Abstract
Tetanus is a vaccine-preventable disease of significant public health importance especially in developing countries. The WHO strategy for the elimination of maternal and neonatal tetanus recommends the promotion of clean delivery practices, systematic immunization of pregnant women and those in the reproductive age (15-49 years) and surveillance for neonatal tetanus. Implementation of the recommended strategy with the support of WHO, UNICEF and other partners has led to significant decline in number of cases and deaths due to NT over the last decades. The coverage with the second or more dose of tetanus toxoid-containing vaccines (TT2+) a proxy for Protection at Birth (PAB) for the WHO African region has risen from 62% in 2000 to 77% by 2015 Reported cases of NT declined from 5175 in 2000 to 1289 in 2015. The goal of eliminating maternal and neonatal tetanus by 2015 was missed, but some progress has been made. By the end of 2016, 37 out of 47 (79%) of the WHO AFR member states achieved elimination. The 10 member states remaining need additional support by all partners to achieve and maintain the goal of MNTE. Innovative ways of implementing the recommendations need to be urgently considered.
Highlights
Tetanus is a non-communicable disease caused by a potent neurotoxin produced by Clostridium tetani bacteria whose resistant spores are present in soil and the environment
The key components of the strategy are the promotion of clean delivery practices, systematic immunization of pregnant women and those in the reproductive age (15-49 years) with a tetanus toxoid-containing vaccine in routine immunization, or provision of at least 3 doses of tetanus toxoid through supplemental immunization activities’ (SIAs) to women of reproductive age that reside in areas classified as being at high risk for maternal and neonatal tetanus (MNT) and the use of case-based surveillance to identify neonatal tetanus (NT) cases and deaths
The results presented reflect data obtained on the implementation of these activities by member States as reported in the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) Joint Reporting Form
Summary
Tetanus is a non-communicable disease caused by a potent neurotoxin produced by Clostridium tetani bacteria whose resistant spores are present in soil and the environment. The causative organism is harboured by humans and animals that excrete the bacteria and spores. Once in a suitable anaerobic environment such as a contaminated wound, the bacteria multiply, releasing tetanus toxin, which is responsible for the symptoms and outcomes of the disease[1,2]. In the case of neonatal tetanus, the entry point for the bacteria is the umbilical stump. Some of the common traditional birth practices such as cutting the umbilical cord with unsterile instruments and the application of traditional substances (herbs, cow dung, rat faeces) onto the umbilical stump expose the newborn child to contamination with spores, thereby increasing the likelihood of infection and disease.
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