February 28, 2026, 11:47 am | Read time: 11 minutes

Tetanus was a dreaded disease for thousands of years. German physician Emil von Bering succeeded in developing an antibody drug against the life-threatening inflammation of wounds in 1890.¹ He was awarded the very first Nobel Prize in Medicine for his work. In 1924, a French research team developed the first tetanus vaccine, which stimulates the production of antibodies in the body itself.² FITBOOK provides a comprehensive overview of the current state of research into tetanus vaccination.

What Is Tetanus?

Tetanus, also known as “lockjaw,” is a potentially fatal infectious disease caused by the bacterium “Clostridium tetani.” This bacterium is anaerobic, which means that it thrives particularly well in environments without oxygen. Under such conditions, it produces spores that can survive in the environment. Especially in soil, dust, and animal droppings, it can survive for decades. Even heat and most disinfectants cannot harm it³

When these spores enter a wound, they can activate in an oxygen-depleted environment. They then begin to release extremely dangerous neurotoxins. The course of tetanus was already described by Hippocrates: Wound, jaw spasm and death⁴ Hence the name: “tetanos” is the Greek word for “tension”⁵ Despite modern intensive medical treatment, 10 to 20 percent of patients still die today—mostly from respiratory distress or heart failure⁶ Tetanus is widespread worldwide. It is a major problem, especially in regions with poor medical care. Fortunately, an effective vaccine against tetanus has been available since 1924⁷

At What Age Is the Tetanus Vaccination Recommended?

The Standing Committee on Vaccination (STIKO) recommends starting basic immunization against tetanus in infancy. It consists of three partial vaccinations at the ages of 2, 4, and 11 months. Starting the vaccination series early is crucial, as infants and toddlers play a lot on the ground or outdoors. Even small, inconspicuous injuries can quickly become dangerous. The vaccination should then be boostered at preschool age (at around 5 to 6 years) and again at the age of 9 to 16 years⁸ As a rule, the basic immunization against tetanus is part of a 6-fold vaccination with a combination preparation, which also includes the vaccination against diphtheria, pertussis (whooping cough), polio (polio), Hib (Haemophilus influenzae type b) and hepatitis B⁹

Many industrialized nations recommend booster vaccinations for their populations every five to 20 years. The STIKO in Germany recommends a tetanus booster every 10 years. The vaccinations are then usually given with combination vaccines, which, in addition to tetanus, also protect against diphtheria and pertussis (whooping cough), and sometimes also polio.

Experts are currently debating whether routine boosters are actually necessary in adulthood. Studies show that the immunity acquired through complete basic immunization may last significantly longer than previously assumed—30 years¹⁰ or possibly even for life. A study analysed tetanus and diphtheria cases from 2001 to 2016 in 31 North American and European countries. It is interesting to note that countries without adult booster vaccinations did not have higher disease rates.¹¹ The previous assumption of regular boosters may be overly cautious. The WHO therefore believes that adult boosters may be unnecessary in countries with high immunization standards and no longer specifies fixed schedules for adult tetanus boosters.¹²

However, supporters of the current practice emphasize that regular boosters are simply safer, especially for people with a high risk of injury or in regions with poor medical care. The individual risk also plays a decisive role here: anyone who spends a lot of time outdoors, regularly works with animals, or works in agriculture should continue to have their vaccination regularly boosted¹³

What Happens if Vaccination Is Incomplete?

Incomplete or missing vaccination protection means that the immune system has holes in it. The only really reliable protection against tetanus is vaccination. Unvaccinated, a minor, trivial injury can quickly become a major problem, especially in the case of:

• puncture wounds or cuts
• bruises, scalds, frostbites
• bites from animals or humans
• contaminated objects such as nails or thorns

If you then go to a clinic, the following will be clarified¹⁴

• Vaccination status: How many tetanus vaccinations are documented?
• Time since last vaccination: When was the last booster?
• Type of wound: Is it a clean, minor injury or a deep and/or dirty wound?

Depending on the combination of these factors, there are three possible measures:

• No treatment necessary if vaccination protection is sufficient and up to date
• A booster vaccination if the vaccination protection is not completely current
• Booster vaccination and an additional tetanus antibody medication, in the case of severe, contaminated wounds or uncertain vaccination protection, in order to intercept the toxin that is still circulating in the bloodstream (a so-called simultaneous vaccination that combines active and passive immunization)^.3

Young infants (up to four months) are initially protected by the antibodies of their tetanus-vaccinated mothers. In addition, injuries and infection with the tetanus bacterium are rather rare at this age. If the mother is not (sufficiently) vaccinated, a decision is made in the hospital about the administration of tetanus antibodies¹⁵

Isn’t it sufficient to vaccinate only after an injury has occurred? No, it is not a good idea to vaccinate after something has already happened. Many people don’t even go to the doctor, especially for minor injuries, but by then the clock is already ticking. The simultaneous vaccination only works well if it is given quickly enough after the infection (after 24 hours at the latest).

In 2016, an 86-year-old woman from Bavaria was injured by a garden rake. Although the wound was stitched in the hospital, her vaccination status was not checked. Five days later, she returned to the clinic with jaw paralysis and facial muscle distortions. However, despite the doctors’ best efforts, the woman died 27 days after her injury as a result of a tetanus infection. This was clearly confirmed at the university hospital by evidence of the bacterium in the wound. It later emerged that the woman had possibly never been vaccinated against tetanus¹⁶

How Dangerous Is Tetanus for Children and Adolescents Without Vaccination?

Tetanus remains one of the most dangerous infectious diseases, especially for unvaccinated children and adolescents. Even minor injuries such as abrasions, scratches, or splinters can be enough to trigger an infection if spores of Clostridium tetani get into the wound. The risk is particularly high in the case of deep or dirty wounds and animal bites. Sure, you can try to “make sure nothing happens.” However, when playing and running around in the garden, sandpit, or forest, it is simply unrealistic that you will never hit a knee or scratch an arm. The bacterium is everywhere—in the soil, in road dust, in wood, and in animal excrement. It is impossible to escape the pathogen through hygiene measures.

In countries with low vaccination rates, tetanus is a major cause of death, especially among newborns and infants. Neonatal tetanus often occurs when the umbilical cord is cut under unhygienic conditions. The WHO reports that in 2018, around 25,000 newborns died from tetanus due to unhygienic obstetric care.¹⁷

Is the Tetanus Vaccine Safe for Children and Adolescents?

The tetanus vaccine is one of the best-researched and safest vaccines in the world and is generally well tolerated.¹⁸ The six-way combination vaccines were specially developed for infants.¹⁹ The most common vaccination reactions are redness or swelling at the injection site, which can also be painful (around 5 to 15 percent of cases). Sometimes, nearby lymph nodes also swell. Chills, tiredness, headaches, aching limbs, irritability, or gastrointestinal complaints may occur. Fever and infections of the upper respiratory tract (bronchitis) are also not uncommon. These vaccination reactions usually subside one to three days after vaccination. About one in 1,000 infants may experience prolonged crying episodes lasting more than three hours after vaccination.

Side effects are very rare. Fever with febrile convulsions may occur in less than one in 10,000 vaccinated people, especially in babies and young children. Rarely, a brief shock-like state occurs in which the muscles relax, and the child does not react for a short time, but this passes quickly and has no consequences. Allergies to components of the vaccine are also possible²⁰

Vaccines contain small amounts of aluminum as adjuvants. This has been done for almost 100 years because it strengthens the body’s immunological response to the vaccine and thus helps to build up sufficient protection.²¹ Nevertheless, there is often discussion as to whether aluminum in vaccines could be a problem. To put this into figures: According to the Paul-Ehrlich-Institut, the aluminum content of all vaccines approved in Europe ranges between 0.125 and 0.82 milligrams of aluminum per dose.²² The European Food Safety Authority assumes that we ingest 0.2 to 1.5 milligrams of aluminum per kilogram of body weight per week through food—almost double that, and that every week.²³ Vaccination, therefore, only accounts for an extremely small proportion compared to our food intake.

Furthermore, clinical studies and data from Germany provide no evidence that these substances cause serious or persistent side effects.²⁴

More on the topic

Protecting Children From Illnesses What Parents Should Know About the Vaccination Schedule

Cause, treatment Signs that indicate a tetanus infection

Why Is the Tetanus Vaccination Also Repeated in Adolescence?

The tetanus vaccination is repeated in adolescence to ensure long-term protection against tetanus. After the basic immunization in infancy and a first booster vaccination in preschool age, the vaccination protection decreases over time. The Standing Committee on Vaccination (STIKO) therefore recommends a further booster vaccination for adolescents aged 9 to 16 years.

This booster vaccination serves to maintain immunity and eliminate the risk of tetanus infection. Adolescents are active and sporty—there is an increased risk of injury, be it mountain biking, skateboarding, or on a hiking day with the school class. The booster vaccination ensures that young people remain well protected. Adolescents are usually vaccinated with a quadruple vaccine—against tetanus, diphtheria, pertussis (whooping cough), and polio.²⁵

Why is tetanus often administered in combination with other vaccinations? There are individual tetanus vaccines, but the STIKO recommends combination vaccinations—triple vaccines with additional protection against diphtheria and pertussis, quintuple vaccines with additional protection against polio and Hib (Haemophilus influenzae type b) ,as well as sextuple vaccines with hepatitis B vaccine as the sixth component. There are also booster vaccines for children.²⁶ Combination vaccines are useful because protection against several serious diseases can be guaranteed simultaneously with one shot. This is much more convenient for children and adolescents than being vaccinated several times. Combination vaccines are very effective for all components.²⁷

When Is Tetanus Vaccination Not Recommended?

The tetanus vaccination is one of the safest medical preventive measures and is well-tolerated in most cases. Nevertheless, there are situations in which the vaccination cannot be administered temporarily or permanently. However, these cases are rare and are assessed on an individual basis.²⁸

Absolute Contraindications

– Severe allergic reaction (anaphylaxis) to a previous dose of the tetanus vaccine: Persons who have reacted with anaphylaxis to a previous vaccination must not receive another vaccine with the same composition. In such cases, an alternative, e.g., a vaccine without the triggering component, will be considered.

Temporary Contraindications

• Acute, severe illness: People with a severe infection or high fever (above 38.5 degrees Celsius) should not be vaccinated until they have recovered. In the case of mild infections, such as a cold, the vaccination can usually be given without hesitation.

• Immunosuppressive therapies or illnesses: In patients receiving immunosuppressive drugs such as chemotherapy drugs or high doses of cortisone, the vaccination response may be reduced. However, vaccination is often still advisable and is considered by doctors in the individual context.

Special Cases

• Pregnancy and breastfeeding: Tetanus vaccination is strongly recommended during pregnancy, especially if the vaccination status is unclear. Combination vaccines that also cover diphtheria and pertussis are safe during pregnancy and protect both the mother and the newborn from serious illness.²⁹

• Neurological disorders after a previous vaccination: If neurological symptoms such as seizures occurred after a previous vaccination, the cause should be clarified before a new vaccination is given.

• Modern vaccines contain only minimal amounts of adjuvants, which rarely cause allergies. If an allergy to a specific component of the vaccine is known, this should be discussed with the doctor beforehand.