Immunization, Vaccines and Biologicals

Maternal and Neonatal Tetanus Elimination (MNTE)

The initiative and challenges

Why Maternal and Neonatal Tetanus Elimination (MNTE)?

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

Maternal and Neonatal Tetanus (MNT) has been among the most common life threatening consequences of unclean deliveries and umbilical cord care practices, and are indicators of inequity in access to immunization and other maternal, newborn, and child health services. 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 children and women with Tetanus Toxoid Containing Vaccines (TTCV), that are inexpensive and very efficacious, through the life course.

The Maternal and Neonatal Tetanus Elimination (MNTE) 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 children, mothers, 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).

The perspective

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 the 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 MNTE strategies, the target date for the attainment of elimination by all countries 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 and elimination of maternal tetanus was added to the goal with a 2005 target date, which was later shifted to 2015. By the end of 2015, there were still 21 countries that have not yet attained elimination, down to 18 countries by the end of 2016, and 16 countries by the end of June 2017- More details available under the partnership section.

While progress continues to be made, by December 2017, 15 countries have still not reached the MNTE status. Activities to achieve the goal are on-going in these countries, with many likely to achieve MNTE in the near future.

WHO estimates that in 2015 (the latest year for which estimates are available), 34,019 newborns died from NT, a 96% reduction from the situation in the late 1980s.