Progress Toward Maternal and Neonatal Tetanus Elimination - Worldwide, 2000–2018

Overview

Maternal and neonatal tetanus1 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. in a health facility or assisted by a medically trained attendant in sanitary conditions) and umbilical cord care. In 1989, the World Health Assembly endorsed the elimination of neonatal tetanus (NT).

In 1999, the initiative was relaunched and renamed the “maternal and neonatal tetanus” (MNT) elimination initiative, targeting 595 priority countries. Elimination strategies include 1) achieving ≥80% coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV) among women of reproductive age through routine immunization of pregnant women and supplementary immunization activities (SIAs) in high-risk areas and districts;) achieving care by a skilled birth attendant (SBA) at ≥70% of deliveries;8 and 3) enhancing surveillance for NT cases. This report summarizes progress towards achieving MNT elimination between 2000 and 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 the 59 priority countries had conducted TTCV SIAs, vaccinating 154 million (77%) of 201 million targeted women with TT2+/Td2+. Globally, the proportion of deliveries assisted by SBAs increased from 62% during 2000–2005 to 81% during 2013–2018, and the estimated number of NT deaths decreased by 85%, from 170 829 in 2000 to 25 000 in 2018. By December 2018, achievement of MNT elimination had been validated by WHO in 45 (76%) of the 59 priority countries. To achieve elimination in the remaining 14 countries and sustain elimination in those that have done so, implementation of MNTE strategies must be maintained and strengthened, and TTCV booster doses should be included in country immunization schedules, as recommended by WHO.