Older Women at Highest Risk of Tetanus Related Death

Tetanus is a serious and often fatal disease caused by a toxin produced by germinated spores of the bacterium Clostridium tetani. Despite the availability of safe and effective vaccines, tetanus cases continue to occur in the United States. 

A new report from the U.S. Centers for Disease Control and Prevention (CDC) covering the years 2009 to 2023 reveals that gaps in routine vaccination and proper wound management contribute to the persistence of preventable cases and deaths. This issue particularly affects unvaccinated or undervaccinated individuals, as well as older adults.

This analysis will be published in the upcoming Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries on April 16, 2026. The CDC provides detailed information on the patients' tetanus toxoid–containing vaccine (TTCV) history, details about their wounds, any medical care received before the onset of the disease, and clinical outcomes, including cases that resulted in death.

During the 15 years, 402 tetanus cases and 37 deaths were reported from 47 states and the District of Columbia. The overall case-fatality rate among patients with known vital status was 12.4% (37 of 299). Deaths occurred predominantly among older adults, with no fatalities reported in persons 17 years or younger.

Most notably, only 45% of persons with a substantial wound sought medical care before tetanus developed.

Women aged 80 years and older had the highest incidence overall: 0.27 cases per 1 million population.

Among those with known vaccination history, 43.9% had received zero doses of TTCV.

Among patients with wounds eligible for post-exposure prophylaxis, just 2.3% received tetanus immune globulin (TIG), and 26% received TTCV according to guidelines.

Current CDC guidelines emphasize lifelong protection through a complete primary vaccination series followed by regular boosters. All adults should receive a tetanus booster every 10 years to maintain immunity.

TIG is added for certain high-risk situations, particularly in people with unknown or incomplete vaccination histories and tetanus-prone wounds.

The CDC says these simple, evidence-based steps — routine childhood vaccination, decennial adult boosters, and prompt wound care — can virtually eliminate the risk of tetanus.

"Despite being preventable through vaccination, tetanus continues to occur among persons of all age groups in the United States," the report notes. "Overall, males have a higher incidence compared with females; however, the highest incidence is among older women."

"Approximately 1 in 10 persons who develop tetanus will die, with the highest mortality and case-fatality rates among older adults.:

" Because C. tetani spores are ubiquitous in soil, dust, and animal feces, sustained high vaccination coverage remains essential.

CDC officials strongly recommend that all Americans — especially older (women) adults and those with uncertain vaccination history — speak with their healthcare provider about staying up to date on tetanus protection.