Neonatal tetanus is a clinical form of tetanus affecting newborns, caused by contamination of the umbilical stump at or following delivery in infants whose mothers did not possess sufficient circulatory antitoxin for passive transplacental protection [1]. The causative agent is the spore-forming bacterium Clostridium tetani, which produces tetanospasmin, a powerful exotoxin that interferes with inhibitory motor neuron signalling [1][2].
Disease overview
Bacterial Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026
Neonatal tetanus is a life-threatening form of tetanus occurring in newborns, resulting from contamination of the umbilical stump with Clostridium tetani spores when the mother lacks protective circulating antitoxin [1]. The disease remains an important vaccine-preventable cause of neonatal mortality in settings with low maternal immunization coverage and unhygienic delivery or cord-care practices [2]. Global efforts under the WHO Maternal and Neonatal Tetanus Elimination (MNTE) initiative have produced an estimated 88% reduction in neonatal tetanus deaths over recent decades, though elimination has not yet been universally achieved [3]. Although rare in high-income countries, neonatal tetanus persists in parts of southern Asia, southeast Asia, and sub-Saharan Africa [4].
Read the full clinical and epidemiological profile 6
Neonatal tetanus is one of four recognized clinical forms of tetanus, alongside generalized, localized, and cephalic forms [1][2]. The disease is driven by tetanospasmin-induced disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, producing intense muscular rigidity and spasm [1]. Shorter incubation and onset times are associated with more severe disease and a poorer prognosis [1].
Neonatal tetanus is particularly common in developing countries, where it is driven by unhygienic childbirth practices, social taboos affecting cord care, and inadequate immunization of pregnant mothers [2]. Although it has become a rarity in high-income countries, tetanus overall remains an important cause of morbidity and mortality, notably in southern Asia, southeast Asia, and sub-Saharan Africa [4]. Tetanus is estimated to affect between 50,000 and 1 million people worldwide each year, with the highest burden in developing regions [2].
Neonatal tetanus results from contamination of the umbilical stump by spores of Clostridium tetani at or following delivery [1]. Protective passive immunity is normally conferred by transplacental transfer of maternal antitoxin; infection therefore occurs predominantly in infants born to mothers without sufficient circulating tetanus antitoxin [1].
Neonatal tetanus is preventable through three principal strategies: universal immunization of women of reproductive age with tetanus toxoid-containing vaccines, clean delivery practices, and hygienic umbilical cord care [3]. The MNTE initiative combines rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, strengthening of clean delivery services for pregnant women, and effective surveillance [3]. In the WHO African Region, supplementary immunization activities have vaccinated over 79 million women of reproductive age, and between 2000 and 2015, the proportion of newborns protected at birth rose from 62% to 77%, alongside increases in DTP3 coverage and TT2+ coverage [5]. Sustaining elimination additionally requires skilled birth attendance, appropriately spaced booster doses, and integration of tetanus vaccination with other health service opportunities [5][3].
- 1 Poudel P et al. Tetanus. Kathmandu Univ Med J (KUMJ). 2009 Jul-Sep. PMID: 20071883. PubMed: https://pubmed.ncbi.nlm.nih.gov/20071883/
- 2 Bhatia R et al. Tetanus. Neurol India. 2002 Dec. PMID: 12577086. PubMed: https://pubmed.ncbi.nlm.nih.gov/12577086/
- 3 Dhir SK et al. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med. 2021. PMID: 34849046. doi: 10.2147/RRTM.S201989. PubMed: https://pubmed.ncbi.nlm.nih.gov/34849046/
- 4 Sudarshan R et al. Tetanus: recognition and management. Lancet Infect Dis. 2025 Nov. PMID: 40543524. doi: 10.1016/S1473-3099(25)00292-0. PubMed: https://pubmed.ncbi.nlm.nih.gov/40543524/
- 5 Ridpath AD et al. Progress towards achieving and maintaining maternal and neonatal tetanus elimination in the African region. Pan Afr Med J. 2017. PMID: 29296159. doi: 10.11604/pamj.supp.2017.27.3.11783. PubMed: https://pubmed.ncbi.nlm.nih.gov/29296159/
- A33
- 1C13
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