Tetanus in England: 2025
Updated 25 June 2026
Applies to England
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This article updates the report Tetanus in England: 2024 (which presented surveillance data for England for that year) and reiterates current recommendations on diagnosis and clinical management of tetanus.
The main points arising from this report are that:
- tetanus is a severe, potentially life-threatening but preventable infection and is very rare in the UK due to the success of the immunisation programme
- there were 8 case recorded between January to December 2024; there was 1 fatality
- 3 of the cases were associated with workplace injuries
- most cases had no, or unknown, vaccination history; 2 cases were fully vaccinated and 2 cases were partially vaccinated
- where an individual presents with a suspected tetanus-prone wound, it is essential to take a full tetanus vaccination history (including primary and boosters) and exposed individuals, depending on their age and vaccination status, should be offered prophylaxis with tetanus immunoglobulin (TIG) along with tetanus vaccine to prevent tetanus, as directed by the Green Book, chapter 30: Tetanus
Surveillance and recent epidemiology
Data sources in England for the enhanced surveillance of tetanus include:
- notifications
- reference and NHS laboratory reports
- death registrations
Detailed information on source of infection and disease severity are sourced from clinicians in primary and secondary care, and from clinical records.
Cases of tetanus are known to be under-reported. A comparison of surveillance data against hospital episode statistics in England between 2001 and 2014 suggested that tetanus was under-reported by 88% during that period. There were 67 additional cases identified in the hospital statistics that were not captured through enhanced surveillance (1).
There were 8 cases of clinical tetanus identified in England between January and December 2025. This compares to 6 cases in 2024, 5 cases in 2023, 4 cases identified in 2022, 11 cases in 2021 and 7 cases in 2020. Tetanus is a notifiable disease in accordance with the amended Public Health (Control of Disease) Act 1984 and the accompanying regulations (SI 2010/659). Five of the cases were notified as tetanus by healthcare professionals in England.
The cases ranged in age from 19 to 82 years, with 3 cases born before 1961 when routine childhood vaccination was introduced in the UK (1, 2). Further details on the age distribution of cases are presented in the table below.
Four cases presented with mild symptoms (grade 1); 2 cases had moderate tetanus and 2 cases had severe tetanus (3A). All cases were hospitalised, and there was 1 fatality. Full details of grading of severity for clinical purposes are contained in the UK Health Security Agency (UKHSA) guidelines, Tetanus: guidance for health professionals.
Of the cases with mild infection, 3 had vaccination records available; 2 individuals had received 5 or more doses of tetanus-containing vaccine. One mild case was partially vaccinated, with the only recorded tetanus vaccination being 7 years prior to infection.
One moderate case had received 4 doses of tetanus-containing vaccine but had not completed the full schedule, reportedly due to disruptions during the COVID-19 pandemic. Immunisation history was unknown or not reported for the remaining 4 cases. These included 1 severe case and 1 moderate but fatal case, both born before the introduction of tetanus vaccination into the national routine programme.
The fatal case received treatment with intravenous immunoglobulin (IVIG) and antibiotics. Detailed information on potential exposure injury and post exposure prophylaxis are not available for this case.
The remaining 7 cases did not seek medical advice at the time of injury. On subsequently presenting with clinical symptoms of tetanus, all 7 cases were treated with IVIG. One severe case additionally received tetanus immunoglobulin (TIG) and a tetanus-containing vaccine as post exposure prophylaxis. Six cases were treated with antibiotics.
Four cases were tested by polymerase chain reaction (PCR) detection of the Clostridium tetani gene and 3 cases were tested by culture. While none of the samples that were laboratory tested were culture or PCR positive for tetanus, negative results for any laboratory test do not exclude tetanus as it is a clinical diagnosis. Serological testing is not a reliable indicator for diagnosis to confirm or to rule out tetanus (3).
Background, diagnosis and immunisation
Tetanus is a life-threatening but preventable disease caused by a neurotoxin (tetanospasmin, TS) produced by C. tetani, an anaerobic spore-forming bacterium. Tetanus spores are widespread in the environment, including in soil, and can survive hostile conditions for long periods of time. Transmission occurs when spores are introduced into the body, often through a puncture wound but also through trivial, unnoticed wounds, chronic ulcers, injecting drug use, and occasionally through abdominal surgery.
Neonatal tetanus is still common in low-income countries where the portal of entry is usually the umbilical stump, particularly if there is a cultural practice of applying animal dung to the umbilicus.
The infection is not transmitted from person to person. The incubation period of the disease is usually between 3 and 21 days, although it may range from one day to several months, depending on the character, extent and localisation of the wound.
Tetanus immunisation was introduced in the 1950s and became part of the national routine childhood programme in 1961. Since then, vaccine coverage at 2 years of age has always exceeded 70% in England and Wales and from 2001 was around or above 95%, the target coverage set by the World Health Organization (WHO). There has however been a gradual decline in uptake across the routine childhood immunisation programmes over the last decade and the annual coverage April 2024 to March 2025 was 92.8% for the 6-in-1 vaccine in children aged 2 years (4)
The objective of the immunisation programme in the UK is to provide a minimum of 5 doses of tetanus-containing vaccine at appropriate intervals for all individuals. As there is no herd immunity effect, individual protection through vaccination is essential. In most circumstances, a total of 5 doses of vaccine at the appropriate intervals are considered to give satisfactory long-term protection. Routine boosters every 10 years are no longer recommended; however, immunity to tetanus wanes over time and therefore additional boosters may be recommended in specific circumstances. Further details on tetanus immunisation information are available in the Green Book, chapter 30: Tetanus.
Clinical management
Recommendations for the treatment of suspected clinical tetanus and management of tetanus-prone wounds are included in the UKHSA national guidelines (3).
Clinical management of tetanus includes administration of IVIG, wound debridement, antimicrobials including agents active against anaerobes such as metronidazole, and vaccination with tetanus toxoid vaccine. The guidelines emphasise the clinical diagnosis of suspected tetanus. Laboratory diagnostic tests are ancillary, and the most useful test is detection of C. tetani from the infection site by PCR and culture.
Debridement of wounds is not only clinically therapeutic, but also diagnostic as the wound samples can be cultured for C. tetani and/or detection of toxin by PCR. However, a negative laboratory test does not necessarily rule out a case.
The guidelines also advise on the assessment and management of tetanus-prone wounds based on age and vaccination status, including a tetanus booster if one has not received any in previous 10 years. It is highlighted that patients born before 1961 in the UK are unlikely to have completed a primary course and this should be taken into account as part of any risk assessment.
The supply of intramuscular IM-TIG is no longer limited and this should be used, as appropriate, for tetanus-prone wounds requiring prophylactic immunoglobulin in addition to a tetanus containing vaccine. Every effort should be made to source IM-TIG directly from the manufacturers but HNIG for subcutaneous use may be given intramuscularly, as an alternative to TIG, if there will be a significant delay in administration. Further details are provided in the revised guidelines (3).
Tetanus cases by age group and year of onset (all sources) in England and Wales from 1984 to 2025. From 2016, data from England only
| Year of onset | 0 to 4 years | 5 to 14 years | 15 to 24 years | 25 to 44 years | 45 to 64 years | 65+ years | Age not known | Total |
|---|---|---|---|---|---|---|---|---|
| 1984 | 0 | 0 | 1 | 1 | 6 | 4 | 0 | 12 |
| 1985 | 0 | 1 | 1 | 1 | 4 | 9 | 0 | 16 |
| 1986 | 0 | 0 | 1 | 3 | 4 | 7 | 0 | 15 |
| 1987 | 0 | 0 | 0 | 4 | 3 | 9 | 0 | 16 |
| 1988 | 0 | 0 | 3 | 3 | 4 | 6 | 0 | 16 |
| 1989 | 0 | 2 | 1 | 3 | 4 | 10 | 0 | 20 |
| 1990 | 0 | 0 | 1 | 1 | 2 | 7 | 0 | 11 |
| 1991 | 0 | 0 | 0 | 2 | 2 | 7 | 0 | 11 |
| 1992 | 0 | 0 | 1 | 2 | 0 | 5 | 2 | 10 |
| 1993 | 0 | 0 | 1 | 2 | 1 | 7 | 0 | 11 |
| 1994 | 0 | 0 | 0 | 1 | 0 | 2 | 0 | 3 |
| 1995 | 0 | 0 | 0 | 1 | 2 | 3 | 0 | 6 |
| 1996 | 0 | 0 | 0 | 1 | 1 | 4 | 1 | 7 |
| 1997 | 0 | 0 | 1 | 0 | 0 | 5 | 0 | 6 |
| 1998 | 0 | 0 | 1 | 2 | 3 | 3 | 0 | 9 |
| 1999 | 0 | 0 | 0 | 1 | 0 | 3 | 0 | 4 |
| 2000 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 2 |
| 2001 | 0 | 0 | 0 | 0 | 2 | 3 | 0 | 5 |
| 2002 | 0 | 1 | 0 | 0 | 1 | 4 | 0 | 6 |
| 2003 | 0 | 0 | 3 | 5 | 2 | 2 | 0 | 12 |
| 2004 | 0 | 1 | 3 | 12 | 5 | 1 | 0 | 22 |
| 2005 | 0 | 0 | 0 | 1 | 3 | 2 | 0 | 6 |
| 2006 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 3 |
| 2007 | 0 | 0 | 0 | 2 | 1 | 1 | 0 | 4 |
| 2008 | 0 | 0 | 0 | 1 | 3 | 0 | 0 | 4 |
| 2009 | 0 | 0 | 0 | 3 | 0 | 4 | 0 | 7 |
| 2010 | 0 | 1 | 0 | 1 | 2 | 6 | 0 | 10 |
| 2011 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 3 |
| 2012 | 0 | 0 | 0 | 2 | 1 | 3 | 0 | 6 |
| 2013 | 0 | 0 | 0 | 3 | 1 | 3 | 0 | 7 |
| 2014 | 0 | 0 | 1 | 1 | 2 | 3 | 0 | 7 |
| 2015 | 0 | 0 | 0 | 0 | 2 | 4 | 0 | 6 |
| 2016 | 0 | 0 | 0 | 3 | 0 | 2 | 0 | 5 |
| 2017 | 0 | 0 | 0 | 2 | 0 | 3 | 0 | 5 |
| 2018 | 0 | 0 | 0 | 2 | 0 | 3 | 0 | 5 |
| 2019 | 0 | 0 | 0 | 1 | 2 | 1 | 0 | 4 |
| 2020 | 0 | 0 | 0 | 0 | 2 | 4 | 1 | 7 |
| 2021 | 0 | 0 | 1 | 4 | 0 | 6 | 0 | 11 |
| 2022 | 0 | 0 | 1 | 1 | 0 | 2 | 0 | 4 |
| 2023 | 0 | 0 | 0 | 1 | 2 | 2 | 0 | 5 |
| 2024 | 0 | 0 | 1 | 0 | 1 | 4 | 0 | 6 |
| 2025 | 0 | 0 | 1 | 2 | 2 | 3 | 0 | 8 |
Data sources: UKHSA enhanced surveillance, notifications, laboratory reports, death certificates and clinical reports.
Note: NOIDs reports, which were published weekly prior to April 2025 and are available at Notifiable diseases: weekly reports for 2025, are temporarily paused.
References
1. Collins S, Amirthalingam G, Beeching NJ, and others (2015). ‘Current epidemiology of tetanus in England, 2001 to 2014’ Epidemiology and Infection: volume 144 number 16, pages 3,343 to 3,353
2. Rushdy AA, White JM, Ramsay ME, Crowcroft NS (2003). ‘Tetanus in England and Wales 1984 to 2000’ Epidemiology and Infection: volume 144, number 16, pages 71 to 77
3. UKHSA (2023). ‘Tetanus: guidance for health professionals’