During the 1950s tetanus was a major public health concern in Israel, with incidence rates of up to 2/100,000 occurring predominantly among farmers and infants (tetanus neonatorum). These rates have declined considerably since then, with an average of 2 cases per year in recent years, and 5 cases in 1988. There has been a major decline in tetanus incidence in Judea/Samaria and Gaza, due to a successful vaccination program reaching over 90% of infants and schoolchildren and to educational programs. In Judea/Samaria and Gaza, prevention of tetanus neonatorum has improved as a result of the increasing number of hospital deliveries (now 62% in the West Bank and 80% in Gaza), and the widespread immunization of pregnant women and adolescent girls of childbearing age. Special efforts were given to the education of traditional birth attendants (dayas). Prevention of adult tetanus was achieved through immunization of high school students and laborers. Recent cases in all three areas are equally distributed between newborns and elderly persons. Because of the persistence of the incidence of tetanus, a review of Israel's immunization policy is indicated, focusing on high risk groups such as Bedouin women of childbearing age and the elderly.