Maternal and Neonatal Tetanus Eliminated in the Region of the Americas

According to a joint announcement from the Pan American Health Organization (PAHO) and the United Nations International Children's Emergency Fund (UNICEF), maternal and neonatal tetanus (MNT) has been eliminated from the Region of the Americas as a result of a widespread vaccination campaign and methods to ensure clean birthing practices.

The World Health Organization (WHO) reports that MNT was responsible for the deaths of 34,000 newborn children in 2015, a 96% reduction from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life, according to the statement. The infection occurs neonatally when a newborn’s unhealed umbilical stump is infected with Clostridium tetani, the bacterium that causes tetanus. This can happen for multiple reasons, including the application of potentially contaminated traditional substances to the stump, the baby being born on a contaminated surface, unsterile equipment being used to cut the stump, or if the hands of the person who delivers the baby are unclean. Paralysis can occur because of the infection and it is often fatal as the infant is unable to breathe and breastfeed. Administration of the diphtheria toxoid (DT) or monovalent tetanus toxoid (TT) vaccines during pregnancy, as well as ensuring that babies are delivered and handled post-delivery in clean areas, are methods to prevent infection.

On a country-level, PAHO/WHO recommended the following 4 lines of action to eliminate MNT:

1. Carry out routine immunization of pregnant women against tetanus
2. Conduct supplemental immunization activities for women of childbearing age so each woman receives at least 2 doses of the vaccine
3. Reinforce surveillance of neonatal tetanus cases
4. Promote clean delivery services

Because C. tetani live in the soil and feces of animals, it cannot be completely eradicated; however, MNT can be considered eliminated if a region sees “an annual rate of <1 case of neonatal tetanus per 1000 live births at the district level,” according to the statement. This is the case in the Region of the Americas.

Cuauhtémoc Ruiz, head of PAHO’s Comprehensive Family Immunization Program spoke about the possibility for a case of MNT occurring since elimination was proclaimed in the announcement, stating, “Because tetanus can never be eradicated, a single case of newborn tetanus in the Americas could still happen. In this case, countries should carry out a thorough evaluation to determine how the case could have been averted in order to prevent new cases.”

When speaking on this progress to eliminate MNT in the announcement, Carissa F. Etienne, director of the Pan American Health Organization/World Health Organization (PAHO/WHO) said, “The elimination of maternal and neonatal tetanus is proof again that vaccines work to save the lives of countless mothers and babies. Let us continue to protect the people of our Region by investing in strong national immunization programs that are capable of vaccinating all individuals and quickly identifying vaccine-preventable diseases.”

With the announcement of the elimination of the disease in Haiti this year, the Region of the Americas reached the regional goal of elimination of MNT. Five other diseases were previously eliminated in this region, starting with smallpox in 1971, poliomyelitis (1994), rubella and congenital rubella syndrome (2015), and measles (2016).

Although 43 countries around the world have eliminated MNT between 2000 and June 2017, 16 countries have yet to hit this important milestone, making efforts for vaccination even more important.