Epidemiology

Following the introduction of universal vaccination with tetanus toxoid-containing vaccines, incidence of tetanus declined significantly in the US in the 1940s and the UK in the 1960s.[3][4]

In the US, there are an average of 30 cases of tetanus reported each year.[5] Surveillance during 2001 to 2008 found the highest incidence was among people aged over 65 years (0.23 cases/million), people of Hispanic ethnicity (most of these were people who injected drugs), and older adults with diabetes mellitus. The majority of cases occurred in people whose immunization history was incomplete or unknown and who sustained an acute injury.[6]​ There were a total of 22 tetanus cases reported in the US in 2022, with an incidence of 0.1 cases/million total population.[7]

In the UK between 2001 and 2014, 96 cases of tetanus were reported (ranging from 3 to 21 cases per year) with an annual average incidence of 0.13/million.[8] The highest incidence of tetanus was observed among adults over the age of 64 years. Among cases with information on immunization status, few had been appropriately immunized for their age.[8] Between July 2003 and September 2004, 25 cases of tetanus were reported in people who inject drugs in the UK.[9] Injection of drugs intramuscularly or subcutaneously ("popping") was associated with tetanus infection in this cluster, and contamination of heroin distributed from Liverpool was thought to account for the outbreak. Since this cluster in 2003/2004, a further 13 sporadic cases of tetanus were reported in people who inject drugs to the end of 2020.[10]​ In England, there were four reported cases of tetanus in 2022; all had a history of domestic or work-related injury.[11]​

Tetanus remains a considerable threat in developing countries, with up to 1 million cases estimated to occur worldwide every year.[12] Estimates from the global burden of disease study suggest there were in excess of 56,000 deaths due to tetanus in 2015.[13] Significant progress has been made in reducing the incidence of maternal and neonatal tetanus over the last two decades. World Health Organization (WHO) figures estimate that 24,000 newborns died from neonatal tetanus in 2021, an 88% reduction from the situation in 2000.[14] The Maternal and Neonatal Tetanus Elimination (MNTE) initiative (a partnership between the WHO, United Nations International Children's Emergency Fund (UNICEF), and the United Nations Population Fund [UNFPA]) has adopted the "high risk approach." In high-risk areas, tetanus immunization is provided through supplemental immunization activities targeting all women of childbearing age (including pregnant women) with 3 doses of tetanus toxoid-containing vaccine.[2][14][15][16] WHO: protecting all against tetanus Opens in new window​​ The ultimate goal of the MNTE initiative is the worldwide elimination of maternal and neonatal tetanus, but this has yet to be achieved in 11 countries, and tetanus resulting from unhygienic delivery practices remains a problem in many resource-poor settings.[14][16][17]​​ The COVID-19 pandemic had a significant impact on global childhood immunization programs, leading to millions of children missing vaccine doses. The WHO and UNICEF estimate in a 2023 Centers for Disease Control and Prevention (CDC) report that during 2021 and 2022, Diphtheria-Tetanus-Pertussis-Containing Vaccines1 (DTPcv1) and DTPcv3 uptake improved in all WHO regions except in Africa, where coverage stagnated at 80% and 72%, respectively, and remained below the 2019 coverage (83% and 77%, respectively).[18]​​

Use of this content is subject to our disclaimer