Tetanus Incidence Decline Over the Last 50 Years
Tetanus incidence in the United States has declined by over 98% from 1947 to 2016, dropping from 560 cases (0.39 per 100,000 population) in 1947 to approximately 30 cases annually (0.01 per 100,000 population) by 2016. 1
Historical Trajectory
Early Reporting Period (1947-1987)
- 1947: 560 reported cases when national reporting began (0.39 per 100,000 population) 1
- 1987: Record low of 48 reported cases at that time 1
- This represents a 91% decline over the first 40 years of surveillance 1
Recent Decades (1986-2016)
- 1986-1989: Cases remained relatively stable at 48-64 cases annually 1
- 1995-1997: Average of 41 cases per year (0.15 per 1,000 population) 2
- 1998-2000: Average of 43 cases annually (0.16 cases per million population) 3
- 2001-2016: 459 non-neonatal cases total (approximately 29 cases per year) with incidence of 0.01 per 100,000 population 1
Key Drivers of Decline
The dramatic reduction resulted from multiple factors 1:
- Widespread tetanus toxoid vaccination introduced in the mid-1940s, with near-universal childhood vaccination (97% of school-entry children receiving ≥3 doses of DTP) 1
- Improved wound management including routine tetanus prophylaxis in emergency departments 1
- Improved hygiene during childbirth and increased maternal immunity 1
- Expanded urbanization 1
Neonatal Tetanus Elimination
- 1972-1984: 29 cases of neonatal tetanus reported 1
- 1985-1989: Zero cases of neonatal tetanus reported 1
- 2001-2016: Only 3 neonatal tetanus cases reported over 16 years 1
Mortality Trends
The case-fatality ratio has also declined significantly 1:
- 1987-1988: 21% case-fatality rate 1
- 1998-2000: 18% case-fatality rate 3
- 2001-2016: 8.0% case-fatality rate 1
Global Context
Worldwide data from 1990-2019 shows continued decline in tetanus incidence and death rates globally, with the most dramatic reductions occurring in high sociodemographic index countries 4. The disease burden decreased significantly across all regions during this 30-year period 4.
Current Epidemiologic Pattern
Despite the dramatic decline, tetanus persists primarily among 1:
- Older adults: 68% of cases occur in persons ≥50 years of age, with median age of 44 years 1
- Unvaccinated or inadequately vaccinated individuals: Disease occurs almost exclusively in this population 1
- Males: 60% of cases occur in males 1
The low prevalence of protective antibodies in older adults (only 45% of men and 21% of women aged ≥70 years have protective levels) explains the continued occurrence in this age group 1.