1. Ergönül O, Kolsuz S, Figueroa JP. Tetanus. The Lancet Seminar. Unpublished manuscript. 2025.
2. Ergonul O, Egeli D, Kahyaoglu B, Bahar M, Etienne M, Bleck T. An unexpected tetanus case. The Lancet Infectious Diseases 2016; 16(6): 746-52.
3. World Health Organization (WHO) – Weekly Epidemiological Record, 2017, vol. 92, 06 [full issue]. Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire 2017; 92(6): 53-76.
4. Mboussou F, Kada S, Danovaro-Holliday MC, et al. Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic.
Vaccines (Basel) 2024; 12(2).
5. BBC. Kenya Catholic Church tetanus vaccine fears ‘unfounded’. 2014 2014. https://www.bbc.com/news/world-africa-29594091.
6. The Washington Post. The tense standoff between Catholic bishops and the Kenyan government over tetanus vaccines. 2014 2014. https://www.washingtonpost.com/news/worldviews/
wp/2014/11/14/the-tense-standoff-between-catholic-bishops-and-the-kenyan-government-over-tetanus-vaccines/.
7. Njuguna HN, Yusuf N, Raza AA, Ahmed B, Tohme RA. Progress Toward Maternal and Neonatal Tetanus Elimination – Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep 2020; 69(17):
515-20.
8. Schofield DF, Tucker MV, Westbrook RG. Neonatal Tetanus in New Guinea. BMJ 1961; 2(5255): 785-9.
9. World Health Organization (WHO) – Maternal and Neonatal Tetanus Elimination (MNTE)-Progress towards global MNT elimination. 2024. https://www.who.int/initiatives/mater-
nal-and-neonatal-tetanus-elimination-(mnte)/progress-towards-global-mnt-elimination.
10. World Health Organization (WHO) – Weekly Epidemiological Record, 2020, vol. 95, 36 [full issue]. Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire 2020; 95(36): 417-
40.
11. Aboagye GR, Amu H, Dowou KR, Bansah P, Oaikhena OI, Bain EL. Prevalence and correlates of tetanus toxoid uptake among women in sub-Saharan Africa: Multilevel analysis of demog-
raphic and health survey data. PLOS ONE 2023; 18(12): e0296174.
12. Jones CE, Yusuf N, Ahmed B, Kassogue M, Wasley A, Kanu FA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination – Worldwide, 2000-2022. MMWR
Morb Mortal Wkly Rep 2024; 73(28): 614-21.
13. Priebe J, Amuasi J, Dartanto T, Mombo-Ngoma G, Guigas M. Factors associated with skilled birth attendance in 37 low-income and middle-income countries: a secondary analysis of natio-
nally representative, individual-level data. The Lancet Global Health 2024; 12(7): e1104-e10.
14. Sudarshan R, Sayo AR, Renner DR, et al. Tetanus: recognition and management. The Lancet Infectious Diseases.
15. Gergen JP, Mcquillan MG, Kiely M, Ezzati-Rice MT, Sutter WR, Virella G. A Population-Based Serologic Survey of Immunity to Tetanus in the United States. New England Journal of Medicine
1995; 332(12): 761-7.
16. Ergönül Ö, Sözen T, Tekeli E. Immunity to Tetanus Among Adults in Turkey. Scandinavian Journal of Infectious Diseases 2001; 33(10): 728-30.
17. ECDC. Tetanus – Annual Epidemiological Report for 2022. European Centre for Disease Prevention and Control 2024.
18. Ergönül Ö, Keske Ş, Ksinzik A, et al. The challenges in the monitoring of infectious diseases after the earthquake in Türkiye in 2023. The Lancet Infectious Diseases 2023/11/01; 23(11).
19. Group EA. Outbreak of tetanus cases following the tsunami in Aceh province, Indonesia. Global Public Health 2006; 1(2): 173-7.
20. Sutiono A, Qiantori A, Suwa H, Ohta T. Characteristic tetanus infection in disaster-affected areas: case study of the Yogyakarta earthquakes in Indonesia. BMC Research Notes 2009; 2(1): 34.
21. Afshar M, Raju M, Ansell D, Bleck PT. Narrative Review: Tetanus—A Health Threat After Natural Disasters in Developing Countries. Annals of Internal Medicine 2011; 154(5): 329.
22. Rapisarda V, Bracci M, Nunnari G, Ferrante M, Ledda C. Tetanus immunity in construction workers in Italy. Occupational Medicine 2014; 64(3): 217-9.
23. Aksel G, İslam MM, Eroğlu ES, Özen C, Sektioğlu KB. Tetanus in refugee patients: Two cases and review of the literature. Turkish Journal of Emergency Medicine 2019; 19(4): 149-51.
24. Megighian A, Pirazzini M, Fabris F, Rossetto O, Montecucco C. Tetanus and tetanus neurotoxin: From peripheral uptake to central nervous tissue targets. Journal of Neurochemistry 2021;
158(6): 1244-53.
25. Binz T, Rummel A. Cell entry strategy of clostridial neurotoxins. Journal of Neurochemistry 2009; 109(6): 1584-95
26. Dong M, Masuyer G, Stenmark P. Botulinum and Tetanus Neurotoxins. Annual Review of Biochemistry 2019; 88(1): 811-37.
27. Pirazzini M, Montecucco C, Rossetto O. Toxicology and pharmacology of botulinum and tetanus neurotoxins: an update. Archives of Toxicology 2022; 96(6): 1521-39.
28. Schiavo GG, Benfenati F, Poulain B, et al. Tetanus and botulinum-B neurotoxins block neurotransmitter release by proteolytic cleavage of synaptobrevin. Nature 1992; 359(6398): 832-5.
29. Sharma N, Li S, Sravanthi VM, et al. Tetanus Complicated by Dysautonomia: A Case Report and Review of Management. Case Reports in Critical Care 2021; 2021: 1-4.
30. Mitsui N, Mitsui K, Hase J. Purification and some properties of tetanolysin. Microbiol Immunol 1980; 24(7): 575-84.
31. Chan ST, Kang CH. A case of tetanus mimicking acute abdomen. Singapore Med J 1994; 35(6): 641-2.
32. Idris I, Mafauzy MM, Baharuddin KA, Alwi F, Mohamad WSW. Localized tetanus mimics acute perforated viscus: A diagnostic challenge and review of case reports. Turk J Emerg Med 2022;
22(4): 226-9.
33. Tsuchiya M, Kobayashi F, Yamashiro N, Nagasaka T, Shindo K, Takiyama Y. [A case of local tetanus presenting spastic paraplegia mimicking myelitis]. Rinsho Shinkeigaku 2018; 58(11): 688-91.
34. Nascimento FA, Hammoud N, Augusto FD. Teaching Video NeuroImages: Cephalic tetanus: Not every facial weakness is Bell palsy. Neurology 2019; 93(21): e1995-e6.
35. Tahir A, Pokorny P, Malek N. Cephalic tetanus presenting with bilateral facial palsy. Scott Med J 2019; 64(3): 108-11.
36. Seo HD, Cho KD, Kwon CH, Kim UT. A Case of Cephalic Tetanus with Unilateral Ptosis and Facial Palsy. Annals of Rehabilitation Medicine 2012; 36(1): 167.
37. Doshi A, Warrell C, Dahdaleh D, Kullmann D. Just a graze? Cephalic tetanus presenting as a stroke mimic. Practical Neurology 2014; 14(1): 39-41.
38. Kolsuz S, Güllü D, Karahan DK, Ergönül Ö. Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis. International
Journal of Infectious Diseases 2025; 153: 107781.
39. Vollman EK, Acquisto MN, Bodkin PR. A case of tetanus infection in an adult with a protective tetanus antibody level. The American Journal of Emergency Medicine 2014; 32(4): 392.e3-.
e4.39.
40. Hao VN, Huyen MNN, Ny HTN, et al. The Role of the Gastrointestinal Tract in Toxigenic Clostridium tetani Infection: A Case-Control Study. The American Journal of Tropical Medicine and
Hygiene 2021; 105(2): 494-7.
41. Li L, Liu Z. Rhabdomyolysis with acute anuria renal failure caused by surgical injection-induced tetanus in an adult. Clinical Medicine 2021; 21(1): e103-e5.
42. Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases – Chapter 21:Tetanus. 14 ed.
Washington D. C. Public Health Foundation: Centers for Disease Control and Prevention.; 2021.
43. Hao VN, Loan TH, Yen ML, et al. Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial ran-
domised controlled trial. The Lancet Global Health 2022; 10(6): e862-e72.
44. Amare A, Melkamu Y, Mekonnen D. Tetanus in adults: Clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia. Journal of the Neurological Sciences 2012;
317(1-2): 62-5.
45. Saltoglu N, Tasova Y, Midikli D, Burgut R, Dündar IH. Prognostic factors affecting deaths from adult tetanus. Clinical Microbiology and Infection 2004; 10(3): 229-33.
46. Phillips LA. A classification of tetanus. The Lancet 1967; 289(7501): 1216-7.
47. Thwaites LC, Yen ML, Glover C, et al. Predicting the clinical outcome of tetanus: the tetanus severity score. Tropical Medicine & International Health 2006; 11(3): 279-87.
48. Bae S, Go M, Kim Y, et al. Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011–2019. BMC Infectious Diseases 2021; 21(1).
49. Cavalcante FJN, Sandeville LM, Medeiros SAE. Incidence of and Risk Factors for Nosocomial Pneumonia in Patients with Tetanus. Clinical Infectious Diseases 2001; 33(11): 1842-6.
50. Araki T, Iwanami N, Yamazaki Y. Severe Tetanus Complicated by Takotsubo Cardiomyopathy. Internal Medicine 2019; 58(14): 2107-12.
51. Komamura K, Fukui M, , Iwasaku T, Hirotani S, Masuyama T. Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. World Journal of Cardiology 2014; 6(7): 602.
52. Pham NKO, Tran NB, Duong CM, et al. Magnitude, Patterns, and Associated Predictors of Cardiovascular Events in Tetanus: A 2-Year, Single-Center, Ambidirectional Cohort Study Involving
572 Patients. Open Forum Infectious Diseases 2023; 10(10).
53. Triplett DJ, Kutlubaev AM, Kermode GA, Hardy T. Posterior reversible encephalopathy syndrome (PRES): diagnosis and management. Practical Neurology 2022; 22(3): practneurol-202.
54. Hughes CH. Blindness in a case of tetanus. Journal of Neurology, Neurosurgery & Psychiatry 2005; 77(3): 420-1.
55. Regaieg K, Bahloul M, Gargouri R, Bouattour A, Chelly H, Bouaziz M. Une complication exceptionnelle du tétanos généralisé: l’embolie pulmonaire. Pan African Medical Journal 2016; 25:
172.
56. Campbell JI, Yen LTM, Loan HT, et al. Microbiologic Characterization and Antimicrobial Susceptibility of Clostridium tetani Isolated from Wounds of Patients with Clinically Diagnosed
Tetanus. The American Journal of Tropical Medicine and Hygiene 2009-05-01; 80(5).
57. Nomura K, Sakawaki E, Sakawaki S, et al. Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review. BMC Infectious Diseases 2021
21:1 2021-01-07; 21(1).
58. Rodrigo C, Fernando D, Rajapakse S, Rodrigo C, Fernando D, Rajapakse S. Pharmacological management of tetanus: an evidence-based review. Critical Care 2014 18:2 2014-03-26; 18(2).
59. Kumar GVA, Kothari MV, Krishnan A, Karnad RD. Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial. Annals of Tropical
Medicine & Parasitology 2004; 98(1): 59-63.
60. Miranda-Filho BDD, Ximenes ADAR, Barone AA, Vaz LV, Vieira GA, Albuquerque GMV. Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrat-
hecal or intramuscular route. BMJ 2004; 328(7440): 615.
61. Sun OK, Chan WY, Cheung FTR, So CP, Yu LY, Li KCP. Management of Tetanus: A Review of 18 Cases. Journal of the Royal Society of Medicine 1994; 87(3): 135-7.
62. Kabura L, Ilibagiza D, Menten J, Ende DVJ. Intrathecal <i>vs.</i> intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus:
a meta‐analysis. Tropical Medicine & International Health 2006; 11(7): 1075-81.
63. Loan TH, Yen ML, Kestelyn E, et al. A Pilot Study to Assess Safety and Feasibility of Intrathecal Immunoglobulin for the Treatment of Adults with Tetanus. The American Journal of Tropical
Medicine and Hygiene 2018; 99(2): 323-6.
64. Robert R, Rouffineau J, Cremault A, et al. [Reversible paraplegia following intrathecal injection of high doses of human gammaglobulins in the treatment of low-grade tetanus. 4 cases]. Presse
Med 1984; 13(32): 1947-9.
65. Borgeat A, Popovic V, Schwander D. Efficiency of a continuous infusion of propofol in a patient with tetanus. Critical Care Medicine 1991; 19(2): 295-6.
66. Powles BA, Ganta R. Use of vecuronium in the management of tetanus. Anaesthesia 1985; 40(9): 879-81.
67. Lien AC, Eikermann M. Neuromuscular Blockers and Reversal Drugs. In: Hemmings HC, Egan TD, editors. Pharmacology and Physiology for Anesthesia. Philadelphia: W.B. Saunders; 2013.
p. 325-48.
68. Kataria V, Agha T, Ryman K, Iyer N. Strategic Utilization of Dantrolene in a Case of Severe Acute Generalized Tetanus. Journal of Pharmacy Practice 2024; 37(3): 766-9.
69. Santos LM, Mota‐Miranda A, Alves‐Pereira A, Gomes A, Correia J, Marcal N. Intrathecal Baclofen for the Treatment of Tetanus. Clinical Infectious Diseases 2004; 38(3): 321-8.
70. Engrand N, Guerot E, Rouamba A, Vilain G. The Efficacy of Intrathecal Baclofen in Severe Tetanus. Anesthesiology 1999; 90(6): 1773-6.
71. Thwaites C, Yen L, Loan H, et al. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. The Lancet 2006; 368(9545): 1436-43.
72. Rodrigo C, Samarakoon L, Fernando DS, Rajapakse S. A meta‐analysis of magnesium for tetanus. Anaesthesia 2012; 67(12): 1370-4.
73. Mathew JP, Samra T, Wig J. Magnesium Sulphate for Treatment of Tetanus in Adults. Anaesthesia and Intensive Care 2010; 38(1): 185-9.
74. Dundee WJ, Morrow FW. Labetalol in severe tetanus. BMJ 1979; 1(6171): 1121-2.
75. Wesley GA, Hariparsad D, Pather M, Rocke AD. Labetalol in tetanus. Anaesthesia 1983; 38(3): 243-9.
76. Buchanan N, Smit L, Cane DR, Andrade DM. Sympathetic overactivity in tetanus: fatality associated with propranolol. BMJ 1978; 2(6132): 254-5.
77. Slifka MA, Park B, Gao L, Slifka KM. Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules. Clinical Infectious Diseases 2021; 72(2): 285-92.
78. Centers for Disease Control and Prevention (CDC) – Adult Immunization Schedule by Age, United States, 2025. 2025 2024. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html.
79. World Health Organization (WHO) – The immunological basis for immunization series: module 3: tetanus. update 2018 ed. Geneva: World Health Organization; 2018.
80. Medu O, Ogunyemi N, Hennink M, et al. Tetanus in a vaccinated soil expert – a case report. BMC Infectious Diseases 2023; 23(1): 760.
81. Zhang C, Hu W, Ma Y, Li L, Si Y, Zhang S. Seroepidemiology of Tetanus among Healthy People Aged 1–59 Years Old in Shaanxi Province, China. Vaccines 2022; 10(11): 1806.
82. Ujiie M. Tetanus Toxoid Antibody Seroprevalence in Japan. Clinical Infectious Diseases 2024; 78(4): 1079-80.
83. Bagordo F, Grassi T, Rota CM, et al. Seroprotection against tetanus in the Italian general population. Vaccine 2024; 42(19): 4040-5.
84. Hendry JA, Quinn EH, Macartney K, Beard HF. Tetanus, pertussis, and diphtheria vaccination coverage in older adults, Australia, 2023: analysis of Australian Immunisation Register data.
Medical Journal of Australia 2024; 221(4): 224-5.
85. Blencowe H, Lawn J, Vandelaer J, Roper M, Cousens S. Tetanus toxoid immunization to reduce mortality from neonatal tetanus. International Journal of Epidemiology 2010; 39(Supplement
1): i102-i9.
86. Demicheli V, Barale A, Rivetti A. Vaccines for women to prevent neonatal tetanus. Cochrane Database of Systematic Reviews. 20051019 ed; 2005. p. Cd002959.
87. Morgan JL, Baggari SR, McIntire DD, Sheffield JS. Pregnancy Outcomes After Antepartum Tetanus, Diphtheria, and Acellular Pertussis Vaccination. Obstetrics & Gynecology 2015; 125(6).
88. Oguti B, Ali A, Andrews N, et al. The half-life of maternal transplacental antibodies against diphtheria, tetanus, and pertussis in infants: an individual participant data meta-analysis. Vaccine
2022; 40(3): 450-8.
89. Kerneis S, Launay O, Turbelin C, Batteux F, Hanslik T, Boelle P-Y. Long-term Immune Responses to Vaccination in HIV-Infected Patients: A Systematic Review and Meta-Analysis. Clinical
Infectious Diseases 2014; 58(8): 1130-9.
90. Kroon PF, Dissel VTJ, Labadie J, Loon VMA, Furth VR. Antibody Response to Diphtheria, Tetanus, and Poliomyelitis Vaccines in Relation to the Number of CD4+ T Lymphocytes in Adults
Infected with Human Immunodeficiency Virus. Clinical Infectious Diseases 1995; 21(5): 1197-203.
91. Dauby N, Gobert C, Benslimane A, et al. Durability of tetanus seroprotection in people living with HIV. AIDS 2022; 36(8): 1135-9.
92. Gobert C, Van Hauwermeiren C, Quoidbach C, et al. Tetanus seroprotection in people living with HIV: Risk factors for seronegativity, evaluation of medical history and a rapid dipstick test.
Vaccine 2021; 39(14): 1963-7.
93. Gupta S, Pellett S. Recent Developments in Vaccine Design: From Live Vaccines to Recombinant Toxin Vaccines. Toxins 2023; 15(9): 563.
94. Przedpelski A, Tepp William H, Pellett S, Johnson Eric A, Barbieri Joseph T. A Novel High-Potency Tetanus Vaccine. mBio 2020; 11(4): 10.1128/mbio.01668-20.
95. Chang M-J, Ollivault-Shiflett M, Schuman R, et al. Genetically detoxified tetanus toxin as a vaccine and conjugate carrier protein. Vaccine 2022; 40(35): 5103-13.