Top 5 Takeaways

1. Significant Reduction in Cases: From 2000 to 2020, reported neonatal tetanus cases decreased by 88%, and estimated deaths declined by 92% globally.
2. Progress in Elimination: 47 out of 59 priority countries achieved maternal and neonatal tetanus elimination (MNTE) by December 2020.
3. Challenges Remain: 12 countries have not achieved MNTE due to conflict, insecurity, and competing health priorities.
4. Increased Vaccination Coverage: The global proportion of infants protected at birth against tetanus increased from 74% in 2000 to 86% in 2020.
5. Need for Sustained Efforts: To maintain MNTE, countries need to enhance routine vaccination, integrate tetanus activities with other health services, and promote a life-course vaccination approach.

Original Article Author and Citation

Corresponding Author

Florence A. Kanu, fkanu@cdc.gov

Suggested Citation

Kanu FA, Yusuf N, Kassogue M, Ahmed B, Tohme RA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2020. MMWR Morb Mortal Wkly Rep 2022;71:406–411. DOI: http://dx.doi.org/10.15585/mmwr.mm7111a2

Summary

Between 2000 and 2020, significant progress was made in reducing maternal and neonatal tetanus (MNT) globally. The number of reported neonatal tetanus cases decreased by 88%, and estimated deaths declined by 92%. By December 2020, 47 out of 59 priority countries had achieved MNT elimination. However, 12 countries still face challenges such as conflict and competing health priorities, preventing them from achieving elimination. Efforts to maintain elimination include enhancing routine vaccination, integrating tetanus activities with other health services, and promoting a life-course vaccination approach.

Methods

The study used data from administrative records and vaccination coverage surveys reported annually by member countries to estimate TTCV vaccination coverage and the number of neonates protected at birth. WHO and UNICEF also received summaries of the number of women of reproductive age receiving TTCV during supplementary immunization activities (SIAs). Additionally, the percentage of births assisted by a skilled birth attendant was estimated from health care facility reports and coverage survey estimates.

Discussion

Substantial progress has been made toward global MNTE, with 80% of the 59 priority countries validated to have achieved MNTE by the end of 2020. This progress is attributed to increased TTCV2+ coverage among women of reproductive age, intensive SIAs in high-risk districts, and a 30% increase in deliveries with a skilled birth attendant. Despite this, challenges remain in countries with suboptimal health systems, conflict, and competing health priorities. The COVID-19 pandemic also disrupted planned TTCV SIAs in several countries. Sustaining MNTE requires integrating MNTE activities with other immunization programs and conducting regular postvalidation assessments.

Conclusion

While significant progress has been made in reducing neonatal tetanus cases and deaths, continued efforts are needed to achieve and sustain MNTE globally. This includes enhancing routine vaccination, integrating tetanus activities with other health services, and promoting a life-course vaccination approach. Countries must also conduct regular postvalidation assessments to ensure sustained elimination and take corrective actions as needed.

This has been your booster shot of MMWR Info! Please check back for more MMWR, Public Health, and Programming Tutorial content daily.