Neonatal tetanus: An old enemy still lurking around in 2021

Neonatal tetanus (NT) is a severe but preventable disease for which South Africa achieved elimination status in 2000. It is under-reported, especially in poorly resourced areas where there is minimal surveillance and immunisation coverage is overestimated, and where traditional practices are employed. The case fatality rate is high and surviving infants often have significant morbidity. The aim of our case report is to alert clinicians to the presence of NT and its clinical presentation and to emphasise the value of notification and surveillance. Prevention of NT should be prioritised through: education around hygienic practices at delivery; ensuring adequate immunity against tetanus in all women through routine childhood immunisation; and administration of tetanus toxoid in each pregnancy. NT should be considered in any neonate who could suck and cry in the first 2 days of life and who, between 3 and 28 days of life, cannot suck normally and becomes stiff or has spasms.