Experts Warn Against Ignoring Tetanus Risk

 Health experts are urging people to keep their tetanus vaccinations up to date after new surveillance data revealed hundreds of infections and dozens of deaths in the United States over the past 15 years, alongside a recent rise in paediatric cases linked to incomplete immunisation.

Two recent reports from the US Centers for Disease Control and Prevention found 402 reported tetanus cases and 37 deaths between 2009 and 2023. The agency also documented four cases of tetanus in children across four states during 2024, prompting renewed concern that declining vaccination rates could leave more people vulnerable to a disease that is preventable but can be fatal.

Emergency physician Dr Leana Wen said tetanus is caused by the bacterium Clostridium tetani, whose spores are commonly found in soil, dust and animal manure. Infection occurs when the spores enter the body through an injury and release a toxin that attacks the nervous system.

She said the popular belief that rusty nails themselves cause tetanus is misleading. Instead, nails and other objects become dangerous when contaminated with bacterial spores, particularly after exposure to the outdoors.

While puncture wounds are commonly associated with the disease, Dr Wen said cuts, burns, crush injuries, open fractures and even relatively minor wounds can also lead to infection if contaminated with dirt or debris. Among the four paediatric cases reported in 2024 were injuries involving an electric scooter accident, a puncture wound and a foot injury.

Medical treatment should be sought promptly after deep puncture wounds, burns, frostbite or injuries contaminated with soil or animal waste, she said. Proper wound cleaning, a tetanus containing vaccine and, in some cases, tetanus immune globulin can prevent infection after exposure.

Symptoms usually appear several days or weeks after an injury. Early signs include jaw stiffness, often known as lockjaw, neck pain, difficulty swallowing and muscle stiffness. As the illness progresses, painful spasms can spread throughout the body, affecting breathing muscles, the airway, blood pressure and heart rhythm. Recovery may take weeks or months, and severe cases can prove fatal despite intensive treatment.

Routine immunisation remains the most effective protection. Children are advised to receive five doses of a tetanus containing vaccine beginning at 2 months of age, followed by a Tdap booster at 11 or 12. Adults should receive booster vaccinations every 10 years, while those with dirty wounds may require one after five years. Tdap vaccination is also recommended during every pregnancy to help protect newborns.

The CDC found that nearly half of infected patients with known vaccination histories had never received a tetanus vaccine. Almost all patients required hospital treatment, about two thirds needed intensive care and more than 40 per cent required mechanical ventilation. Around 1 in 10 people infected died.

The four children diagnosed in 2024 all developed generalised tetanus and required hospital stays lasting between eight and 45 days. None had completed the primary vaccination series. In two cases, families sought medical attention after the injury but declined the recommended vaccine and tetanus immune globulin.

Dr Wen said adults should check their vaccination records, avoid ignoring contaminated wounds and remember that tetanus remains present in the environment. “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,” she said.

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