Tetanus Cases in US Children in 2024
In 2024, four children diagnosed with tetanus in the United States had not finished their recommended series of tetanus toxoid-containing vaccines (TTCV). Notably, none of them received any TTCV or preventive tetanus immunoglobulin (TIG) following their exposure to the bacteria before exhibiting symptoms.
All four children were hospitalized for periods ranging from eight to 45 days, and two of them required additional rehabilitation afterward. Interestingly, only one of the children managed to complete the TTCV series after their illness, as reported in a study by the Centers for Disease Control and Prevention (CDC) and local health departments across four states.
This study, which was released recently in the Morbidity and Mortality Weekly Report, outlines these cases, including the first reported pediatric tetanus infection in Idaho in over three decades, along with individual cases in Minnesota, Missouri, and Wisconsin. These incidents were tracked through the National Notifiable Diseases Surveillance System.
Tetanus is a serious neuromuscular infection caused by a toxin produced by the bacteria Clostridium tetani. These spores are found everywhere—soil, dust, manure—and can enter the body through wounds. Once inside, they produce a potent neurotoxin that can lead to severe symptoms, including lockjaw, muscle spasms, difficulty swallowing, fever, and stiffness in various body areas.
The authors of the report pointed out that pediatric tetanus is quite rare in the United States, largely due to widespread vaccination—with only about four cases reported annually. However, a recent summary indicated that 44% of those with tetanus had not received a TTCV dose, highlighting a concerning trend.
Injury Context and Vaccination Decisions
Among the tetanus patients, two were in the 10- to 15-year age range, and one each fell into the one- to four-year and five- to nine-year categories. Of the four, two lived in urban areas while two resided in rural regions.
For one case, the exposure source was uncertain, but others were linked to specific injuries: an electric scooter accident resulting in a compound ankle fracture, a knee puncture from an animal bone, and a foot injury incurred from a horse hoof.
The three patients who had a clear timeline between their injuries and when they fell ill sought medical attention seven to ten days later. However, two of the patients did not seek care before the onset of their symptoms, and importantly, the parents of two children declined both TTCV and TIG prophylaxis in that critical period.
All four children experienced generalized tetanus, suffering from symptoms like pain in the back, neck, and jaw, along with muscle spasms and difficulties in walking. They were all hospitalized—averaging a 25-day stay—and received TIG for treatment, as well as an initial TTCV dose to prevent further issues.
Consequences and Recommendations
Out of the four patients, two had documentation of receiving a second TTCV dose, but only one completed the full vaccine series afterward. At least two of the children needed follow-up care, including readmission for rehabilitation, yet thankfully, all survived.
The report emphasized missed opportunities for prevention, such as not being vaccinated before injuries, delays in appropriate wound care, and the refusal of timely TIG administration following exposure.
The researchers highlighted that tetanus can lead to serious health challenges that necessitate extensive medical intervention and considerable expenses. Emphasizing the urgency of prompt wound care, especially in contaminated or penetrating injuries, they underscored that TIG or TTCV should be administered without delay in unvaccinated or undervaccinated children.
In conclusion, completing the primary TTCV series and staying updated with vaccinations is crucial for preventing tetanus—individuals with wounds at risk should receive prompt care according to established recommendations.
