Immunization, Vaccines and Biologicals

Maternal and Neonatal Tetanus (MNT) elimination

The initiative and challenges

Why Maternal and Neonatal Tetanus elimination?

In many countries, deliveries take place in unhygienic circumstances, putting mothers and their newborn babies at risk for a variety of life-threatening infections.

Maternal and neonatal tetanus (MNT) have been among the most common lethal consequences of unclean deliveries and umbilical cord care practices. When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available.

This happens despite the fact that MNT deaths can be easily prevented by hygienic delivery and cord care practices, and/or by immunizing mothers with tetanus vaccine that is cheap and very efficacious.

The MNT Elimination Initiative aims to reduce MNT cases to such low levels that the disease is no longer a major public health problem. Unlike polio and smallpox, tetanus cannot be eradicated (tetanus spores are present in the environment worldwide), but through immunization of pregnant women and other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices, MNT can be eliminated (defined as less than one case of neonatal tetanus per 1000 live births in every district).

A challenge

In 1988, WHO estimated that 787,000 newborns died of neonatal tetanus (NT). Thus, in the late 1980s, the estimated annual global NT mortality rate was approximately 6.7 NT deaths per 1000 live births - clearly a substantial public health problem

In 1989, the 42nd World Health Assembly called for elimination of neonatal tetanus by 1995

The following year, the 1990 World Summit for Children listed neonatal tetanus elimination as one of its goals, and the goal was again endorsed by the 44th World Health Assembly in 1991

Due to slow implementation of the recommended MNT elimination strategies, the target date for MNT elimination was postponed to 2000. In 1999, when progress towards the attainment of the global elimination goal was reviewed by UNICEF, WHO and UNFPA, the Initiative was re-constituted (see below) and elimination of maternal tetanus was added to the goal with a 2005 target date, which was later shifted to 2015.

WHO estimates that in 2013 (the latest year for which estimates are available), 49,000 newborns died from NT, a 94% reduction from the situation in the late 1980s.

While progress continues to be made, by October 2016, 18 countries have still not reached the MNT elimination status. Activities to achieve the goal are on-going in these countries, with many likely to achieve MNT elimination in the near future.