booster shots.

Since 2010, there have been fewer than 40 reported cases of tetanus each year in the United States.