How do tetanus vaccination rates by state and age correlate with incidence in 2025?
This fact-check may be outdated. Consider refreshing it to get the most current information.
Executive summary
Tetanus is rare in the U.S.; since 2010 there have been fewer than 40 reported cases per year and most cases occur in adults not up to date on tetanus vaccines (CDC surveillance) [1]. Childhood school‑age coverage for DTaP/Td/Tdap remains high but has declined modestly in 2024–25 (DTaP coverage among kindergartners ~92.1%) and exemptions have risen, creating state variation that could matter for local risk [2] [3].
1. Low incidence, concentrated in under‑protected adults
National surveillance and recent analyses show tetanus is now an uncommon disease in the United States; CDC reports sporadic cases with fewer than 40 reported annually since 2010 and an overall historic decline tied to vaccine use [1]. Clinical and serologic studies confirm the majority of reported U.S. cases occur in adults — more than half among people aged 20–59 and substantial numbers among those ≥60 — and almost all cases are in people unvaccinated or not up to date [4] [1].
2. State vaccination rates vary — and so do exemption patterns
State‑level vaccination coverage is uneven. National kindergarten data for 2024–25 show DTaP coverage at about 92.1% overall but with substantial state variation and rising non‑medical exemptions (exemptions rose to record highs and exceeded 5% in 17 states), meaning pockets of lower childhood protection exist [2] [3]. Aggregated rankings also show top vaccinating states (e.g., Massachusetts, Connecticut) and lower‑coverage states (e.g., Alaska, Idaho) in recent reports [5] [3].
3. Correlation between state coverage and incidence: limited by low case counts
Because tetanus cases are rare, statistical correlation between state vaccination rates and state tetanus incidence in 2025 is difficult to demonstrate with confidence in public data: CDC surveillance notes sporadic, low counts (fewer than 40 cases annually), and small absolute differences in case counts produce large percentage swings [1]. State health pages (for example Minnesota in 2025) report zero confirmed cases to date, illustrating how infrequent cases are and how noisy any state‑level correlation would be [6].
4. Age matters more than geography in current risk profiles
Multiple sources identify age and vaccination status, rather than geography alone, as the dominant risk factors: serologic surveys show gaps in protection increase with age, and surveillance and case series repeatedly attribute most U.S. cases to adults who lack recent boosters or the primary series [4] [1]. Historical analyses and CDC guidance likewise flag older adults, diabetics and injection‑drug users as higher‑risk groups [7] [8].
5. What the data allow — and what they don’t
Available sources permit these conclusions: tetanus is rare in the U.S., cases cluster among under‑vaccinated adults, and kindergarten‑level DTaP coverage slipped slightly in 2024–25 while exemptions rose [1] [4] [2] [3]. What the sources do not provide is a robust, state‑by‑state statistical correlation linking 2025 tetanus incidence to state vaccination rates by age with sufficient power; surveillance case counts are too small and public datasets shown here do not present linked, age‑stratified, state‑level incidence for 2025 (available sources do not mention a state×age correlation analysis for 2025).
6. Competing explanations and practical implications
Two interpretations emerge from the sources. Public‑health officials emphasize maintaining high childhood and adult booster coverage because even small declines can allow preventable cases (CDC, ACIP guidance) [9] [1]. Academic reviews suggest that the main policy lever to reduce U.S. tetanus remains sustaining childhood immunization and improving adult booster uptake, and some researchers argue booster schedules might be optimized if childhood rates remain high [9] [10]. At the same time, surveillance‑driven observers caution that low case counts limit the ability to infer causal links between small state coverage differences and incidence [1] [4].
7. What journalists and policymakers should watch next
Watch for updated CDC surveillance releases and state SchoolVaxView tables that pair vaccination coverage, exemptions and any tetanus reports; those are the only sources that can credibly link coverage trends to incidence over time [2] [1]. Also monitor adult serologic surveys and booster‑uptake data — these consistently explain where cases arise and which age groups are vulnerable [4]. If kindergarten coverage continues to fall and exemptions keep rising, public‑health experts warn that local outbreaks of vaccine‑preventable diseases (even if not tetanus) could become more likely [3].
Limitations: this analysis relies only on the supplied sources, which document national surveillance, kindergarten coverage and serologic studies but do not offer a comprehensive, age‑stratified, state‑by‑state 2025 incidence vs. vaccination correlation suitable for statistical testing (available sources do not mention such an analysis) [1] [2] [4].