Tetanus cases are rising. How to prevent getting this potentially fatal disease
By Faye Chiu, CNN
(CNN) — Tetanus may sound like a disease from another era, but experts are warning that it remains a serious threat.
Two recent reports from the US Centers for Disease Control and Prevention found hundreds of tetanus cases and dozens of deaths over 15 years, along with four cases in children in 2024 alone. At the same time, vaccination rates have declined, worrying experts that more people could become vulnerable to this potentially deadly but preventable infection.
To help us understand what tetanus is, why it remains dangerous and how people can protect themselves, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.
CNN: What exactly is tetanus? Is it true that people get it from stepping on a rusty nail?
Dr. Leana Wen: Tetanus is caused by a bacterium called Clostridium tetani. The bacteria produce spores that are extremely common in the environment. The spores can be found in soil, dust and animal manure. Tetanus occurs when the spores enter the body through an injury. Once inside, the bacteria can produce a potent toxin that attacks the nervous system.
As for that rusty nail, the rust itself is not the problem. Nails and other objects are a concern because they may be contaminated with these bacterial spores, especially if they have been outdoors.
Many kinds of injuries can lead to tetanus. Puncture wounds are a classic example, but lacerations, fractures that break the skin, burns, crush injuries and even relatively minor cuts can also pose a risk if they are contaminated with dirt or debris. In a recent CDC case series involving infections in four children, injuries included an ankle fracture sustained while riding an electric scooter, a puncture wound and a foot injury.
CNN: If someone gets a cut or other injury, when should they worry about tetanus?
Wen: People should seek medical attention if they have a deep puncture wound, a wound contaminated with dirt or animal feces, a crush injury, a burn, a frostbite injury, or a wound containing debris that cannot easily be cleaned. The clinician will not only clean the wound but also determine whether additional tetanus protection is needed.
It’s essential to seek care right away. Tetanus can often be prevented after an injury through proper wound care, administration of a tetanus-containing vaccine and, in some cases, tetanus immune globulin, which contains antibodies that provide immediate protection.
CNN: What are the symptoms of tetanus, and why can it become so dangerous?
Wen: Symptoms often begin several days to weeks after an injury. Many people have heard the term “lockjaw,” and that’s one of the classic symptoms. Patients may initially experience jaw stiffness, neck pain, back pain or difficulty swallowing.
As the disease progresses, muscles throughout the body can become rigid and go into painful spasms. The disease can quickly become life-threatening. Muscles involved in breathing may stop functioning properly. Some patients develop spasms of the vocal cords that obstruct the airway. Others develop dangerous fluctuations in blood pressure and abnormal heart rhythms because the autonomic nervous system becomes affected. Recovery can take weeks or months, and even with excellent medical care, the disease can be fatal.
CNN: What vaccines are recommended and when should people receive them?
Wen: The American Academy of Pediatrics recommends that children receive five doses of a tetanus-containing vaccine as part of the routine childhood immunization schedule, beginning at 2 months of age. Adolescents should then receive a Tdap or tetanus, diphtheria and acellular pertussis booster at age 11 or 12.
Adults should receive a tetanus booster every 10 years thereafter. Those who have sustained a severe burn or dirty wound should follow up with a booster after five years, according to the CDC. And pregnant individuals should also receive a Tdap vaccine during each pregnancy to help protect newborns.
CNN: Who is most at risk today?
Wen: The people most at risk are those who are unvaccinated or did not complete their primary vaccination series. A CDC surveillance report found that among people who developed tetanus and whose vaccination history was known, nearly half had never received a tetanus vaccine.
Children whose parents or caregivers decline vaccination are particularly vulnerable. This also includes newborns; receiving a tetanus-containing vaccine during pregnancy helps protect infants against neonatal tetanus.
Older adults are another important group. The highest rates of tetanus cases and tetanus-related deaths occurred among women age 80 and older, according to the CDC report. The primary series of the tetanus vaccine was first recommended in 1947. It’s possible that some of these older women never received the primary series, and did not receive it as part of military services like men of similar ages did.
CNN: Is tetanus contagious? Can you catch it from another person?
Wen: No. Tetanus is not contagious. This is important for people to know, first because it helps them understand how tetanus is spread, and second because it highlights why vaccination is so important.
With diseases such as measles, one person’s vaccination helps protect others because it reduces transmission within a community — what we call herd immunity. Tetanus does not work the same way. You cannot rely on others around you being vaccinated to keep you safe.
CNN: What did the CDC reports find that prompted renewed warnings?
Wen: The CDC surveillance summary examined tetanus cases in the United States from 2009 through 2023. During that 15-year period, there were 402 reported cases and 37 deaths. Almost all patients required hospitalization, with roughly two-thirds of those admitted needing intensive care. More than 40% of hospitalized patients underwent mechanical ventilation, and about 1 in 10 of all infected individuals died.
The other report described four cases of tetanus in children in four different states — Idaho, Minnesota, Missouri and Wisconsin — all occurring in 2024. That handful may not sound like a lot, but pediatric tetanus is extremely rare in the US. There were only about four pediatric cases reported nationally per year between 2013 and 2023.
All four children developed generalized tetanus. In this most common and severe form of the disease, the toxin affects muscles throughout the body rather than remaining confined to one area. Each patient required hospitalization, with hospital stays ranging from eight to 45 days.
Importantly, none of these children had completed the primary tetanus vaccination series. All four developed tetanus after sustaining injuries that could have allowed the bacteria to enter the body. In two of the cases, families sought medical care after the injury but declined the recommended preventive treatment, including a tetanus-containing vaccine and tetanus immune globulin.
CNN: What is your bottom-line advice for people who want to protect themselves and their families?
Wen: First, know your vaccination status. A lot of adults cannot remember when they last received a tetanus booster or whether they ever had their primary vaccine series. This is something that can easily be checked with your healthcare provider.
Second, don’t ignore wounds. Seek prompt medical attention for deep puncture wounds or wounds contaminated by dirt or debris.
Third, recognize that tetanus is still here. It has become rare because vaccines work so well, not because the disease has disappeared. The bacteria that cause tetanus are everywhere in our environment and cannot be eliminated, which is why staying up to date on vaccination is so important. This is one of those situations in medicine where we have a safe, highly effective way to prevent a potentially life-threatening disease, and we should take advantage of it.
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