{
  "abstract": "The following case describes a case of tetanus that occurred in a previously healthy child vaccinated in accordance with the national immunisation programme of São Tomé e Príncipe in 2021. The tetanus vaccination schedule consists of a primary three-dose series within the first 4 months of life, followed by a booster at 10 years of age. Figure 1 depicts a school-aged girl who developed generalised tetanus after sustaining an injury from a dirty glass shard in her right ankle. She was taken to the hospital and was initially discharged without antibiotic treatment or a tetanus booster. She returned three days later with gait disturbances that rapidly progressed to muscle rigidity, short spasms, opisthotonus (figure 2), trismus (figure 3) and dysphagia (figure 4) . After a few hours of hospital stay, she was diagnosed with generalised tetanus, grade 3 (severe), according to the Ablett Classification of Tetanus Severity. She was treated with intravenous penicillin G (100,000 U/kg/day, every 6 hours) and metronidazole (30 mg/kg/day, every 8 hours) for 21 days and diazepam, chlorpromazine and pyridoxine along with sensorial stimuli restriction (figure 1) (figure 4). The wound was cleaned, disinfected and debrided. Neither antitetanic immunoglobulin nor intravenous immunoglobulin was available in the country. After 32 days, she was discharged home with ongoing diazepam tapering and referred for outpatient physiotherapy, following a tetanus booster.",
  "authors": [
    {
      "affiliations": [
        "Pediatrics, Hospital de Santa Maria, Lisboa, Portugal"
      ],
      "name": "Carolina Castro"
    },
    {
      "affiliations": [
        "Maternidade Alfredo da Costa, Neonatal Intensive Care Unit, Paediatrics Department, Unidade Local de Saude Sao Jose, Lisbon, Portugal"
      ],
      "name": "Isabel Coelho"
    },
    {
      "affiliations": [
        "Pediatric Neurology, Pediatrics Department, Hospital de Santa Maria, Lisboa, Portugal"
      ],
      "name": "Joana Coelho"
    },
    {
      "affiliations": [
        "Hospital Ayres de Menezes, São Tomé, Sao Tome and Principe"
      ],
      "name": "Swasilanne Sousa"
    }
  ],
  "title": "Tetanus in a developing nation: a rare disease in the vaccination era?",
  "uid": "d668f983-f4d4-52af-b445-72347f3756d4"
}