What Everyone Needs to Know About the Tetanus Vaccine

“Tetanus, although preventable by a highly effective vaccine, continues to cause 30,000-50,000 deaths annually.”

Onder Ergonul, et al., “Tetanus,” The Lancet, February 14, 2026

“Sustained routine vaccination with TTCV [Tetanus toxoid-containing vaccine] and prompt identification and management of tetanus-prone injuries are essential to preserving the current low incidence of this potentially fatal disease.” Michelle M. Hughes,  et al., “Tetanus Surveillance—United States, 2009-2023,” Morbidity and Mortality Weekly Report, April 16, 2026

Tetanus (aka “lockjaw”) is a life-threatening infection characterized by severe neuromuscular dysfunction resulting in painful, involuntary muscular rigidity and spasms. For years, tetanus was relegated to the dustbin of infections that have been defeated, but not eliminated, by highly effective vaccines. Due to the rise in vaccine denial in the U.S., however, the case numbers of vaccine-preventable infections are climbing and tetanus is among them.

In its April 16, 2026 Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) described four cases of tetanus in American children who were hospitalized with the infection in 2024. None of the children had completed a recommended primary tetanus toxoid-containing vaccine (TTCV) series, and none received TTCV or preventive tetanus immunoglobulin (TIG) between their exposure and symptom onset. This CDC report prompted me to write this Germ Gems post.

What is tetanus? Tetanus is an extremely serious but vaccine-preventable disease caused by a toxin produced by spores of the gram-positive anaerobic bacterium Clostridium tetani which is commonly found in dust, soil and animal excrement. Key in its pathogenesis is the inoculation of bacteria into penetrating wounds where C. tetani can thrive, sporulate, and produce tetanospasmin, a potent neurotoxin, that can cause severe, even fatal illness characterized by jaw cramping (lockjaw), painful muscle spasms, dysphagia (difficulty swallowing), and opisthotonos  (arching of the back with total body rigidity).

The World Health Organization reports approximately 73,000 tetanus cases worldwide annually. It is, however, extremely rare in the U.S. but does occur mainly among unvaccinated or under-vaccinated people. (In my almost 50 year medical career, I was involved in the care of only two patients with tetanus, both of whom were farmers deferred from serving in WWII, thereby denying them tetanus vaccination. One patient died and the other survived after a gruesome illness.)

Everyone should get the tetanus vaccine. Unlike certain other infectious diseases, becoming ill and recovering from tetanus does not make one immune from the disease. The only way people can become immune to getting tetanus is by getting the tetanus vaccine.

Most people my age are familiar with the original whole-cell diphtheria, pertussis, tetanus (DPT) vaccine. (The primary series of tetanus vaccine was recommended for routine use in 1947). DPT is now largely obsolete in developed countries and has been replaced by DTaP vaccine for children and Tdap vaccine for adolescents and adults. These modern vaccines use acellular pertussis (aP) components, resulting in fewer side effects. More important, they are safer and more effective than the DPT vaccine.

The tetanus vaccine is a toxoid vaccine, meaning it is an inactivated form of the toxin that causes the continuous, uncontrolled neuromuscular activation resulting in spasms and rigidity—the hallmark of the disease. The vaccine works by training the immune system to fight the harmful toxin produced by C. tetani, rather than by affecting the bacteria itself.  It has a near 100% effectiveness rate in preventing tetanus for roughly 10 years.

Vaccination is the only way to protect yourself from this infection. Depending on one’s age, everyone needs to be vaccinated with either DTaP or Tdap. In addition, all adults should receive a Tdap booster every 10 years. But if you sustain a tetanus-prone wound (i.e., one that is deep, dirty, or contaminated), a Tdap booster should be given if it’s been more than 5 years since your last tetanus shot.

Four unvaccinated American children get tetanus. The CDC reported that in 2024, four children (one case each in Idaho, Minnesota, Wisconsin and Missouri) were diagnosed with tetanus. (In Idaho, it was the first pediatric tetanus infection in more than 30 years). The likely exposure route in one case was unknown but a compound ankle fracture, a knee puncture from an animal bone and a crushing foot injury from a horse hoof while barefoot were the other three likely exposure routes. None of the children had been immunized against tetanus.

All four children experienced generalized tetanus with symptoms such as back, neck, and jaw pain; muscle spasms and rigidity; and problems walking. All patients were hospitalized (average stay, 25 days) and were given TIG for treatment and an initial TTCV dose for prevention of future disease. All four children recovered.

Tetanus can result in serious health consequences and even death. Fortunately, all four of these children survived. But there were missed prevention opportunities for these children including the failure to be vaccinated, delays in wound care, and lack of TIG after exposure and before the illness began. Parents of two children even refused having their children receive post-injury vaccine prophylaxis.

Tetanus still a risk in the U.S.  The number of reported cases of tetanus had dropped more than 95% since the introduction of routine childhood tetanus vaccination in the late 1940s, and deaths had declined more than 99%. (Rudd, T., “Tetanus Deaths Still Happening in the U.S., CDC Report Shows,” MedPage Today, April 16, 2026).  Despite being preventable through vaccination, tetanus cases do, however, continue to occur in the U.S. among persons of all age groups and “approximately 1 in 10 persons who develop tetanus will die, with the highest mortality and case-fatality rates among older adults.” (Hughes, M.M, et al., “Tetanus Surveillance—United States, 2009-2023, MMWR, April 16, 2026).

During 2009-2023, a total of 402 tetanus cases, 37 of which were fatal, were reported in the U.S. Among persons whose vaccination status history was known, 43.9% had not received any tetanus toxoid-containing vaccine doses. And of the reported cases, 86.8% were linked to an acute wound, but only 45% of patients sought medical care.

Tetanus remains a risk for those who are unvaccinated, under-vaccinated or who do not receive recommended wound management. The best protection against tetanus, therefore, is to receive the primary vaccine series and boosters throughout one’s lifespan. It’s that simple.