What are the current tetanus incidence and mortality rates in the United States in 2025 by state and age group?
Executive summary
Tetanus in the U.S. remains exceedingly rare: roughly 20–50 cases reported per year in recent decades, with average annual incidence around 0.01 per 100,000 (≈0.10 per 1 million) and an average case-fatality historically near 10–13% overall and higher in older adults (≈31% among ≥65 in one CDC review) [1] [2]. State-by-state and 2025-by-age granular incidence/mortality breakdowns are not reported in the available sources; CDC and state pages report national totals and some state-level counts historically but not a full 2025 matrix [3] [1] [4].
1. National picture: rare but severe when it occurs
Tetanus cases have declined by more than 95% since national reporting began in 1947 and deaths by more than 99%, leaving an average of about 29–30 reported U.S. cases per year in multiple summaries and an average annual incidence around 0.10 per 1 million in the 2001–2008 CDC review [3] [1] [5]. Clinical reviews underline that even with low incidence, tetanus carries substantial mortality: historical CDC analyses from 2001–2008 reported a 13.2% case-fatality rate overall (rising to ~31.3% in persons ≥65) [1] [2].
2. What the data sources provide — and what they don’t
CDC’s 2025 surveillance pages and state health sites document that tetanus is nationally notifiable and tracked, and they summarize long-term trends and periodic counts [3] [4]. Several state pages repeat the national message that about 30 cases occur annually and that most patients are unvaccinated or under‑vaccinated [5] [6]. However, the sources in hand do not publish a complete 2025 table of incidence and deaths by state and age group — that granular breakdown is not found in current reporting provided here [3] [1] [4].
3. Age patterns: newborns and the elderly bear highest risk
Global and U.S.-focused analyses both identify extremes of age as highest risk: neonatal tetanus remains a major problem in low-resource settings, while in high-income settings most sporadic U.S. cases occur among older adults and the unvaccinated [7] [2]. CDC-era data show elevated incidence and far higher case‑fatality among those ≥65 years (case-fatality ≈31% in 2001–2008) [1] [2]. Serologic surveys suggest broad population sero-protection through age 69 but falling immunity at advanced ages (e.g., ~75.8% protective antibody prevalence in ≥80-year-olds in NHANES 2015–2016) [8].
4. State-level reporting: sporadic counts but no comprehensive 2025 matrix in sources
Historical CDC MMWR analyses list state counts for multi-year periods (for 2001–2008, California, Florida, Texas, New York and Pennsylvania accounted for half of cases) and state health departments publish their own counts [1] [4]. But the present source set does not include a 2025 state-by-state incidence and mortality table. For Minnesota specifically, state reporting showed zero confirmed/probable cases in 2025 preliminarily [4]; other states’ 2025 figures aren’t provided in these materials [4].
5. Why granular 2025 breakdowns are hard to extract and where to look
Tetanus surveillance in the U.S. is passive and case numbers are small, so annual totals fluctuate and CDC publishes periodic summaries rather than a public, fully disaggregated 50×age‑group grid in the documents cited here [1] [3]. For a definitive state-by-state and age-group table for 2025, the appropriate sources would be CDC’s detailed surveillance reports or the National Notifiable Diseases Surveillance System (NNDSS) extracts and individual state health department datasets — items not included among the sources provided [3] [1]. Available sources do not mention a completed 2025 national age-by-state breakdown.
6. Context, caveats and competing viewpoints
Some reviewers argue adult boosters could be reduced or eliminated if childhood coverage stays high and surveillance supports that move; proponents estimate large cost savings, while others caution that elderly, under‑vaccinated, foreign‑born and injection‑drug‑using populations would remain at elevated risk [9] [10] [11]. Surveillance limitations (small numbers, underreporting in passive systems) mean incidence and mortality rates can be imprecise year-to-year; several analyses stress maintaining vaccination and wound‑management practices to keep cases near zero [1] [3] [5].
If you want, I can: (A) pull the latest CDC surveillance tables or NNDSS extracts (if you supply them) and produce a state×age table; or (B) draft a short FOIA-style request template you could send to CDC or individual state health departments asking for 2025 tetanus counts by age group and outcome.