The incidence of reported tetanus in Italy decreased from 0.5/100,000 in the 1970s to 0.2/100,000 in the 1990 s. During this period of time, the case-fatality ratio decreased from 68% to 39%. Italy has the highest reported number of tetanus cases in European countries. Elderly women are the most affected: the proportion of women aged over 64 years among cases has increased from 60% in the 1970s to 76% in the 1990s. Vaccination campaigns need to be conducted to target this group, and the surveillance of tetanus has to be improved to identify additional groups of population at risk.