BQ Journal Vol 47 - Q2 2022 - 27

Morbidity and Mortality Weekly Report
Summary
What is already known about this topic?
In 1999, the maternal and neonatal tetanus (MNT) initiative was
relaunched to focus on 59 priority countries still at risk for
maternal and neonatal tetanus.
What is added by this report?
During 2000-2020, 47 countries achieved elimination of MNT,
reported neonatal tetanus cases decreased 88%, and estimated
deaths declined 92%. Despite progress, 12 countries have not
achieved elimination and are challenged by conflict, insecurity,
and competing priorities. Other countries are struggling to
maintain elimination.
What are the implications for public health practice?
To achieve MNT elimination in remaining priority countries and
to maintain it globally, efforts are needed to enhance routine
vaccination, integrate tetanus activities with other health
activities, and promote a life-course vaccination approach for
tetanus protection.
The findings in this report are subject to at least three
limitations. First, TTCV coverage among pregnant women
can underestimate true tetanus protection because it excludes
women who were unvaccinated during current pregnancy
but protected through previous vaccination or those missing
documentation of previous doses (6). Second, the percentage
of infants protected at birth could be underestimated because
of doses provided outside routine services (6). Finally, <10% of
neonatal tetanus cases and deaths are estimated to be reported
(2); although neonatal deaths are projected using mathematical
models, cases and deaths might still be underestimated,
especially in communities with suboptimal health systems.
The Immunization Agenda 2030,††††† the global immunization
strategy for the next decade, includes MNTE as an
endorsed vaccine-preventable disease elimination target. To
achieve and sustain MNTE, strong national commitment
and integration are needed, including integrating MNTE
activities with polio, measles, cholera, yellow fever, or other
vaccine-preventable disease SIAs, using MNTE to promote
equitable access to health services, such as clean deliveries,
and promoting a life course approach to tetanus vaccination
by integrating TTCV booster doses in school health programs
and other life course immunization platforms (10).
††††† https://www.who.int/publications/m/item/implementing-theimmunization-agenda-2030
Acknowledgments
UNICEF
country offices in Central African Republic, Nigeria, South
Sudan; Jose Chivale; Mohammed Farid; Quamrul Hasan; Javid Iqbal;
Julien Hyacinte Kabore; Mouctar Kande; Emmaculate Lebo; Richard
Luce; Osama Mere; Terna Nomhwange; Constance Razaiarimanga;
Abdoul Karim Sidibe; Maleghemi Sylvester; Patricia Tanifum.
Corresponding author: Florence A. Kanu, fkanu@cdc.gov.
1Global Immunization Division, Center for Global Health, CDC;
2Immunization, Vaccines and Biologicals, World Health Organization, Geneva,
Switzerland; 3Maternal, Newborn, and Adolescent Health Program Division,
UNICEF, New York, New York.
All authors have completed and submitted the International
Committee of Medical Journal Editors form for disclosure of potential
conflicts of interest. No potential conflicts of interest were disclosed.
References
1. World Health Organization. Tetanus vaccines: WHO position paper-
February 2017. Wkly Epidemiol Rec 2017;92:53-76. PMID:28185446
2. World Health Organization. Maternal and neonatal tetanus elimination:
the strategies. Geneva, Switzerland: World Health Organization; 2021.
https://www.who.int/initiatives/maternal-and-neonatal-tetanuselimination-(mnte)/the-strategies
3.
Njuguna HN, Yusuf N, Raza AA, Ahmed B, Tohme RA. Progress toward
maternal and neonatal tetanus elimination-worldwide, 2000-2018.
MMWR Morb Mortal Wkly Rep 2020;69:515-20. PMID:32352953
https://doi.org/10.15585/mmwr.mm6917a2
4. World Health Organization. Protection at birth (PAB) against neonatal
tetanus and tetanus toxoid-containing vaccine (TT2+/Td2+) vaccination
coverage. Geneva, Switzerland: World Health Organization; 2021.
https://immunizationdata.who.int/pages/coverage/tt2plus.html?COD
E=Global&ANTIGEN=PAB+TT2PLUS&YEAR=
5. World Health Organization. Maternal and neonatal tetanus elimination:
programmatic update. Geneva, Switzerland: World Health Organization;
2021. https://www.who.int/initiatives/maternal-and-neonatal-tetanuselimination-(mnte)/programmatic-update
6.
World Health Organization. Protecting all against tetanus: guide to
sustaining maternal and neonatal tetanus elimination (MNTE) and
broadening tetanus protection for all populations. Geneva, Switzerland:
World Health Organization; 2019. https://www.who.int/publications/i/
item/protecting-all-against-tetanus
7. UNICEF; World Health Organization. UNICEF/WHO joint database:
delivery at care. New York, NY: UNICEF; 2019. https://data.unicef.
org/topic/maternal-health/delivery-care/
8. World Health Organization. Surveillance standards for vaccinepreventable
diseases. Geneva, Switzerland: World Health
Organization; 2018. https://www.who.int/publications/i/item/
surveillance-standards-for-vaccine-preventable-diseases-2nd-edition
9. Yen LM, Thwaites CL. Tetanus. Lancet 2019;393:1657-68.
PMID:30935736 https://doi.org/10.1016/S0140-6736(18)33131-3
10. Yusuf N, Raza AA, Chang-Blanc D, et al. Progress and barriers towards
maternal and neonatal tetanus elimination in the remaining 12 countries:
a systematic review. Lancet Glob Health 2021;9:e1610-7.
PMID:34678200 https://doi.org/10.1016/S2214-109X(21)00338-7
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / March 18, 2022 / Vol. 71 / No. 11
411
Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
27
A Henry Schein Publication

BQ Journal Vol 47 - Q2 2022

Table of Contents for the Digital Edition of BQ Journal Vol 47 - Q2 2022