Deadly ‘lockjaw’ disease is having a resurgence in the US, experts warn… as cases reach 20-year high
A deadly disease dating back hundreds of years and long thought to have been eradicated is having a resurgence in the US, experts have warned.
Tetanus is a life-threatening disease requiring intensive treatments and often a lengthy hospital stay in the intensive care unit.
It is caused by the bacterium Clostridium tetani, which is naturally present in nature. When it enters the body, most often through a wound, it releases tetanus toxin.
The toxin interferes with the release of neurotransmitters, which causes muscle contractions and intractable muscle spasms. One of the early hallmark signs of tetanus is lockjaw, a painful condition in which the jaw cannot move or open properly.
Body-wide contractions and spasms can lead to respiratory failure due to chest wall spasms, dysfunction of the diaphragm and obstruction of the airway from spasms of the vocal cords.
Further complications include widespread nervous system dysfunction, high blood pressure and irregular heart rhythms. About one-in-ten infected patients will die from tetanus.
Provisional data for 2025 shows a tetanus case count of 38. This is an increase from 33 in 2024 and the highest number since 2026, when there were 41 cases, which has doctors concerned.
And writing in an article in JAMA, two pediatricians said the fact that there were four pediatric tetanus cases in one year – 2024 – was ‘striking,’ as many cases of tetanus are in the elderly, who likely never received a primary dose of the vaccine that protects against the disease because it wasn’t recommended yet at the time of their childhood.
Tetanus is a life-threatening disease requiring intensive treatments and often a lengthy hospital stay in the intensive care unit
Also ‘extremely concerning,’ the doctors wrote, is that in two of the pediatric cases, families refused tetanus treatment and the tetanus vaccine, which can be administered prophylactically after a cut or injury where tetanus is a concern.
They said: ‘Both the lack of appreciation of the tetanus-prone wound status and the inadequate implementation of recommended post-exposure tetanus prophylaxis due to incomplete clinician care or refusal of receipt by the patient or parent are extremely concerning.’
None of the four pediatric patients, who ranged in age from one to 15 years old, were vaccinated against tetanus, according to the CDC report detailing the cases.
Overall, in people who sought care, tetanus treatment was administered only two percent of the time and the tetanus vaccine was administered only 26 percent of the time when it was indicated.
The doctors added that recent data on the disease ’emphasize the serious nature of tetanus, with nearly all cases being hospitalized and many requiring mechanical ventilation and tracheostomy’ to sustain life for recovery.
Tetanus is not spread from person-to-person so there is no concept of herd immunity to the bacterium. The only way to prevent it is through a vaccine, most commonly the Tdap vaccine.
Tdap protects against tetanus, as well as diphtheria and pertussis – or whooping cough. The combination vaccine was first recommended in 1948.
In children under seven, tetanus protection is offered through the DTaP vaccine, which offers the same protection as the Tdap vaccine in a slightly different formulation.
Tetanus is caused by the bacterium Clostridium tetani, which is naturally present in nature. When it enters the body, most often through a wound, it releases tetanus toxin
The above shows the national coverage rate for vaccines that protect against tetanus among children entering kindergarten for the 2024-2025 school year
The series consists of five doses given as shots at two months, four months, six months, between 12 to 18 months and between four to six years old.
Then, the Tdap vaccine is recommended at 11 to 12 years old as a single booster.
These shots should be followed by a booster dose once every ten years or after five years in the case of a severe or dirty wound or burn.
Pregnant women are also recommended to receive the Tdap vaccine during the third trimester in each pregnancy to protect their newborns from infections.
However, an increased sentiment of vaccine hesitancy and doubt has caused a dip in tetanus vaccinations.
The CDC reported a decline to 92 percent in DTaP vaccination among kindergarteners during the 2024-2025 school year.
The rate has been declining since the 2019-2020 school year, when coverage sat at 95 percent.
‘As pediatricians, we are particularly concerned about the declining primary immunization rates in children and the lack of vaccination with the tetanus vaccine in pregnant women to prevent infant disease,’ the doctors added.
The Tdap vaccine, widely used since the 1940s, is safe and effective in preventing infection and death.
According to the CDC, mortality due to tetanus has declined more than 99 percent since the early 1900s, when a first-line treatment for tetanus began being used, and has remained consistent at about two deaths per year since 2000.
Additionally, since the disease was made reportable to the CDC in 1947, tetanus incidence has declined by 99 percent.
Tetanus can be prevented through a vaccine, most commonly the Tdap vaccine.
The above map shows the state-by-state coverage rate for vaccines that protect against tetanus among children entering kindergarten for the 2024-2025 school year
A recent CDC report found there were 402 tetanus cases and 37 deaths in the US between 2009 and 2023. Forty-four percent of patients who had a known vaccine history had not received any previous tetanus vaccination, ‘highlighting substantial gaps in coverage.’
Thirty-three percent had only received one or two doses and 23 percent had received three or more doses.
Additionally, among people who had received at least one dose of the Tdap, 59 percent had gotten a shot more than 10 years prior to their infection.
The doctors writing in JAMA, who analyzed CDC reports and data on tetanus, said: ‘Although the report affirmed the remarkable effectiveness of the tetanus vaccine, it raised several concerns, particularly because the value of all vaccines is increasingly being questioned.
‘First, since the Covid-19 pandemic, vaccination rates have declined, particularly in children who are eligible for the Vaccines for Children program, and the percentage of children with vaccine exemptions has increased.
‘Tetanus is a frightful disease that causes incredible suffering and even death in some cases. Vaccination with the tetanus vaccine and a high index of suspicion for tetanus are key.
‘It is the responsibility of clinicians to engage patients and parents with empathy, address misinformation directly, and advocate for accessible and culturally sensitive immunization efforts. The medical community has had decades of experience with the tetanus vaccine, and it has a strong record of safety and effectiveness.
‘If vaccine hesitancy increases and mandatory school entry vaccination requirements are weakened, increases in vaccine-preventable diseases (including tetanus) would be expected to occur.’
