Maternal and Neonatal Tetanus Elimination: Where are We Now?

Shashi Kant Dhir,1 Pooja Dewan,2 Piyush Gupta2 1Department of Pediatrics, Guru Gobind Singh Medical College, Punjab, India; 2Department of Pediatrics, University College of Medical Sciences, Delhi, IndiaCorrespondence: Piyush GuptaDepartment of Pediatrics, University College of Medical Sciences, Delhi, IndiaTel +919811597172Fax +91-11-22590495Email piyush.gupta@gmail.comAbstract: The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.Keywords: tetanus toxoid containing vaccines, clean delivery, maternal tetanus, neonatal tetanus, strategy, tetanus immunization, MNTE validatio