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Immunization

Maternal and neonatal tetanus

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The Disease:
Referred to in the Old Testament as the “seventh-day death,” neonatal tetanus strikes rapidly, killing newborns soon after birth. Tetanus occurs when a bacterium, Clostridium tetani, enters the body through an open wound or puncture. The bacteria spores are ubiquitous – they live in the soil, in animal dung, and in faeces – and tetanus can affect anybody. The bacteria produce a toxin (poison) that attacks the central nervous system.

 

A newborn can be infected with tetanus due to unhygienic birthing practices, such as cutting the umbilical cord with unsterile instruments or treating it with contaminated dressings. If the spores enter, the infection can spread and the child usually dies a quick and painful death. Mothers can also be infected with tetanus during unsafe or unsanitary delivery if there are unsanitary conditions where the tetanus spores are present. Tetanus is called the “silent killer” because so many of these women and newborns die at home and both the births and the deaths go unreported.

 

Symptoms:
A newborn infected with tetanus may appear perfectly healthy. The first sign usually comes two to three days later, when the baby’s jaw and facial muscles may tighten due to the tetanus poison. The baby’s mouth will continue to grow more rigid so that it becomes “locked” (thus the name “lockjaw” given to tetanus) and the newborn will no longer be able to breastfeed. The newborn’s body may stiffen or arch and he or she may convulse when stimulated by light, sound or being touched. Finally, the newborn may no longer be able to breathe and may die. Between 70 and 100 per cent of deaths occur between three days and 28 days after birth.

 

Immunization:
Maternal and neonatal tetanus (MNT) is totally preventable through immunization and hygienic birth practices. Tetanus toxoid (TT), the vaccine that protects mothers and newborns from tetanus, is a detoxified version of the poison that causes the disease. It has been available for decades and is generally given as part of a combination vaccine for diphtheria, tetanus and pertussis (DTP) to children under one and as a single antigen (TT) to women as part of their routine antenatal care.

 

It is recommended that women receive five doses of TT to confer lifetime protection against tetanus. However, in areas where this is quite a challenge to achieve, the strategy focuses on administering three doses of TT to women of childbearing age, providing at least 10 years of protection (to cover childbearing age years). Once the mother is protected, she will pass on the immunity to her child, who will be protected for the first months of life. Thereafter, the child should be immunized at  four, six and 10 weeks, to boost this immunity.

 

Goal:
Eliminate maternal and neonatal tetanus from the 58 countries where it is still a public health problem.


Definition of ‘elimination of MNT’:
MNT elimination in a country is defined as a neonatal tetanus rate of less than 1 case per 1000 live births in every district of the country.

 

Programmatic update:
Country commitment as reflected by availability of a country plan of action for MNT elimination:

Partners:
UNICEF is committed to eliminating MNT as a public health problem, a goal shared by our partners, including the World Health Organization (WHO), the United Nations Population Fund (UNPFA), Becton Dickinson (BD), the Gates Foundation, UNICEF National committees and governments throughout the world. UNICEF's main role will be to provide technical and financial support to MNT elimination country programmes.