Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2020
Authors: Florence A. Kanu, Nasir Yusuf, Modibo Kassogue, Bilal Ahmed, Rania A. Tohme
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

Maternal and neonatal tetanus (MNT)* remains a major cause of neonatal mortality with an 80%-100% case-fatality rate among insufficiently vaccinated mothers after unhygienic deliveries, especially in low-income countries (1).In 1989, the World Health Assembly endorsed elimination † of neonatal tetanus; the activity was relaunched in 1999 as the MNT elimination (MNTE) § initiative, targeting 59 ¶ priority countries.MNTE strategies include 1) achieving ≥80% coverage with ≥2 doses of tetanus toxoid-containing vaccine (TTCV2+)** among women of reproductive age through routine and supplementary immunization activities (SIAs) † † in highrisk districts, § § 2) achieving ≥70% of deliveries by a skilled birth attendant, ¶ ¶ and 3) implementing neonatal tetanus case-based surveillance (2).This report summarizes progress toward achieving and sustaining MNTE during 2000-2020 and updates a previous report (3).By December 2020, 52 (88%) of 59 priority countries had conducted TTCV SIAs.Globally, infants protected at birth*** against tetanus increased from 74% (2000) to 86% (2020), and deliveries assisted by a skilled birth attendant increased from 64% (2000)(2001)(2002)(2003)(2004)(2005)(2006) to 83% (2014)(2015)(2016)(2017)(2018)(2019)(2020).Reported neonatal tetanus cases worldwide * Tetanus occurring during pregnancy or within 6 weeks of the end of pregnancy; maternal tetanus infection occurs during abortion, miscarriages, or birth with unhygienic delivery.Neonatal tetanus occurs during the first 28 days of life, either following the cutting of the umbilical cord under nonsterile conditions or applying nonsterile traditional remedies to the umbilical stump in an infant without passively (transplacentally) acquired maternal antibodies.† The occurrence of less than one neonatal tetanus case per 1,000 live births per year in every district in every country.§ Neonatal tetanus elimination is considered a proxy for maternal tetanus elimination; the same strategies for elimination are shared.¶ Initially, the total number of priority countries was 57.The creation of Timor-Leste in 2002 and South Sudan in 2011 increased the number of priority countries to 59. ** Tetanus toxoid (TT2+) or tetanus-diphtheria toxoid (Td2+).† † Mass vaccination campaigns that aim to administer doses of tetanus toxoidcontaining vaccines to women of reproductive age.§ § Districts considered at high risk because the estimated neonatal tetanus case rate exceeds one per 1,000 live births, clean delivery coverage is <70%, and coverage with 3 tetanus toxoid-containing vaccine doses among pregnant women is <80% during the past 5 years.¶ ¶ A doctor, nurse, midwife, or health worker trained in providing lifesaving obstetric care, including giving necessary supervision, care, and advice to women during pregnancy, childbirth, and the postpartum period.*** The status of an infant born to a mother who received 2 doses of TTCV during the last birth, ≥2 doses with the last dose received ≤3 years before the last delivery, ≥3 doses with the last dose received ≤5 years earlier, ≥4 doses with the last dose received ≤10 years earlier, or receipt of ≥5 previous doses.