Tetanus has been almost completely eradicated from public life in South Africa and many other countries since the early 2000s. Although a tetanus vaccine has existed since the ’70s, infant mortality and overall cases were still high. The transition to administering two vaccines paved the way for fewer than one case per 1,000 people and a tenfold drop in the infant mortality rate.

Bacterial Infections in South Africa

Newborns are the most vulnerable group, especially regarding exposure to bacterial infections such as tetanus, diphtheria and whooping cough. Children are better protected when mothers receive a Tdap vaccine during the final two trimesters of pregnancy. The vaccine protects against all three illnesses. Because of the mother and child’s symbiotic relationship, the vaccine immunizes the mother and also benefits the child via the placenta.

Every year, young children, especially infants aged 0 to 1, have the highest infection rate of all three illnesses. In 2025, there were 614 reported cases of whooping cough in South Africa, with more than half occurring in children under 5 years of age. For all other age groups combined, there were fewer than 1,000 total cases during that period.

Symptoms

Tetanus symptoms include muscle spasms, muscle and jaw tightness and fever. Diphtheria causes fever, sore throat and nasal discharge. In addition to a harsh cough that starts about one to two weeks into the illness, whooping cough also causes vomiting and sneezing. It poses a long recovery time of a few weeks or more likely a few months, for infants.

Infants with these infections naturally have a much higher mortality rate. Their much narrower airways are ill-equipped to handle such severe respiratory infections. Fortunately, South African hospitals are stocked with high-end medical equipment such as ventilators to aid recovery. Tetanus is the deadliest of the three infections because almost all infants who get it will die without proper treatment. Even with such treatment, the number still exceeds 50%.

Widespread Support

Although tetanus infection rates have remained consistently low since 2002, diphtheria and whooping cough have fluctuated over the years. Widespread vaccination has consistently helped curb the infections. In addition to making the DTaP and Tdap vaccines widely available and affordable, the National Department of Health helps fund campaigns to mobilize larger groups to get vaccinated.

People did not stay up to date on their vaccines in 2021 during the COVID-19 lockdowns. There were supply shortages from the pandemic, but the lack of vaccinations continued for months even after supplies became available. During that time, community members stepped in with their own campaign to remind individuals to protect their health.

While the main purpose of these campaigns was to promote the COVID-19 vaccine, citizens were also encouraged to receive other vaccines like DTaP and Tdap. People involved in the campaign set up information tables, hung vaccine banners, drove around town with signs and went door-to-door to promote vaccination.

The Path Forward

There are still 11 different countries with high rates of tetanus infections, primarily due to a lack of adequate health care resources. Although South Africa is not one of these countries, immunization rates may be much lower and infection rates higher than reported because it is more difficult to track data accurately for developing countries. However, community and government support continue to improve access to the vaccine and help keep bacterial infections low in South Africa.

– Logan Hessek

Logan is based in Northglenn, CO, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr