Problem/condition: Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s.

Reporting period: This report covers surveillance data for 1998--2000.

Description of system: Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states.

Results and interpretation: During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis.

Interpretation: The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged >60 years were at highest risk for tetanus and tetanus-related death.

Public health actions: Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.