Prevention and control of tetanus in childhood.

Until recently, tetanus was estimated to be killing well over half a million children each year in the developing world, most commonly through neonatal tetanus, the incidence of which was around six per 1000 live births. Neonatal tetanus most commonly occurs through cord contamination of the umbilical stump. Vaccination of pregnant women and infants is an effective and inexpensive intervention that results in major health gains, although educating traditional birth attendants and mothers about safer birthing practices probably also lowers the incidence of tetanus. Recently, however, new vigor and strategies in immunization programs have resulted in substantial improvements. Immunization of pregnant women, and identification and targeting of areas and populations in which neonatal tetanus is occurring are especially effective. Tetanus will continue to be a pediatric problem until vaccination strategies are effectively implemented, surveillance systems are improved, and hygienic birthing practices become standard in all countries.