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Neonatal Tetanus Outbreak in Makkah City, on February 2019.


Neonatal tetanus (NT) is a highly fatal infection that occurs in newborn infants caused by a neurotoxin produced by Clostridium tetani. In February 2019, the Saudi Arabian Field Epidemiology Training Program (FETP) was notified of a neonatal tetanus outbreak in the neonatal intensive care unit of a maternity and children hospital in Makkah in western Saudi Arabia.


A team of FETP went to Makkah and worked with the Preventive Department in Makkah Health Directorate to gather information. We collected data by in-person interviews of both father& mother of neonatal tetanus cases, and review of medical files. We used a modified MOH structured questionnaire.


We identified three cases of neonatal tetanus in the Makkah region. Cases ranged from 8-9 days of age at their primary presentation to the hospital. Three infants presented with fever, difficulty breathing, and seizure; two presented in a semiconscious state. All infants received antibiotics, antiepileptic medication, and tetanus anti-toxoid. One infant was discharged after 26 days; two of the infants died. Investigation of delivery practices found that all three infants were born full-term and delivered at home. None of the deliveries involved sterile instruments. Each of the three cases lived in a different part of Makkah, and each case was of different non-Saudi ethnicity.


Cases were diagnosed as neonatal tetanus based on clinical features. Infection occurred among infants who had been delivered at home by unskilled personnel, with the use of unsterilized instruments. It is essential to established campaigns to educate pregnant women, and those of child-bearing age, about the risks of home delivery and the importance of tetanus immunization. Since non-Saudis are not eligible for free healthcare, they may be less likely to obtain appropriate prenatal care. These communities should specifically be targeted.