Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body's muscles and nerves. It typically arises from a skin wound that becomes contaminated by a bacterium called Clostridium tetani, which is often found in soil. Common first signs of tetanus are a headache and muscular stiffness in the jaw, followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating and fever. As the toxin produced by the bacteria circulates more widely, the toxin interferes with the normal activity of nerves throughout the body, leading to generalized muscle spasms. Symptoms usually begin 8 days after the infection, but may range in onset from 3 days to 3 weeks. Without treatment, tetanus can be fatal. Vaccination is the best way to protect against tetanus.
Neonatal tetanus (NT) is a form of generalized tetanus in newborn infants that do not have protective passive immunity because the mother is not immune. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. Neonatal tetanus is estimated to kill over 200,000 newborns each year; almost all these deaths occur in developing countries while it is very rare in developed nations.
Reducing deaths from neonatal tetanus is one of the simplest and most cost-effective means to reduce the neonatal mortality rate. Tetanus transmission can be prevented during childbirth by improving immunization services, especially for pregnant women, promoting clean delivery and cord-care practices, and strengthening disease surveillance and case investigation. Vaccination with tetanus toxoid (TT) will also protect the mothers from maternal tetanus during pregnancy and delivery. Although data are very incomplete it is estimated that maternal tetanus is responsible for 5% of maternal mortalities, particularly in the developing world.
[more on NT]
Update on Maternal and Neonatal Tetanus Elimination -
Lao People's Democratic Republic (23 January 2012)
The Lao People’s Democratic Republic continues to make progress towards the national goal of maternal and neonatal tetanus elimination (MNTE). With the recent completion of three rounds of tetanus toxoid (TT) supplementary immunization activities (SIAs) in the majority of districts and mop-up immunization campaigns based on district risk assessment strengthening of neonatal tetanus (NT) surveillance has become a priority in MNTE approaches towards validation. With support of WHO, UNICEF and Luxemburg Development the Ministry of Health conducted a NT surveillance training 18-20 January 2012.
Participation of immunization, surveillance and mother and child health (MCH) staff from the national level and all provinces provided an excellent opportunity to review the current situation of MNTE in the country and defined jointly the way forward. The workshop enhanced technical skills of different MNTE strategies, identified through interactive group work relevant aspects of community involvement and opportunities for future collaboration of the three groups (EPI, surveillance, MCH) and drafted workplans for future collaboration.
As a first time approach to conduct such vaccine preventable diseases (VDP) surveillance training for EPI, surveillance and MCH staff this workshop succeeded as an innovative approach to foster greater coordination between different health programmes.
Main recommendations of the workshop included creating a national MNTE coordination group, developing risk assessment and NT surveillance guidelines, conducting risk assessment by district including field investigations, investigating all notified NT cases, establishing provincial plans on strengthening NT surveillance and training at the district level, ideally combined with surveillance for other EPI diseases.
Update on Maternal and Neonatal Tetanus Elimination (MNTE)
Maternal and neonatal tetanus elimination in the Western Pacific Region has kept its momentum. Cambodia is strengthening its neonatal tetanus surveillance system. The country has completed two rounds of tetanus toxoid (TT) supplementary immunization activities (SIAs) for childbearing age women (CBAW) in the remaining four districts considered at high risk. The Lao People’s Democratic Republic analyzed the outcomes of its recent large-scale TT SIAs for CBAWs in 99 high-risk districts (out of 143 districts total) and implemented two rounds of mop-up vaccination as required. Papua New Guinea is developing its MNTE national action plan in close collaboration with its EPI and Maternal and Child Health (MCH) programmes and TT SIAs will be carried out net spring. The Philippines is about progressing with TT SIAs in 10 high risk areas, of which eight are in Mindanao, and have added oral poliovirus vaccine (OPV) for children under 5 years.
MNTE annual progress report 2010
New momentum for maternal and neonatal tetanus elimination
Following a joint WHO/UNICEF Workshop on Elimination of Maternal and Neonatal Tetanus (MNT) in the Countries of East Asia and Pacific Region, held in Bangkok, Thailand, in October 2008, all countries concerned showed appreciation of the longstanding international commitment to MNT elimination and expressed their programmes' willingness to target elimination by 2012, as currently expected globally. The five countries in the Western Pacific that have yet to achieve the goal (Cambodia, China, the Lao People’s Democratic Republic, Papua New Guinea and the Philippines) have since then undertaken concrete steps to do so.
[more on MNT elimination]
Technical note
A WHO/UNICEF Workshop on Elimination of Maternal and Neonatal Tetanus (MNT) in the Countries of East Asia and Pacific Region, was held in Bangkok, Thailand, from 7 to 9 October 2008. It targeted Ministries of Health of countries in the East Asia and Pacific region that are MNT endemic, namely Cambodia, China, Indonesia, the Lao People's Democratic Republic, Myanmar, Papua New Guinea, the Philippines and Timor Leste.
Date of last update: January 2012
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