2020 Q3 BQ Journal Vol 40 - 24

Morbidity and Mortality Weekly Report

TABLE. (Continued) Estimated coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV) among women of reproductive age (WRA)
administered through routine immunization services, estimated percentage of newborns protected at birth (PAB), number of WRA vaccinated
with TTCV during supplementary immunization activities (SIAs), percentage of deliveries attended by a skilled birth attendant (SBA), and
number of reported neonatal tetanus cases - 59 priority countries, 2000-2018
MNT
elimination
priority
countries

WRA TT2+/Td2+
coverage (%)
Year
2000

Newborns PAB (%)

WRA vaccinated during
TTCV SIAs*

Year†

Year

Change
2000-2018
2018
(%)
2000

Change No. of TT2+/
2000-2018 Td2+ doses
2018
(%)
received

Not validated for MNT elimination by the end of 2018
Afghanistan
20
85
325
32
68
Angola
NA
66
NA
60
78
Central African 20
89
345
36
60
Republic
12
69
475
39
78
Chad§
Democratic
25
96
284
45
85
Republic of
the Congo§
Guinea
43
70
63
79
80
Mali
62
60
−3
50
85
Nigeria
NA
62
NA
57
60
Pakistan
51
60
18
71
85
Papua New
10
30
200
24
70
Guinea
Somalia
22
59
168
47
67
South Sudan
NA
44
NA
NA
NA
Sudan
34
51
50
NA
80
Yemen
31
22
−29
54
70
All 59 priority -
-
-
-
-
countries

SBA attendance at
delivery (%)

%
vaccinated

2000

Change
2000-2018
(%)
2018

No. of neonatal tetanus cases
Year
2000

2018

Change
2000-2018
(%)

113
30
67

5,211,872
7,097,552
804,984

46
84
78

14
NA
32

59
47
NA

321
NA
NA

139
131
37

53
86
39

−62
−34
5

100
89

3,222,840
10,342,937

84
92

14
61

20
80

43
31

142
77

189
47

33
−39

1
70
5
20
192

3,545,105
4,086,957
4,986,353
21,143,148
450,739

91
49
84
87
15

49
41
34
23
39

55
67
43
69
NA

12
63
26
200
NA

245
73
1643
1380
138

107
10
130
0
0

−56
−86
−92
−100
−100

43
NA
NA
30
-

497,561
5,223,306
4,780,345
3,043,456
154,476,411

27
65
89
52
-

25
NA
NA
27
-

NA
NA
78
45
-

NA
NA
NA
67
-

NA
NA
88
174
16,754

NA
NA
NA
116
1,760

NA
NA
NA
−33
-

Abbreviations: MNT = maternal and neonatal tetanus; NA = not available; Td2+ = 2 or more doses of tetanus and diphtheria toxoid-containing vaccine; TT2+ = 2 or
more doses of TTCV.
* Includes first-year SIA conducted in Bangladesh in 1999 and first- and second-year SIAs conducted in Ethiopia in 1999.
† Includes SBA attendance surveys conducted within 5 years for year 2000 and year 2018.
§ Validated for MNT elimination in 2019.

because women of reproductive age are targeted for vaccination during pregnancy, and 5 TTCV doses are provided in the
routine vaccination schedule for children and adolescents.†††

NT mortality estimates. Because most NT deaths occur
in the community and are not reported to WHO, NT deaths
are usually estimated using mathematical models (6). During
2000-2018, the estimated number of NT deaths decreased by
85% from 170,829 to 25,000 (Figure 2). In 2018, neonatal
tetanus accounted for 1% of major causes of neonatal deaths,
a significant decrease compared with a 7% contribution to
all-cause neonatal mortality in 2000.§§§

Surveillance Activities
Reported NT cases and incidence. WHO recommends
nationwide case-based surveillance for NT, including zero-case
reporting (submission of reports even if no NT cases are seen),
active surveillance through regular site visits, and retrospective record review at major health facilities at least once a year
(2). During 2000-2018, the number of reported NT cases
worldwide (i.e., including nonpriority countries) decreased
by 90% from 17,935 to 1,803 (3). In 2018, 13 (22%) of 59
priority countries reported zero NT cases (Table). The number
of NT cases reported annually is likely to represent <11% of
the actual number of NT cases occurring worldwide annually,
because NT tends to occur in remote areas and cases might
not be seen by health care workers (5).
†††

Deliveries Assisted by Skilled Birth Attendants
WHO and UNICEF estimate the percentage of births
attended by an SBA from health facility reports and coverage
survey estimates shared by countries (7). During 2000-2018,
the percentage of deliveries attended by an SBA increased by
31% from 62% during 2000-2005 to 81% during 2013-2018
(7). In 2018, among 51 priority countries with available data,
≥70% of deliveries were attended by an SBA in 24 (47%)
countries (Table).

https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2015/12/
Ni n a - S c h w a l b e - 1 . p d f ; h t t p s : / / a p p s . w h o. i n t / i r i s / b i t s t r e a m /
handle/10665/232360/WER7901_02_2-6.PDF?sequence=1&isAllowed=y.

§§§

https://www.unicef.org/media/60561/file/UN-IGME-child-mortalityreport-2019.pdf.

US Department of Health and Human Services/Centers for Disease Control and Prevention

MMWR / May 1, 2020 / Vol. 69 / No. 17

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2020 Q3 BQ Journal Vol 40

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