**1. Introduction**

Tetanus is an acute, potentially fatal disease that is characterized by generalized increased rigidity and convulsive spasms of skeletal muscles. It is caused by a neurotoxin released by *Clostridium tetani*. *C. tetani* is a spore-forming bacterium that is widely distributed in soil and it is also found in the intestines and feces of animals such as horses, sheep, cattle, dogs, cats, rats and guinea pigs. Agriculturally, soil treated with manure may contain large numbers of spores also. In agricultural areas due to soil treatment with manure, a significant number of human adults may harbor the organism too. It enters the body through breaks in the skin and germinates under anaerobic conditions [1]. Tetanus is a vaccine-preventable disease that remains a common cause of acute critical illness in low-income and middle-income countries (LMICs). It is estimated that the annual mortality of tetanus is around 200,000–300,000 with over a half of these deaths found in neonates. Neonatal tetanus is a severe, often fatal disease caused by a toxin of *C. tetani.* The World Health Organization defines a confirmed case of neonatal tetanus as an illness in a child who has normal feeding and crying during the first 2 days of life but loses the ability between age 3 and 28 days of life and becomes rigid and has spasms. It occurs through infection of the umbilicus when the cord is cut with an unclean instrument or when substances heavily contaminated

with tetanus spores are applied to the umbilical stump. Infants who have not acquired passive immunity from the mother because she has not been immunized are at an increased risk. Tetanus is however relatively rare in the developed world. Where they occur, it is usually in the adult. Neonatal tetanus has been eliminated in Europe [2].
