Maternal and Neonatal Tetanus Eliminated in the Americas
The World Health Organization has reached another disease elimination milestone: the organization announced on September 21, 2017, that maternal and neonatal tetanus (MNT) have been eliminated from the WHO Region of the Americas. This achievement comes after a concerted campaign in Haiti to prevent the disease through intensive immunization campaigns, improved surveillance, and attention to safe birth and umbilical care practices.
Tetanus is a serious infection with particularly high case-fatality rates in neonates, who may contract the disease via unhygienic birth practices and through improper handling of the umbilical cord and stump.
Tetanus has an unusual elimination threshold – unlike other disease that have been eradicated (smallpox) or eliminated regionally (polio, rubella, and measles in the Americas for example), tetanus is not passed person-to-person. Rather, an individual becomes infected by coming into contact with tetanus in the environment, such as in spores in the soil or on medical instruments. Therefore, it will be impossible ever to declare tetanus eradicated, since the environmental reservoir will never disappear. The WHO considers tetanus eliminated when the annual rate of neonatal tetanus is less than one case per 1,000 live births in a district.
Great challenges remain with tetanus elimination – about 90% cases of MNT occur in the WHO Region of Africa, and MNT remains a major public health concern in the following 16 countries: Afghanistan, Angola, Central African Republic, Chad, Congo DR, Guinea, Kenya, Mali, Nigeria, Pakistan, Papua New Guinea, Philippines, Somalia, Sudan, South, Sudan, and Yemen.
Since 1989 the WHO has identified elimination of MNT as a goal, with the first target of global elimination being set for 1995. As the strategies identified to make MNT elimination a reality have proven difficult to implement, the target date for elimination has been extended several times. Still, the progress has been enormous: in 1988, the WHO estimated that 787,000 newborns died of tetanus; that number was reduced to about 34,000 in 2015, the last year for which the estimate is available. Most cases of neonatal tetanus are fatal, and so the estimated number of cases of the disease in neonates is likely to be close to the number of deaths. The WHO South-east Asian Region eliminated MNT in 2016 and the European Region in 2009.
Tetanus outside maternity and the neonatal period still occurs: the WHO has reported that in 2011, the estimated deaths from tetanus in all stages of life numbered about 73,000.
UNICEF. Region of the Americas eliminates maternal and neonatal tetanus. Press release. Septemver 21, 2017. Accessed September 28, 2017.
WHO, Region of Africa. Maternal and neonatal tetanus. No date. Accessed September 28, 2017.
WHO. Maternal and neonatal tetanus elimination: the initiative and challenges. August 1, 2017. Accessed September 28, 2017.
WHO. Maternal and neonatal tetanus elimination: the partnership. August 1, 2017. Accessed September 28, 2017.
WHO. WHO South-east Asia Region eliminated maternal and neonatal tetanus. May 19, 2016. Accessed September 28, 2017.