Issue: June 2020
Disclosures: The authors report no relevant financial disclosures.
May 19, 2020
2 min read

Neonatal tetanus deaths decrease by 85% as elimination efforts continue

Issue: June 2020
Disclosures: The authors report no relevant financial disclosures.
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Globally, reported cases of neonatal tetanus decreased by 90% from 2000 to 2018 and neonatal deaths from the bacterial infection fell 85%, according to a report published recently in MMWR, which summarized progress toward eliminating maternal and neonatal tetanus (MNT).

Henry N. Njuguna

During the same time, tetanus vaccination among women of reproductive age increased by 16% to 72%, researchers reported. Elimination strategies have achieved a more than 80% rate of vaccination coverage among women of a reproductive age in 17 of 59 priority countries; in 39 of 48 priority countries for which data were available, vaccine coverage increased since 2000.

“To achieve and sustain maternal and neonatal tetanus elimination, countries must include three tetanus-containing vaccine booster doses in immunization schedules, vaccinate pregnant women, ensure clean deliveries, and implement periodic assessments to identify areas at risk for reemergence,” Henry N. Njuguna, MD, MPH, a medical epidemiologist in CDC’s Global Immunization Division, told Healio.

By December 2018, 88% of the 59 priority countries had conducted supplementary tetanus immunization activities, which vaccinated 154 million of 201 million targeted women, or 77%, Njuguna and colleagues reported. By the end of 2018, WHO validated 45 of the 59 countries for achieving MNT elimination.

Njuguna and colleagues noted that Chad and the Democratic Republic of the Congo were validated by WHO in 2019 for MNT elimination, increasing the total to 47 countries.

To achieve MNT elimination in the other 12 counties, strategies need to be strengthened, the researchers said. Maternal, newborn and child health care services with vaccination services should be included in these strategies.

“Despite progress, 47 million women and their babies remain unprotected against tetanus, and 49 million women remain unreached by tetanus toxin-containing vaccine,” Njuguna said. “Innovative approaches to reach remote and unsafe areas could include the use of self-vaccination devices; integration of reproductive, maternal, newborn, and child health services with vaccination services to optimize maternal immunization; and integration of tetanus vaccination campaigns with other vaccination campaigns, such as serogroup A meningococcal vaccine, measles-rubella, yellow fever, and polio campaigns.”

Njuguna said that, despite the decrease in MNT worldwide, elimination efforts should not let up — especially in those 12 countries.

“Maternal and neonatal tetanus remains a major public health problem in 12 countries globally, with an 80% to 100% case-fatality rate among neonates, especially in areas with poor immunization coverage and limited access to clean deliveries and umbilical cord care,” he said. “People of all ages need tetanus vaccine throughout the lifespan. Tetanus cannot be eradicated as spores remain in the environment and is especially dangerous in newborns. Vaccination is safe and is the only protection against tetanus.”