Tetanus Remains a Significant Health Threat

Tetanus might evoke thoughts of an old illness, but experts are raising alarms about its ongoing risk. Recent findings from the US Centers for Disease Control and Prevention reveal hundreds of tetanus cases and several deaths over the past 15 years, with four cases in children reported just in 2024. Meanwhile, dropping vaccination rates are causing concern among health professionals, as more people could be exposed to this serious yet preventable illness.

To delve into what tetanus is and how individuals can safeguard themselves, I had a conversation with Dr. Leana Wen, a wellness expert for CNN. She is an emergency physician and clinical associate professor at George Washington University, plus she has experience as Baltimore’s health commissioner.

CNN: What is tetanus exactly? Is it true that people can catch it from stepping on rusty nails?

Dr. Leana Wen: Tetanus is caused by a bacterium named Clostridium tetani. This bacterium can create spores that are widely present in our environment, particularly in soil, dust, and animal waste. The infection occurs when these spores enter the body through a wound. Once inside, they generate a powerful toxin that affects the nervous system.

As for rusty nails, it’s not the rust itself that’s dangerous. The real issue lies in objects like nails being contaminated with these spores, especially if they’ve been outdoors.

A variety of injuries can lead to tetanus. Puncture wounds are a typical example, but cuts, fractures, burns, and even minor injuries can pose risks if they are contaminated with dirt or debris. For instance, a recent CDC report highlighted injuries in children, including a fracture from riding an electric scooter and various foot injuries.

CNN: If someone has a cut or injury, when is it time to worry about tetanus?

Wen: Anyone with deep puncture wounds, wounds contaminated with dirt, animal feces, crush injuries, burns, or wounds with debris that can’t be cleaned easily should seek medical help. Healthcare providers can clean the injury and assess whether a tetanus booster is necessary.

Prompt action is crucial. Proper wound care and administration of a tetanus-containing vaccine or tetanus immune globulin after an injury can often prevent the disease.

CNN: What symptoms should one watch for regarding tetanus, and why can it be such a grave illness?

Wen: Symptoms usually appear days or weeks after the initial injury. “Lockjaw” is one well-known symptom, but patients may first feel stiffness in their jaw, neck, or back, and experience difficulty swallowing.

As it progresses, muscle stiffness and painful spasms can affect the entire body, making the situation potentially life-threatening. Muscles that assist in breathing may stop functioning correctly, and some may face obstructions in their airways due to spasms in the vocal cords. The illness can also disturb blood pressure and heart rhythms, and recovery may span weeks or months. Tragically, the disease can still be fatal even with advanced medical care.

CNN: What vaccines are recommended, and when should they be administered?

Wen: The American Academy of Pediatrics suggests that children receive five doses of a tetanus-containing vaccine during their routine immunizations, starting at two months old. Teens should get a Tdap booster around ages 11 or 12. Adults are advised to get a booster every ten years, and if they’ve suffered severe or unclean wounds, they should consider a booster after five years. Pregnant individuals ought to receive the Tdap vaccine with each pregnancy to protect newborns.

CNN: Who tends to be most at risk nowadays?

Wen: The highest risk falls on individuals who haven’t been vaccinated or haven’t completed their vaccination series. A CDC report indicated that nearly half of the individuals who contracted tetanus had never received a tetanus vaccine.

Children whose caregivers opt against vaccines are especially at risk. This also extends to newborns; maternal vaccination offers protection against neonatal tetanus. Additionally, older adults are particularly vulnerable, as the highest numbers of tetanus cases and deaths are found among women aged 80 and older, many of whom might not have received their primary vaccinations post-1947.

CNN: Is tetanus something that can be spread from person to person?

Wen: No, tetanus is not contagious. It’s crucial for everyone to understand that, as it underscores the importance of vaccination. Unlike diseases like measles, where individual vaccination aids community protection, tetanus doesn’t work the same way. You can’t depend on others being vaccinated to keep you safe.

CNN: What did the CDC reports reveal that caused renewed caution?

Wen: The CDC report analyzed tetanus cases from 2009 to 2023, finding 402 reported cases and 37 fatalities in that 15-year span. Most affected individuals were hospitalized, with a significant portion requiring intensive care. Over 40% of those hospitalized needed mechanical assistance to breathe, and about one in ten who contracted the disease succumbed to it.

In 2024 alone, there were four cases of pediatric tetanus across different states—Idaho, Minnesota, Missouri, and Wisconsin. While that might not appear excessive, pediatric tetanus is exceedingly rare in the US.

Each of the four children experienced generalized tetanus, a severe form of the disease where the toxin impacts muscles throughout the entire body. All required hospitalization, staying anywhere from eight to 45 days. Crucially, none of the children had completed their primary vaccination series, and two of the families declined the recommended preventative treatments after seeking medical care.

CNN: What would be your key advice for those wanting to protect themselves?

Wen: First off, be aware of your vaccination status. Many adults can’t recall when they last had a tetanus booster or even if they received the primary series; this information is easy to verify with your healthcare provider.

Secondly, don’t overlook wounds. Seek immediate medical help for any significant cuts or injuries that are contaminated.

Lastly, recognize that tetanus is still a reality. Its rarity is due to effective vaccines, not because the disease has disappeared. The bacteria causing tetanus are prevalent in our environment, so staying current with vaccinations is essential. We have a safe and effective method to prevent a serious disease; we should utilize it.