Abstract
Despite the availability of effective tetanus prevention strategies, as of 2016, Maternal and Neonatal Tetanus Elimination (MNTE) has not yet been achieved in 18 countries globally. In this paper, we review the status of MNTE in the World Health Organization African Region (AFR),and provide recommendations for achieving and maintaining MNTE in AFR. As of November 2016, 37 (79%) AFR countries have achieved MNTE, with 10 (21%) countries remaining. DTP3 coverage increased from 52% in 2000 to 76% in 2015. In 2015, coverage with at least 2 doses of tetanus containing vaccine (TT2+) and proportion of newborns protected at birth (PAB) were 69% and 77%, compared with 44% and 62% in 2000, respectively. Since 1999, over 79 million women of reproductive age (WRA) have been vaccinated with TT2+ through supplementary immunization activities (SIAs). Despite the progress, only 54% of births were attended by skilled birth attendants (SBAs), 5 (11%) countries provided the 3 WHO-recommended booster doses to both sexes, and about 5.5 million WRA still need to be reached with SIAs. Coverage disparities still exist between countries that have achieved MNTE and those that have not. In 2015, coverage with DTP3 and PAB were higher in MNTE countries compared with those yet to achieve MNTE: 84% vs. 68% and 86% vs. 69%, respectively. Challenges to achieving MNTE in the remaining AFR countries include weak health systems, competing priorities, insufficient funding, insecurity, and sub-optimal neonatal tetanus (NT) surveillance. To achieve and maintain MNTE in AFR, increasing SBAs and tetanus vaccination coverage, integrating tetanus vaccination with other opportunities (e.g., polio and measles campaigns, mother and child health days), and providing appropriately spaced booster doses are needed. Strengthening NT surveillance and conducting serosurveys would ensure appropriate targeting of MNTE activities and high-quality information for validating the achievement and maintenance of elimination.
Highlights
Introduction in MaliClin Infect Dis. 2015 Nov 15;61 Suppl 5:S57885.52
We describe the current status of progress towards Maternal and Neonatal Tetanus Elimination (MNTE) in African Region (AFR), discuss the challenges and barriers to reaching elimination, and make recommendations for reaching and maintaining elimination in the region
Pentavalent vaccine (Penta 3) among children aged
Summary
For each country in AFR, we reviewed national vaccination schedules, vaccination coverage estimates and reported NT cases from the WHOUNICEF joint reporting form available on the WHO website [16,17,18,19,20,21]. Table 5: number of TT supplementary immunization activities and years conducted, number of TT2+ doses provided through SIAs, current skilled birth attendant coverage, and reported neonatal tetanus cases and incidence in countries that have not achieved. Countries with weak health systems that achieved elimination through SIAs need to have employed additional strategies for reaching women beyond routine services, which may include continued SIAs in high risk areas and outreach activities during child health days or antenatal care, to ensure population immunity does not lapse after MNTE validation [7]. In countries that have achieved MNTE, tetanus serosurveys of tetanus immunity in countries that have achieved MNTE can help supplement district level data reviews by identifying immunity gaps, which can provide evidence for the need for booster doses, including optimal schedules, and the need for targeted vaccination [31, 36]
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