Four Pediatric Tetanus Cases in 2024 Highlight Critical Gaps in Vaccination and Wound Care
Four children in the United States were diagnosed with tetanus in 2024. None had completed the recommended primary tetanus vaccine series before their illness, and all required lengthy hospitalizations.
The cases, identified through the National Notifiable Diseases Surveillance System, occurred in Idaho, Minnesota, Missouri, and Wisconsin. Notably, the Idaho case was the state's first pediatric tetanus diagnosis in over 30 years.
Case Details and Demographics
The affected children ranged in age from 1 to 15 years old. Geographically, two lived in metropolitan areas and two in non-metropolitan areas.
- Age Distribution: Two children were 10-15 years old, one was 5-9 years old, and one was 1-4 years old.
- Hospitalization: All four children required hospitalization for 8 to 45 days. Two of the children needed additional inpatient rehabilitation following their acute care.
Missed Prevention Opportunities
A series of missed opportunities for prevention were identified in each case. None of the children had received the full primary series of the tetanus toxoid-containing vaccine (TTCV) prior to their injuries. Furthermore, none received a TTCV dose or preventive tetanus immunoglobulin (TIG) in the window between their exposure and the onset of symptoms.
- Exposure Routes: Injuries included a compound ankle fracture from an electric scooter accident, a knee puncture from an animal bone, a crushing foot injury from a horse hoof, and one case with an unknown exposure route.
- Delayed or Declined Care: Three patients sought care 7-10 days after their initial injury, while two did not seek any medical care before becoming ill. Parents of two children declined TTCV and TIG prophylaxis when it was offered before symptom onset.
Illness and Treatment
All patients developed generalized tetanus. Symptoms included severe back, neck, and jaw pain; muscle spasms and rigidity; and difficulty walking.
As part of their treatment, all patients received TIG and an initial dose of TTCV to provide future protection. Only one of the four children went on to complete the full TTCV series after recovering from tetanus.
Background on Tetanus
Tetanus is a serious neuromuscular infection caused by Clostridium tetani bacteria, whose spores are common in soil, dust, and manure. The spores can enter the body through wounds and produce a potent neurotoxin called tetanospasmin.
Pediatric tetanus is rare in the United States, with approximately four cases reported annually. However, a recent surveillance summary found that among persons with tetanus whose vaccination history was known, 44% had not received a single dose of TTCV.
Key Recommendations for Prevention
The report underscores several critical actions to prevent future cases:
- Complete Vaccination: Completing the primary TTCV series and staying up to date with recommended boosters is the most effective way to prevent tetanus.
- Prompt Wound Care: Immediate and thorough care is essential for wounds, especially those that are contaminated or penetrating.
- Timely Post-Exposure Prophylaxis: Administration of TIG or TTCV when indicated should not be delayed, particularly for unvaccinated or undervaccinated children. Patients with tetanus-prone wounds must receive TTCV and TIG according to established guidelines.
Source: This investigation was conducted by the Centers for Disease Control and Prevention (CDC) and local health departments. The findings were published in the Morbidity and Mortality Weekly Report.