Maternal and Neonatal Tetanus Elimination

Maternal and Neonatal Tetanus Elimination

Programmatic update

WHO/Sanjit Das
Children outside of a school in India at the border with Bangladesh.
© Credits

 

As a first step, countries are encouraged to develop an MNT plan of action (PoA), detailing how they would proceed to eliminate MNT through the implementation of the recommended strategies.

The PoA is then submitted to UNICEF or other partners for financial and technical support. One major component of most plans is the implementation of Td Supplementary Immunization Activities (Td-SIAs) in high-risk districts (HRD). TT/Td SIAs are then implemented as per the country's capacity and available resources.

Global progress 1999-2023:

  • > 252 m Women of Reproductive Age (WRA) targeted with TT/Td-SIAs;
  • > 178 m WRA reached with at least 2 doses of TT/Td;
  • In 2014, 11 countries implemented TT SIAs: Angola, Cambodia, DRC, Haiti, Indonesia, Kenya, Mali, Niger, Nigeria, Papua New Guinea Conakry and South Sudan;
  • In 2015, 8 countries implemented TT SIAs: Afghanistan, Chad, Ethiopia, Haiti, Mali, Pakistan, Sudan, South Sudan;
  • In 2016, 10 countries implemented TT SIAs: Chad, Ethiopia, Guinea Conakry, Kenya, Nigeria, Pakistan, PNG, Philippines, South Sudan and Sudan;
  • In 2017, 6 countries implemented TT SIAs: Mali, Nigeria, Papua New Guinea, Sudan, South Sudan and Yemen;
  • In 2018, 4 countries implemented TT SIAs: DRC, Guinea Conakry, Nigeria, Sudan and Yemen;
  • In 2019, 8 countries implemented TT SIAs: Afghanistan, Guinea Conakry, Mali, Nigeria, Pakistan, South Sudan, Sudan and Yemen;
  • In 2020, 7 countries implemented Td SIAs: CAR, Guinea Conakry, Mali, Nigeria, South Sudan, Pakistan and Yemen;
  • In 2021, 4 countries implemented TT/Td SIAs: CAR, Nigeria, Pakistan and South Sudan;
  • In 2022, 7 countries implemented TT/Td SIAs: CAR, Guinea, Nigeria, Pakistan, South Sudan, Sudan and Yemen
  • In 2023, 1 country implemented TT/Td SIAs: Pakistan

 

Cumulatively, 52 countries initiated or expanded TT/Td-SIAs between 1999 and 2023; 48 countries eliminated MNT.

This update has been consolidated with WHO/UNICEF MNT collected data, as of March 2024

Implementation of Supplementary Immunization Activities (SIAs)

Td-SIAs are among the strategies to achieve MNT elimination. Three doses of tetanus toxoid containing vaccines TTCV are given to all women of reproductive age (usually women between 15 and 45 years of age) who live in "high risk areas", using a campaign-style approach. In practice, 3 rounds of campaigns are organized in the selected areas with at least one month interval between rounds 1 and 2, and at least six months between 2 and 3. The criteria to label districts as "high risk" are country-specific. The Td-SIAs provide protection for at least 5 years, and need to be complemented by follow-up doses, usually given as part of the antenatal care. In many countries, Td-SIAs are implemented in a phased manner, and it can therefore take several years before all high-risk districts will actually have been targeted.

Cumulatively, 52 countries initiated or expanded Td-SIAs between 1999 and 2023.
 

 


Td-SIAs is one strategy to achieve MNT elimination. Three doses of Td vaccine are given to all women of child bearing age who live in "high risk areas". This means that 3 rounds of campaign-style activities are implemented, with at least one month interval between rounds 1 and 2, and at least six months between 2 and 3.

Between 1999 and 2023, 52 countries implemented Td-SIAs in parts of the country: Afghanistan, Angola, Bangladesh*, Benin*, Burkina Faso*, Burundi*, Cambodia*, Cameroon*, Central African Republic (the), Chad*, Comoros (the)*, Congo (the)*, Cote d'Ivoire*, Democratic Republic of the Congo (the)*, Egypt*, Equatorial Guinea*, Ethiopia*, Gabon*, Ghana*, Guinea Conakry, Guinea-Bissau*, Haiti*, India*, Indonesia*, Iraq*, Kenya*, Lao People's Democratic Republic (the)*, Liberia*, Madagascar*, Mali, Mauritania*, Mozambique*, Myanmar*, Nepal*, Niger (the)*, Nigeria, Pakistan, Papua New Guinea, Philippines*, Senegal*, Sierra Leone*, Somalia, South Sudan, Sudan, Togo*, Timor-Leste*, Turkey*, Uganda*, United Republic of Tanzania (the)*, Viet Nam*, Yemen and Zambia*


*indicates the country has been validated as having eliminated MNT

 

Programmatic update continued

Through the implementation of Supplementary Immunization Activities (SIAs) from 1999 to 2023, over 178 million of Women of Reproductive Age (WRA) have been protected against tetanus.

Some of the women not fully protected during the campaigns, particularly those that received one dose of the vaccine, might have likely been protected with just one additional dose during their pregnancies if they had the opportunity to go for antenatal care.

List of Supplementary Immunization Activities