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

Area of Science:

• Public Health
• Epidemiology
• Vaccinology

Background:

• Maternal and neonatal tetanus (MNT) poses a significant public health threat, particularly in regions with inadequate immunization and delivery care.
• The World Health Assembly set goals for neonatal tetanus (NT) elimination in 1989, later expanding to MNT elimination in 1999, targeting 59 priority countries.

Purpose of the Study:

• To summarize the progress made in achieving Maternal and Neonatal Tetanus (MNT) elimination between 2000 and 2018.
• To evaluate the effectiveness of key MNT elimination strategies implemented in priority countries.

Main Methods:

• Analysis of vaccination coverage data for tetanus toxoid-containing vaccines (TTCV) among women of reproductive age.
• Review of supplementary immunization activities (SIAs) conducted in high-risk areas.
• Assessment of trends in skilled birth attendant (SBA) assisted deliveries and NT case surveillance.

Main Results:

• Coverage with at least two doses of TTCV (TT2+/Td2+) increased from 62% to 72% among women of reproductive age.
• Skilled birth attendant (SBA) assisted deliveries rose globally, contributing to an 85% decrease in estimated neonatal tetanus deaths (from 170,829 in 2000 to 25,000 in 2018).
• By December 2018, 45 (76%) of 59 priority countries achieved WHO validation for MNT elimination.

Conclusions:

• Significant advancements have been made towards MNT elimination, evidenced by increased vaccination coverage and reduced mortality.
• Sustaining and strengthening elimination strategies, including booster doses and integrated health services, is vital for remaining countries.
• Enhanced surveillance and innovative approaches are necessary to reach hard-to-reach populations and maintain elimination status.