Tetanus in Four Unvaccinated Children, 2024

Tetanus is caused by a toxin from the bacterium Clostridium tetani. Its spores are everywhere — in soil, dust and manure — and usually get into the body through an injury, where they germinate and make tetanospasmin, a powerful nerve toxin that can cause severe and sometimes fatal disease.

Because most U.S. children are vaccinated, childhood tetanus is rare: an average of 4.4 cases a year were reported to CDC's National Notifiable Diseases Surveillance System in 2013–2023, though vaccination coverage varies by state. In a recent surveillance summary, 44% of people with tetanus whose history was known had never had a dose of tetanus vaccine.

In July 2024, Idaho reported its first childhood tetanus case in more than 30 years. Three more children fell ill that year, in Minnesota, Missouri and Wisconsin, and CDC and the four states looked at what had happened.

The four children

None had ever received a tetanus vaccine. Two lived in metropolitan counties and two in nonmetropolitan ones.

The illness

All four had generalized tetanus: pain in the back, neck and jaw, muscle spasms and rigidity, and trouble walking.

• All were hospitalized — 25 days on average (8 to 45).
• All received tetanus immunoglobulin (TIG) as treatment and a first dose of tetanus vaccine in hospital.
• At least two needed care after discharge, including readmission for inpatient rehabilitation.
• No one died.
• Only one child went on to complete the recommended vaccine series.

Chances that were missed

The report lists the missed chances to prevent these cases:

1. No vaccination before the injury.
2. Delayed wound care.
3. No TIG or vaccine between the injury and the illness — including two families who refused it when it was offered.

Two facts matter here:

• Tetanus does not spread from person to person, so herd immunity cannot protect an unvaccinated child.
• Having tetanus does not make you immune. Survivors must complete the vaccine series to be protected in future.

What providers should do

• Talk with parents about staying up to date with all recommended vaccines, including tetanus. For children, tetanus vaccine is usually given as five doses of DTaP (diphtheria, tetanus and acellular pertussis) starting at 2 months.
• Stress getting medical care early after a wound that may be contaminated.
• Give prompt wound care, especially for dirty or penetrating wounds, and do not delay TIG or tetanus vaccine when they are indicated — above all for unvaccinated or undervaccinated children. CDC's clinical guidance sets out which is needed.

Tetanus-prone wounds include wounds contaminated with dirt, feces, soil or saliva; puncture wounds; avulsions; and wounds from missiles, crushing, burns and frostbite.

Sources

Based on Campbell KL, Amin AB, Goswitz J, et al., "Notes from the Field: Tetanus in Four Children — Idaho, Minnesota, Missouri, and Wisconsin, 2024," MMWR Morbidity and Mortality Weekly Report volume 75, number 14, Centers for Disease Control and Prevention; a work of the United States government in the public domain.