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Maternal and Neonatal Tetanus Elimination

Tetanus
Similar to the progress seen with measles, WHO estimates a 94% reduction in neonatal deaths from
tetanus since the 1980s. Despite this marked improvement, 49,000 newborns died from tetanus in
2013 and as of June 2016, 19 countries continue to struggle with reaching maternal and neonatal
tetanus (MNT) elimination status.

In May 2016, WHO's Southeast Asia region announced that it had eliminated MNT. However, “unlike
smallpox and polio, tetanus cannot be eradicated as tetanus spores remain stubbornly present in the
environment worldwide. As the risk of tetanus persists, maintaining and enhancing high population
immunity with tetanus vaccination during infancy, for women of childbearing age and during
adolescence through school immunization programmes, achieving high coverage of skilled birth
attendance and promotion of appropriate cord care after birth is needed to maintain MNTE.”

The fight continues

Great progress has been made in reducing tetanus, measles, and rubella, but the fight for
elimination continues. The Global Vaccine Action Plan (GVAP) has set targets for the elimination of
these diseases, but the GVAP targets are off track. Increased leadership and accountability are
needed if progress is to be seen by 2020. To read about these elimination goals, review the GVAP
report(link is external)(link will open new window).

Source: WHO 2016

Trends in Routine Immunization Coverage

 DT
P3 coverage is often used as a proxy to measure the ability of the health system to reach
children multiple times with immunization.

WHO and UNICEF report that global coverage of infants with three doses of diphtheria-tetanus-
pertussis (DTP3) vaccine was 86% in 2015.

This means that approximately 116 million children were reached with DTP3 vaccination that year, a
significant accomplishment. However, it also indicates that more than 19.4 million children under age
one remain overlooked by routine immunization services.

It is important to remember that global estimates of immunization coverage mask important

disparities among regions and countries. During the 1990s, WHO and UNICEF estimated DTP3
coverage in the range of 85% to 90% in the Americas, whereas DTP3 coverage was only around
55% in Africa. Today, the lowest immunization coverage persists in sub-Saharan Africa, where
DTP3 coverage in 2015 was 76%.

Highlights
Every year, approximately 131 million children are born and need to be immunized.

Reaching these children requires intensive and sustained efforts on a continual basis.

Trends in Routine Immunization Coverage

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The graph below depicts global immunization trends for DTP3 from 1980 to 2015. It shows that
although clear improvement has been made since the 1980s, in the world’s poorest countries, we
still find lower coverage and stagnation of coverage. 

Global trend data for DTP3 coverage, 1980-2015

Disparities in Immunization Coverage

In many lower-income countries, large disparities in immunization coverage exist between the
wealthiest and poorest communities. An analysis done using Demographic Health Survey (DHS)
data from 16 countries for 2009-2014 found that coverage is consistently lower in the poorest wealth
quintile than in the highest quintile. The children who are missed are often the greatest in need of the
protection immunization offers. (Click on image to see enlarged view.)
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Poverty is usually the main underlying factor in disparities with immunization coverage; however,
culture, ethnicity, gender, and location also play a role. As countries continue to urbanize, reaching
urban poor and mobile populations will be critical, and specific strategies are needed to reach these
populations. See Session 7(link will open new window) for additional information regarding special
populations.

A new global coalition is urging governments to ensure that all people have access to quality health
care and emphasize the importance of universal health coverage. It is still unclear what the
ramifications are for immunization. 

To improve equitable coverage in all countries, the current strategy for routine immunization, the
Reaching Every District (RED) strategy, is in the process of being redesigned to focus on the
community level and improving strategies to reach marginalized and disadvantaged communities.  
 

Public Health Emergencies

Outbreaks of Ebola, influenza, and the Zika virus highlight how epidemics can expand rapidly and
cause havoc in the absence of a strong health system and integrated response.

These public health emergencies underscore the need to support countries with health system
strengthening; building the capacity of health workers; improving clinical and diagnostic
infrastructure; expanding information, education, and communication; and supporting general health
infrastructure. 

Health system strengthening requires donors, governments, and implementing agencies to commit
to specific, significant, and sustained resources.

Source: Barbiero 2014