Public Health England undertakes surveillance of vaccine preventable diseases including enhanced surveillance of clinically suspected tetanus. In the United Kingdom, tetanus has become increasingly rare due to the success of the national routine immunization program. Consequently, few practitioners have experience of diagnosing and managing patients with clinical tetanus. We report two cases of tetanus where comparatively minor wounds proved fatal. These cases highlight the importance of the accurate identification and management of tetanus prone wounds and the fatal consequences from untreated injuries in susceptible individuals. We conclude that appropriate risk assessment for tetanus prophylaxis forms an essential part of wound management.