Once nearly eradicated in the United States, tetanus is making a comeback.
Often called “lockjaw,” tetanus is a life-threatening bacterial infection that causes painful and violent muscle contractions. Despite modern medical care, the disease kills up to 20% of those infected.
A full series of tetanus vaccinations is nearly 100% effective at preventing illness. Widespread immunization efforts dating back to World War II drove U.S. cases to historic lows. In 2019, the Centers for Disease Control and Prevention (CDC) reported just 23 cases in 2019 — a dramatic decline from more than 600 cases recorded in 1948.
But new CDC data point to a reversal of that progress. Reported tetanus cases climbed from 32 in 2024 to 37 in 2025. The vast majority of those affected were inadequately immunized, either because they missed part of the recommended five-dose childhood series, or failed to stay current with 10-year adult booster shots.
A December 2025 study by Stanford University and NBC News found a nationwide decline in diphtheria, tetanus, and pertussis (DTaP) vaccination coverage among kindergartners. In 2020, 94.9% of children were fully vaccinated; by 2025, that figure had dropped to 92.1%, leaving 260,700 children susceptible to infection. The CDC’s public health goal is a 95% vaccination rate; New York ranked in the top ten states with 97.2%.
Adult immunization rates have also slipped. According to the CDC, only 59.4%of adults ages 19 and older were up to date with tetanus boosters in 2022, the most recent year for which data are available. That marks a decline from 65.1% in 2019. New York is ranked among the bottom ten states, with one of the lowest adult tetanus vaccination coverage.
Public health experts attribute the drop in immunizations to vaccine hesitancy, fueled by skepticism among the public about the safety and effectiveness of immunizations and a decline in trust of health authorities. That anti-vaccination sentiment has extended into federal advisory bodies, such as the Advisory Committee on Immunization Practices, a subdivision of the CDC.
Tetanus is caused by Clostridium tetani, a bacterium that produces powerful toxins affecting the nervous system. These toxins block the release of neurotransmitters in the brain and spinal cord, leading to uncontrolled muscle spasms and rigidity. The organism survives for years in soil and animal feces — particularly from livestock such as cattle, horses and chickens — by forming hardy spores that resist extreme heat and many disinfectants.
The spores germinate in low-oxygen environments, especially in deep, dirty puncture wounds from nails, (rusty or not); animal bites, or crush injuries. Many tetanus victims don’t remember getting hurt, and an estimated 25% have no identifiable cause.
Disease symptoms generally appear a week after an injury. The classic hallmarks of tetanus include difficulty opening the mouth (hence the nickname “lockjaw”), a rigid grimace (the “devil’s smile”), and severe arching of the back (opisthotonus). Critical cases can result in fractures, inability to breathe requiring mechanical ventilation, and death.
Those at highest risk for tetanus are the under-vaccinated, followed by individuals over 65, diabetics, and the immunosuppressed. Occupations and recreational activities involving frequent contact with soil, manure, or stagnant water — common among agricultural workers, first responders, veterinary staff, and gardeners — also increase the chances of tetanus exposure.
Timely administration of a tetanus shot following injury can prevent tetanus from developing, especially if given within 48 hours. The CDC recommends vaccinations for dirty wounds if it’s been more than five years since the last booster.
Diagnosis and treatment of tetanus is based on a thorough history and physical examination. Primary care providers often perform the “spatula test”, touching the back of the victim’s throat with a small probe, which triggers jaw-clenching in the tetanus victim instead of the normal gag reflex. Wounds are thoroughly debrided and cleansed to eradicate as many spores as possible and minimize the severity of the illness. Blood and laboratory tests are not performed due to their inaccuracy.
Severe cases require hospitalization and administration of tetanus immune globulin, which provides immediate, short-term protection against the bacteria’s neurotoxins not yet bound to nerve tissue. Patients are typically placed in a dim, quiet room, sedated to avoid triggering muscle spasms, and closely monitored for any trouble breathing.
Staying up to date on your tetanus shot is the single best defense against the disease. Medicare, Medicaid, and nearly all health insurance plans cover the vaccination without charging a copayment.
Simple precautions also help reduce risk: Wear close-toed shoes and gloves when working outdoors, exercise caution around sharp tools, thorny bushes, and debris, and clean all wounds promptly with soap and water. Deep wounds, especially those caused by objects contaminated with soil or feces, require immediate medical attention.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.