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In 1948 it became available in a combined vaccine (DTP) with diphtheria toxoid and the pertussis vaccine.
In the late 1940s, tetanus toxoid-containing vaccines were introduced into routine childhood vaccination and tetanus became a nationally notifiable disease. At that time, between 500–600 cases (approximately 0.4 cases per 100,000 population) were reported per year.
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After the 1940s, reported tetanus incidence rates declined steadily. Since the mid-1970s, about 50 to 100 cases (approximately 0.05 cases per 100,000) have been reported annually in the United States. More recently, from 2009–2018, an average of 29 (range 18–37) cases were reported per year. Of the 297 cases reported during this 10-year timeframe, there were 19 deaths, all in adults aged 55 years or older. In 2018, 23 tetanus cases were reported, with no deaths.
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