WHO Informal consultation on tetanus and voluntary medical male circumcision

3 June 2016 - Technical consultation update to the WHO March 2015 meeting report

Key advice

For conventional surgical methods of male circumcision, the experts recommended that no modification be made to the advice provided in the 2015 report. The strategies used will depend on the country’s tetanus-toxoid-containing vaccine (TTCV) schedule and practices, and its tetanus burden. Ministries of health are advised to develop and phase in effective and practical delivery strategies for providing at least one dose of TTCV at the time of voluntary medical male circumcision (VMMC), unless an individual has documented evidence of protection through receipt of the necessary number of doses of TTCV.

For circumcision with a device method that requires that the foreskin remains in situ for several days before it is removed, the June 2016 consultation updated its previous advice. Circumcision with such a method should only be undertaken if the client is adequately protected against tetanus by immunization with TTCV. The manufacturer of the currently prequalified elastic collar compression device has updated the instructions for use and issued a Field Safety Notice (FSN-identifier: 002_2016) to reflect this advice, which supersedes the advice of the WHO 2015 report.

There is a need to strengthen efforts to better educate all male circumcision clients, their parents and care givers (in the case of adolescents), and communities and traditional healers on the importance of avoiding harmful wound-care practices. This applies to all male circumcision methods.