(tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used. The World Health Organization certifies countries as having eliminated maternal or neonatal tetanus. Certification requires at least two years of rates of less than 1 case per 1,000 live births. In 1998 in Uganda, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda in 2011 was certified as having eliminated maternal and neonatal tetanus. Post-exposure prophylaxis Tetanus toxoid can be given in case of suspected exposure to tetanus. In such cases, it can be given with or without tetanus immunoglobulin (also called tetanus antibodies or tetanus antitoxin). It can be given as intravenous therapy or by intramuscular injection. The guidelines for such events in the United States for non-pregnant people 11 years and older are as follows: Treatment Mild tetanus Mild cases of tetanus can be treated with: Tetanus immunoglobulin (TIG), also called tetanus antibodies or tetanus antitoxin. It can be given as intravenous therapy or by intramuscular injection. Antibiotic therapy to reduce toxin production. Metronidazole intravenous (IV) is a preferred treatment. Benzodiazepines can be used to control muscle spasms. Options include diazepam and lorazepam, oral or IV. Severe tetanus Severe cases will require admission to intensive care. In addition to the measures listed above for mild tetanus: Human tetanus immunoglobulin injected intrathecally (which increases clinical improvement from 4% to 35%) Tracheotomy and mechanical ventilation for 3 to 4 weeks. Tracheotomy is recommended for securing the airway because the presence of an endotracheal tube is a stimulus for spasm Magnesium sulfate, as an intravenous infusion, to control spasm and autonomic dysfunction Diazepam as a continuous IV infusion The autonomic effects of tetanus can be difficult to manage (alternating hyper- and hypotension hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, or nifedipine Drugs such as diazepam or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the person with curare-like drugs and use a mechanical ventilator. To survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3,500 to 4,000 calories and at least 150 g of protein per day is often given in liquid form through a tube directly into the stomach (percutaneous endoscopic gastrostomy), or through a drip into a vein (parenteral nutrition). This high-caloric diet maintenance is