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Infant and maternal tetanus has officially been eliminated from the Americas this year, the Pan American Health Organization announced.

The infection was the cause of 10,000 newborn deaths annually in the Western Hemisphere, a number considered low by experts due to severe underreporting of cases. Neonatal tetanusand still kills about 35,000 infants around the world, a 96% reduction from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life. Complete eradication is not possible with this disease, at the bacteria that causes it exists in the soil environment,  but the vaccination of pregnant women and mothers, and the availability of clean and safe medical birth procedures has reduced the incidence of neonatal tetanus to less than one per 1,000 births.

The elimination of the disease was declared this year in Haiti, which made it possible to reach the regional goal. MNT is the sixth vaccine-preventable disease to be eliminated from the Americas, following the regional eradication of smallpox in 1971, poliomyelitis in 1994, rubella and congenital rubella syndrome in 2015, and measles in 2016.

“The elimination of maternal and neonatal tetanus is proof again that vaccines work to save the lives of countless mothers and babies,” said Carissa F. Etienne, director of the Pan American Health Organization/World Health Organization (PAHO/WHO). “Let us continue to protect the people of our Region by investing in strong national immunization programs that are capable of vaccinating all individuals and quickly identifying vaccine-preventable diseases.”

Neonatal tetanus introduced in a newborn’s unhealed umbilical when the instrument used to cut the umbilical cord is unsterile, or the birthing area is unsterile. It is causes paralysis that impairs breathing and breastfeeding.

Recent progress in global elimination has led to 43 countries, including Haiti, eliminating MNT between 2000 and June 2017. There are 16 countries worldwide that have yet to eliminate the disease.

Path to tetanus elimination in the Americas

In 1989, the World Health Assembly resolved to eliminate neonatal tetanus by 1995. To reach the goal, four action steps were followed: 1) routine immunization of pregnant women 2) supplemental immunization  for women of childbearing age that would ensure each woman receives at least two doses of the vaccine; 3) surveillance of neonatal tetanus cases; and 4) clean obstetric services.

While most countries in the Americas had eliminated MNT by the early 2000s. Starting in 2003, special programs were initiated in Haiti. All women of reproductive age were vaccinated against tetanus, pregnant women were also vaccinated against the disease and neonatal tetanus was monitored along with diseases like measles, rubella, polio, diphtheria, and pertussis. Facilities for clean births and deliveries and practices for proper umbilical care were introduced.

To maintain MNT elimination, Haiti has developed a plan with seven lines of action:

  • achieve and maintain immunization coverage of at least 80% of the vaccine against tetanus;
  • establish periodic risk analysis of MNT;
  • organize supplemental immunization activities in high-risk departments when found necessary based on the risk analysis;
  • adopt and implement a policy for additional dT vaccination among children and adolescents;
  • improve accessibility and quality of assisted births;
  • strengthen community education about umbilical cord care; and
  • improve surveillance.

Although Haiti was an area of particular focus, all countries in the Region must strengthen their efforts to maintain coverage of maternal immunization against tetanus at the recommended 95%, as several have fallen short of this goal during recent years.

“Because tetanus can never be eradicated, a single case of newborn tetanus in the Americas could still happen,” said Cuauhtemoc Ruiz, head of PAHO’s Comprehensive Family Immunization Program. “In this case, countries should carry out a thorough evaluation to determine how the case could have been averted in order to prevent new cases.”