In 1947, a combination diphtheria and tetanus toxoids for pediatric use was first licensed in the U.S.

After the introduction of universal vaccination with tetanus toxoid–containing (TT) vaccines, the incidence of reported tetanus in the United States declined by >98%, from 0.39 per 100,000 population in 1947, when national reporting began, to 0.01 per 100,000 population by 2016 (CDC, unpublished data, 2016).

The decline in incidence occurred across all age groups. Deaths from tetanus also declined similarly during this period. The decline in morbidity and mortality is attributable to widespread use of tetanus toxoid–containing vaccines; improved wound management, including use of tetanus prophylaxis in emergency departments; improved hygiene during childbirth; increased levels of maternal immunity; and expanded urbanization