Progress Toward Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2018
Henry Njuguna, Nasir Yusuf, Azhar Raza, Bilal Ahmed, Rania A. Tohme
Abstract
Maternal and neonatal tetanus* (MNT) remains a major public health problem, with an 80%-100% case-fatality rate among neonates, especially in areas with poor immunization coverage and limited access to clean deliveries (i.e., delivery in a health facility or assisted by medically trained attendants in sanitary conditions) and umbilical cord care (1). In 1989, the World Health Assembly endorsed the elimination of neonatal tetanus (NT), and in 1999, the initiative was relaunched and renamed the MNT elimination initiative, targeting 59 priority countries (1). Elimination strategies include 1) achieving 80% coverage with 2 doses of tetanus toxoidcontaining vaccine (TTCV) among women of reproductive age through routine immunization of pregnant women and supplementary immunization activities (SIAs)** in high-risk areas and districts ; 2) achieving care at 70% of deliveries by a skilled birth attendant (SBA) ; and 3) enhancing surveillance for NT cases (1). This report summarizes progress toward achieving MNT elimination during 2000-2018. Coverage with 2 doses of TTCV (2 doses of tetanus toxoid [TT2+] or 2 doses of tetanus-diphtheria toxoid [Td2+]) among women of reproductive age increased by 16%, from 62% in 2000 to 72% in 2018. By December 2018, 52 (88%) of 59 priority countries had conducted TTCV SIAs, vaccinating 154 million (77%) of 201 million targeted women of reproductive age with TT2+/Td2+. Globally, the percentage of deliveries assisted * Maternal tetanus is defined as tetanus occurring during pregnancy or within 6 weeks of the end of pregnancy (birth, miscarriage, or abortion). Maternal tetanus infection occurs during abortion, miscarriages, or unhygienic delivery.