Tetanus
Key facts
- Tetanus is acquired when the spores of the bacterium clostridium tetani infect a wound or a newborn's umbilical stump.
- These spores are universally present in the soil.
- People of all ages can contract tetanus but the disease is particularly common and serious in newborn babies (neonatal tetanus) and women during pregnancy (maternal tetanus).
- Neonatal tetanus, which is mostly fatal, is particularly common in rural areas where deliveries are at home without adequate sterile procedures.
- Neonatal tetanus requires treatment in a medical facility, often in a referral hospital.
- Maternal tetanus shares the same risk factors and means of prevention as neonatal tetanus.
Prevention
- Tetanus can be prevented through immunization with tetanus-toxoid (TT)-containing vaccines.
- Neonatal tetanus can be prevented by immunizing women of childbearing age with TT, either during pregnancy or outside of pregnancy. This protects the mother and – and through a transfer of tetanus antibodies to the fetus –her baby.
- Hygienic practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus.
- People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.
- To be protected for life, an individual should receive three doses of diphtheria/tetanus/pertussis vaccine in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood.
Elimination goal
- A global neonatal tetanus elimination goal was launched at the World Health Assembly in 1989 to reduce neonatal tetanus as a public health problem (defined as less than one case of neonatal tetanus per 1,000 live births in every district) in all countries.
- The Maternal and Neonatal Tetanus (MNT) Elimination Initiative was launched by the United Nations Children’s Fund (UNICEF), WHO and the United Nations Population Fund (UNFPA) in 1999, revitalizing the goal of MNT elimination as a public health problem. Maternal tetanus was added as it is assumed to be eliminated once neonatal tetanus elimination has been achieved.
- Currently, the target year for global elimination of MNT is 2015.
Global progress
- Over 113 million women of child bearing age were reached with two doses of the tetanus toxoid (TT) vaccine from 1999-2011.
- Of the 59 countries targeted, 28 (including China from October 2012) have been validated to have attained maternal and neonatal tetanus elimination. Three countries (Ethiopia, India and Indonesia) have partially validated parts of their countries.
- WHO estimates that in 2008 (the latest year for which estimates are available), 50,000 newborns died from neonatal tetanus, a 92% reduction from the situation in the late 1980s.
- 31 countries have yet to eliminate MNT as of November 2012.
Progress in China
- Efforts to eliminate MNT in China began in the early 1950s through improving the hygiene associated with home deliveries, and community education on the importance and prevention of neonatal tetanus (NT) and other maternal and newborn infections.
- Since 1980s, a number of programmes financed by the Government and external donors have been implemented to improve the quality of and access to primary health services, as well as to strengthen planning and management of those services. In addition, tetanus toxoid (TT) immunization of women of reproductive age has been systematically introduced in areas found to be at high risk for NT.
- In 2011, only 785 NT cases were reported in China and only 15 counties reported rates of > one NT case per 1,000 live births, due to joints efforts between the Ministry of Health, other Government sectors and partners working together to improve the health of mothers and children.
- Through the validation survey, on 30 October 2012, WHO confirmed that China has eliminated maternal and neonatal tetanus.
- WHO considers neonatal tetanus to have been eliminated when the incidence is <1 case/1000 live births in every district in a country. Maternal tetanus is considered to be eliminated when neonatal tetanus has been eliminated.
Elimination strategy
- The primary strategies for eliminating MNT in China are implemented through the Ministry's Maternal and Child Health (MCH) programme through improvement of antenatal care and promotion of clean and institutional deliveries. This approach is supported by upgrading infrastructure and equipment in county and township hospitals, improving the skills of obstetric staff, subsidizing hospital delivery in poor areas and providing transportation to hospitals in remote areas, as well as through health education and social mobilization.