Tetanus is acquired when the spores of the bacterium Clostridium Tetani infect a wound or the umbilical stump. Spores are universally present in the soil. People of all ages can get tetanus but the disease is particularly common and serious in newborn babies ("neonatal tetanus"). It requires treatment in a medical facility, often in a referral hospital. Neonatal tetanus, which is mostly fatal, is particularly common in rural areas where deliveries are at home without adequate sterile procedures. WHO estimated that neonatal tetanus killed about 180 000 babies in 2002.
Tetanus can be prevented through immunization with tetanus-toxoid (TT) -containing vaccines. Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid, either during pregnancy or outside of pregnancy. This protects the mother and - through a transfer of tetanus antibodies to the fetus - also her baby. Additionally, clean practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus. People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized. To be protected throughout life, an individual should receive 3 doses of DTP in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood.
Worldwide, all countries are committed to "elimination" of maternal and neonatal tetanus (MNT), i.e. a reduction of neonatal tetanus incidence to below one case per 1000 live births per year in every district. As of December 2007, 47 countries remain that have not eliminated MNT.