Risk of Exposure to Tetanus and Diphtheria Increases With Seasonal Outdoor Activities and Travel

WASHINGTON -- For many, warm weather means sports, gardening, camping, backyard activity or trips overseas. But many people may be unaware that these activities present an increased risk for exposure to tetanus and diphtheria (Td), two potentially fatal and preventable diseases, according to the National Foundation for Infectious Diseases (NFID).

In anticipation of this seasonal swell in outdoor activity and travel, the National Foundation for Infectious Diseases (NFID) is alerting Americans to make sure their Td immunization is up to date.

"While nearly every child in the U.S. is protected against these two diseases, more than half of American adults over age 20 do not have protective antibody levels against them," says NFID President, Susan Rehm, MD. "The likely reason is that they have failed to get their routine booster shots every 10 years after childhood."

Two-time Olympic gold medalist in softball (1996, 2000) and orthopedic surgeon, Dot Richardson, MD, is joining NFID in encouraging everyone to check their Td booster status with their physicians and make sure they stay up-to-date.

"Warm weather and softball are core to the natural athlete in me, and I was surprised to learn that tetanus can be caused by something as simple as a splinter from a bench or a scrape sliding into home plate," says Richardson.

"Adults and teens need to keep their 10-year boosters up-to-date to prevent infections from cuts and scrapes that may not seem serious enough to be treated by a doctor," adds Rehm. "The vaccine is a combined shot that also protects against diphtheria."

"Diphtheria is still prevalent in 87 countries outside the U.S. and should not to be taken lightly when planning a trip overseas," stresses Rehm. "While diphtheria is just a plane ride away, there is peace of mind knowing that a single booster shot can protect against both tetanus and diphtheria for the next 10 years."

Most people who have ever stepped on a rusty nail likely received a vaccine to thwart off potential "lockjaw." However, many people are surprised to learn that rusty nails are not the only way someone can contract tetanus. In fact, two cases recently reported in Puerto Rico, were caused by splinter wounds. (1)

Despite the official recommendations for adults to get Td boosters every 10 years, 70% of the cases in the U.S. over the last two decades were among persons 40 years of age or older. (2) According to the CDC, the percentage of tetanus cases among persons aged 29-59 years old has increased during the last decade; previously, most cases were among persons aged older than 60 years. (3)

For adolescents and adults, some of the most common outdoor activities that pose a potential risk for tetanus infection are bicycling, walking, basketball, roller sports, soccer, backpacking and baseball/softball. (4) Other activities strongly associated with a potential tetanus risk include gardening/landscaping and yard work around the house, which accounted for approximately 39 precent of tetanus cases in 2001, according to the CDC. (5)

Almost all reported cases of tetanus occur in persons who have either never been vaccinated, or those who completed a primary series but have not had a booster vaccination in the past 10 years.

Diphtheria is still common outside the U.S., and some strains continue to circulate in parts of the U.S. Travel destinations were diphtheria is still common include certain parts of Africa, Europe, Central America, the Caribbean, the former Soviet republics, and Asia.

According to the NFID, with fewer people staying up-to-date with immunizations, there is also a risk that the disease could increase in the general population, resulting in a dangerous comeback of the disease. One such instance, where diphtheria made a comeback due to lack of adult immunity, was in Russia from 1990-95. (6) Because a large number of people were not immunized, this particular outbreak of diphtheria in Russia resulted in more than 157,000 cases and 5,000 preventable deaths.

In February 2003, NFID and the National Coalition for Adult Immunization (NCAI) launched Power of 10, a consumer awareness effort to relay the importance of receiving tetanus-diphtheria (Td) boosters every 10 years, as recommended by the Centers for Disease Control and Prevention.

NFID has developed a variety of initiatives to drive awareness and increase discussions between the public and health care professionals about Td boosters. For more information about the Power of 10 campaign, including more details about tetanus or diphtheria, visit www.nfid.org.

Founded in 1973, NFID is a non-profit organization dedicated to public and professional education programs about, and in support of research into the causes, treatment and prevention of infectious diseases. The Power of 10 campaign is made possible by an educational grant to NFID from Aventis Pasteur.


(1) CDC. Morbidity and Mortality Weekly Report. Atlanta, GA; 2002, July 19,

Vol. 51, No.28.

(2) ibid

(3) CDC. Tetanus Surveillance-United States, 1995-97. In: CDC Surveillance

Summaries, July 3, 1998. MMWR 1998; 47 (No. SS-2): 1-13.

(4) USDA; http://www.srs.fs.usda.gov/trends/Nsre/Round1rptuw.pdf

(5) CDC Tetanus Surveillance Summary

(6) CDC. Morbidity and Mortality Weekly Report. Atlanta, GA; 1996, Aug 16,

Vol. 45, No.32.

Source: National Foundation for Infectious Diseases