Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2020

• Published in: MMWR. Morbidity and mortality weekly report 2022-03, Vol.71 (11), p.406-411
• Main Authors: Kanu, Florence A, Yusuf, Nasir, Kassogue, Modibo, Ahmed, Bilal, Tohme, Rania A
• Format: Article
• Language: English
• Subjects: Adult; Age; Attended births; Births; Coronaviruses; COVID-19 vaccines; Developing Countries - statistics & numerical data; Disease Eradication - methods; Disease Eradication - statistics & numerical data; DPT vaccine; Fatalities; Female; Full Report; Health Priorities; Humans; Immunization; Immunization Programs; Infant Health; Infant, Newborn; Infants; Infants (Newborn); Maternal Health; Measles; Middle Aged; Midwifery; Mortality; Neonates; Patient outcomes; Poliomyelitis; Pregnancy; Prenatal care; Public health; Tetanus; Tetanus - prevention & control; Tetanus antitoxin; Tetanus Toxoid - administration & dosage; Vaccination; Vaccination Coverage; Vaccines; Womens health; World health
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/mmwr.mm7111a2

Maternal and neonatal tetanus (MNT)* remains a major cause of neonatal mortality with an 80%-100% case-fatality rate among insufficiently vaccinated mothers after unhygienic deliveries, especially in low-income countries (1). In 1989, the World Health Assembly endorsed elimination of neonatal tetanus; the activity was relaunched in 1999 as the MNT elimination (MNTE) initiative, targeting 59 priority countries. MNTE strategies include 1) achieving ≥80% coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV2+)** among women of reproductive age through routine and supplementary immunization activities (SIAs) in high-risk districts, 2) achieving ≥70% of deliveries by a skilled birth attendant, and 3) implementing neonatal tetanus case-based surveillance (2). This report summarizes progress toward achieving and sustaining MNTE during 2000-2020 and updates a previous report (3). By December 2020, 52 (88%) of 59 priority countries had conducted TTCV SIAs. Globally, infants protected at birth*** against tetanus increased from 74% (2000) to 86% (2020), and deliveries assisted by a skilled birth attendant increased from 64% (2000-2006) to 83% (2014-2020). Reported neonatal tetanus cases worldwide decreased by 88%, from 17,935 (2000) to 2,229 (2020), and estimated deaths decreased by 92%, from 170,829 (2000) to 14,230 (2019). By December 2020, 47 (80%) of 59 priority countries were validated to have achieved MNTE, five of which conducted postvalidation assessments. To achieve elimination in the 12 remaining countries and sustain elimination, innovation is needed, including integrating SIAs to cover multiple vaccine preventable diseases and implementing TTCV life course vaccination.