Nikki Arellano Recovers After 5 Days of Tetanus Treatment From Small Leg Scratch

Q: With tetanus cases at a two-decade high, is your old vaccination enough to protect you now?

No—an old tetanus shot may not be enough if you are no longer up to date. Protection from tetanus vaccine wanes over time, and adults are generally advised to get a Td or Tdap booster every 10 years. For a dirty, deep, puncture, crush, or contaminated wound, doctors may recommend a booster if it has been more than five years since the last dose. That matters because tetanus is still present in soil, dust, and manure, and infection can follow even a small cut. The disease is rare in the United States largely because vaccination works, but recent surveillance shows cases have risen, reaching 38 in 2025, the highest level in nearly two decades. A 2026 review of U.S. cases from 2009 to 2023 found that most patients with known vaccine history were either unvaccinated or had gone more than 10 years since their last tetanus-containing shot. Tetanus is severe and preventable. Once symptoms begin—often jaw stiffness, muscle spasms, and trouble swallowing—there is no cure for the toxin itself, and many patients need intensive care. Surviving tetanus does not give natural immunity, so vaccination is still required afterward. If you cannot remember your last shot, experts say it is safer to check with a clinician than assume you are protected. If you have a high-risk wound and are not fully vaccinated or your history is uncertain, you may need both a vaccine and tetanus immune globulin, along with prompt wound cleaning.

Q: Rust isn't the real tetanus culprit, so what common backyard objects pose the biggest hidden threat?

The biggest hidden tetanus risks in a backyard are not rust itself, but **soil-, dust-, ash-, or manure-contaminated objects that can break the skin**. The bacterium *Clostridium tetani* lives as hardy spores in the environment, especially in dirt and animal feces, and can enter through even a small cut. That makes common items such as **garden tools, pruning shears, shovels, rakes, plant stakes, nails, screws, barbed wire, splintered wood, broken pottery, broken glass, and metal scraps** the main concern. **Thorns and splinters** are also important because they can create small, deep puncture wounds, which are especially risky since tetanus bacteria thrive in low-oxygen tissue. Experts stress that **“rusty” objects are only a warning sign because they are often old, dirty, and outdoors**, not because rust causes tetanus. A clean-looking object can still carry spores if it has been in contact with soil, dust, or animal waste. Even **playground equipment, fences, or stored metal parts** can be a source if they cause a cut and have environmental contamination. The practical takeaway is that **any backyard object that can puncture or cut skin after contact with dirt or manure is a potential tetanus hazard**. Prevention is straightforward: clean wounds promptly, seek care for deep or dirty injuries, and keep tetanus vaccination up to date with boosters every 10 years, or sooner after a high-risk wound if a booster is overdue.

1 articles · Updated · The Washington Post · Jul 18

Five days into treatment, Nikki Arellano’s jaw began to unlock, and by day six the 42-year-old Reno woman was able to eat after severe tetanus left her hospitalized.
A small cut from a metal church arch led to lockjaw about a week later, followed by painful whole-body spasms that required round-the-clock medication, muscle relaxants and tetanus immune globulin.
Doctors said tetanus can enter through even minor skin breaks if a person is not fully protected; Arellano said her last Td booster was likely more than 10 years earlier.
U.S. tetanus remains rare at fewer than 40 cases most years, but 38 cases last year were the highest since 2006, with experts warning that falling vaccination rates could drive more infections.