Neonatal tetanus continues to be a cause of neonatal death in the low- and middle-income countries. Recently we managed two cases of neonatal tetanus at our institute. Both the families were migrants, one from Bihar and other from Jharkhand. Both the pregnancies were unsupervised and delivery was conducted at home. There was history of application of cowdung on umbilical stump in first case and oil in second case. Both infants presented in unstable condition to our centre;one died of refractory shock and the other developed nephropathy but recovered fully.

As tetanus spores cannot be removed from the environment, the eradication is unlikely, and new phase of activities are required to sustain neonatal tetanus elimination [1]. These cases encountered by us suggest that neonatal tetanus continues to occur due to poor antenatal care and unhygienic delivery practices, particularly in migrant population. This migrating population is logistically difficult to track, but primary health workers should address this at-risk population at priority. With large number of migrant labour population in India, which remains at risk, it seems a daunting task for India’s health policy makers to maintain elimination of neonatal tetanus. Efforts to sustain the elimination of neonatal tetanus can also reduce tetanus in the population in general [3].

Funding: None; Competing interest: None stated.

1. Maternal and neonatal tetanus elimination: validation survey in 4 States and 2 union territories in India, May 2015. Wkly Epidemiol Rec. 2015 ;90:589-608.

2. Cousins S. India is declared free of maternal and neonatal tetanus. BMJ. 2015;350:h2975.