Currently a rarity in high-income countries, tetanus is a diagnosis not to miss. Deaths from tetanus fell by almost 90% between 1990 and 2019, largely reflecting the success of the World Health Organization’s Maternal and Neonatal Tetanus elimination campaign. However, deaths amongst children and adults have plateaued, and tetanus remains an important vaccine-preventable cause of morbidity and mortality, notably in South Asia, Southeast Asia, and Sub-Saharan Africa. Tetanus results from infections with spore-forming Clostridium tetani bacteria, usually acquired via contaminated wounds and burns. C. tetani releases a potent neurotoxin, causing muscle spasms, rigidity, and dysautonomia. Important complications include laryngeal spasm, leading to airway obstruction and respiratory arrest; nosocomial infections; and sequelae of prolonged immobility. Tetanus is a clinical diagnosis, but microbiological tests may serve as useful adjuncts. Treatment is multifaceted, requiring source control, antibiotic therapy, and antitoxin administration. With prolonged, quality intensive care, many patients survive with good functional outcome. However, due to challenges in leveraging routinely-collected healthcare data and performing high-quality trials in resource-constrained settings, several key questions remain unanswered and optimal treatment strategies are contested. In this review, we provide a state-of-the-art summary of global tetanus epidemiology; its clinical features and differential diagnosis; principles of management; and prognosis.