Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all

Abstract

A total of 35 of the 59 countries that had not eliminated maternal and neonatal tetanus (MNT) as a public health problem in 1999 have since achieved the MNT-elimination goal. Neonatal tetanus deaths have decreased globally from 200,000 in 2000 to 49,000 in 2013. This is the result of increased immunization coverage with tetanus toxoid-containing vaccines among pregnant women, improved access to skilled birth attendance during delivery, and targeted campaigns with these vaccines for women of reproductive age in high-risk areas. In the process, inequities have been reduced, private–public partnerships fostered, and innovations triggered. However, lack of funding, poor accessibility to some areas, suboptimal surveillance, and a perceived low priority for the disease are among the main obstacles. To ensure MNT elimination is sustained, countries must build and maintain strong routine programs that reach people with vaccination and with clean deliveries. This should also be an opportunity to shift programs into preventing tetanus among all people. Regular assessments, and where needed appropriate action, are key to prevent increases in MNT incidence over time, especially in areas that are at higher risk. The main objective of the paper is to provide a detailed update on the progress toward MNT elimination between 1999 and 2014. It elaborates on the challenges and opportunities, and discusses how MNT elimination can be sustained and to shift the program to protect wider populations against tetanus.

Tetanus in Southern Vietnam: Current Situation

“…Although there are relatively robust methods of recording cases of neonatal tetanus, in many countries, the reporting of tetanus in other age groups remains inaccurate with significant underreporting 1,15. In 2012, the WHO reported a total of 186 cases in Vietnam as a whole, 33 cases fewer than admitted to our hospital alone 16.…”

“…Tetanus is a vaccine-preventable disease occurring rarely in high-income settings but is a continuing concern in many low- and middle-income countries (LMICs) 1. Except for neonatal tetanus, where there is a well-established surveillance system, the true global incidence of tetanus is unknown.…”

“…The initiative has achieved remarkable success throughout the world. Vietnam achieved World Health Organization (WHO) Maternal and Neonatal Elimination Status in 2005, although the disease has not been completely eradicated and occasional cases of neonatal tetanus continue to be reported 1,7–9…”

Successful elimination of maternal and neonatal tetanus in India: Ray of hope for other nations

“…[1] A wide range of challenges, such as the extent of political commitment to sustain efforts, monetary constraints, questionable effectiveness of the awareness campaigns, lack of access to the tetanus vaccine, inadequate sensitization of the health professionals to immunize pregnant females, conduction of home deliveries under septic conditions, and myths associated with vaccines in the society, have seriously hampered the accomplishment of the global target to ensure elimination of MNT by the year 2015. [23]…”

“…[3] In order to globally achieve the target of MNT elimination at the earliest, it is time that experts should critically assess the existing challenges in the nations that have failed to achieve the target, devise a systematic plan with appropriate indicators to implement the elimination activities in a sustainable manner, strengthen routine antenatal services, explore the option of assistance from the private sector, and implement successful strategies from other nations in appropriate settings. [125]…”