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Landmark reached in fight against tetanus, as over half of 59 priority countries declare victory, partners say

2013-05-15

NEW YORK/ HONG KONG, 15 May 2013 – Tetanus, one of the most deadly diseases a mother and her newborn can face, has been eliminated in over half of 59 priority countries, the Maternal and Neonatal Tetanus Elimination Initiative partners announced today.

Tetanus kills one newborn baby every nine minutes and almost all of these babies are born in poor families living in the most disadvantaged areas and communities.

A woman is vaccinated against tetanus at a health outreach centre in the village of Kakail Chew in the eastern Ajmeriganj Subdistrict. The village is in the country's remote 'haor', or wetlands area, which is submerged under water for almost half the year. During the flooding period, villages become 'islands' and access to services is limited. In 2006, Bangladesh continues its decades-long trend toward reducing neonatal, infant and child mortality, and is on track to achieve Millennium Development Goals for both child and maternal mortality reduction. In the last two years, sanitation coverage has also increased, and the Government aims to achieve 100 per cent coverage by 2010. However, entrenched poverty and the lack of stable governance continue to threaten the lives of children. An estimated 30 million children live in poverty, lacking minimum access to health, education and basic social services, especially in remote, rural areas. Despite modest improvements in child stunting levels, the nutritional status of children and pregnant women remains inadequate. The problem of malnutrition begins at birth, with approximately one-third of infants born underweight. In addition, arsenic contamination in the groundwater remains affects 12 to 15 million people. UNICEF supports programmes to reduce infant and maternal mortality and improve the health and nutritional status of pregnant women. UNICEF also supports early childhood development and primary education, especially for girls; immunization and growth-monitoring programmes; and community-based water and sanitation initiatives.

A health worker prepares a pentavalent vaccine at a health centre in the community of Corosal in Cobán Municipality, in Alta Verapaz Department. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). The centre, which is open once a month, serves a population of 1,000, and is run by the Ministry of Health with support from UNICEF. Volunteer health workers provide routine health care and immunizations for pregnant women and children under 5 in five surrounding communities. [#2 IN SEQUENCE OF THREE] In November 2012 in Guatemala, the Government and other partners are continuing to assure sustained routine immunization of children now reaching 92 per cent of all infants against a range of vaccine-preventable diseases. The countrys last endemic case of measles was in 1997. In the entire Americas Region (covering North, Central and South America), the last endemic measles case was in 2002 and the last endemic case of rubella was in 2009 part of global efforts to eradicate these diseases. Worldwide, measles remains a leading cause of death among young children: In 2010, an estimated 139,300 people mainly children under the age of 5 died from the disease. Nevertheless, these deaths decreased by 71 per cent from 2001 to 2011, thanks in part to the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), WHO and UNICEF. In Guatemala, despite this success, significant other challenges for children remain, much of it related to poverty levels that affect more than half of all children and adolescents. Poverty also contributes to chronic malnutrition affecting half of all under-5 children (with higher rates among indigenous populations); an average national education level of under six years of primary school (under three years for the rural poor); and high, though decreasing, rates of violence. Guatemala is also one of the worlds most vulnerable countries to climate change, suffering a major climate-related emergency every year since 2008. On the positive side, birth registration is improving, with more than 95 per cent of newborns now being registered. UNICEF is working with the Government and other partners to sustain achievements in health, address the high levels of malnutrition, strengthen responses to crimes against children and increase protection services for children throughout public services.

The disease, easily preventable with a vaccine administered to the mother, is transmitted when children are born in unhygienic conditions, and non-sterile materials are used to cut the umbilical cord, or are applied to the umbilical bump. At that point, the mother’s life is also in danger. With at least three protective doses that cost about US$2, the mother and her future newborns are protected for five years.

Since 1999, more than 118 million women of child-bearing age have been vaccinated against tetanus in 52 countries. Many of these women received their tetanus vaccine as part of an integrated campaign which included other life- saving interventions for children – such as immunization against measles, Vitamin A supplements, deworming tablets and information on umbilical cord care.

The announcement came during the annual MNT Initiative stakeholders’ meeting.

The Maternal and Neonatal Tetanus Elimination Initiative is a model of how partners can work together to achieve results. In 2000, one year after the initiative began, it was estimated that over 200,000 deaths of newborns occurred annually from tetanus. By 2010, this number had dropped to an estimated 58,000 annually.

Despite the progress, more than 28 priority countries have still not reached the elimination goal. This is a formidable challenge in the quest to reach the global target of elimination of MNT in all priority countries by 2015.

(Right) Alba Flor Bol, an indigenous Mayan woman, holds her 3-month-old daughter, Esteyner Leandrinho Chen, as health worker Lourdes Rodriguez administers a pentavalent vaccination, at a health centre in the community of Corosal in Cobán Municipality, in Alta Verapaz Department. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). The centre, which is open once a month, serves a population of 1,000, and is run by the Ministry of Health with support from UNICEF. Volunteer health workers provide routine health care and immunizations for pregnant women and children under 5 in five surrounding communities. [#3 IN SEQUENCE OF THREE] In November 2012 in Guatemala, the Government and other partners are continuing to assure sustained routine immunization of children now reaching 92 per cent of all infants against a range of vaccine-preventable diseases. The countrys last endemic case of measles was in 1997. In the entire Americas Region (covering North, Central and South America), the last endemic measles case was in 2002 and the last endemic case of rubella was in 2009 part of global efforts to eradicate these diseases. Worldwide, measles remains a leading cause of death among young children: In 2010, an estimated 139,300 people mainly children under the age of 5 died from the disease. Nevertheless, these deaths decreased by 71 per cent from 2001 to 2011, thanks in part to the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), WHO and UNICEF. In Guatemala, despite this success, significant other challenges for children remain, much of it related to poverty levels that affect more than half of all children and adolescents. Poverty also contributes to chronic malnutrition affecting half of all under-5 children (with higher rates among indigenous populations); an average national education level of under six years of primary school (under three years for the rural poor); and high, though decreasing, rates of violence. Guatemala is also one of the worlds most vulnerable countries to climate change, suffering a major climate-related emergency every year since 2008. On the positive side, birth registration is improving, with more than 95 per cent of newborns now being registered. UNICEF is working with the Government and other partners to sustain achievements in health, address the high levels of malnutrition, strengthen responses to crimes against children and increase protection services for children throughout public services.

The main challenges to MNT elimination are a lack of access to communities because of insecurity, cultural barriers, competing priorities, sustaining elimination after validation and inadequate funding.

The MNT Elimination Initiative is an international private-public partnership that includes National Governments, UNICEF, WHO, UNFPA, GAVI, USAID/Immunization Basics, CDC, UNICEF National Committees, the Government of Japan, Save the Children, PATH, RMHC, The Bill & Melinda Gates Foundation, Kiwanis International, Pampers – a division of Procter & Gamble, and BD.

Nurse Emmanuel Kalwazi fills a syringe with tetanus toxoid vaccine, which he will administer to a pregnant woman in Mukanga-Moke Village, Katanga Province. The vaccines have been provided by UNICEF. [#4 IN SEQUENCE OF ELEVEN] In Feuary 2011 in the Democratic Republic of the Congo, women and children remain vulnerable to maternal and neonatal tetanus (MNT), an infection that has no cure but is preventable with routine immunization. MNT threatens the lives of 130 million women and babies in 38 countries around the world, including D. R. Congo, where the disease sickened at least 1,038 babies and killed 483 last year. Globally, the disease kills 59,000 infants within their first month of life, the equivalent of one death every nine minutes, every year. Limited access to basic health services and poor hygiene conditions during birth are the major contributors to MNT mortality: Many infections take place when women give birth at home, alone or in the presence of an untrained birth attendant. Delivery on unclean surfaces and handling with unclean hands or instruments increase the chance of MNT infection in both mother and baby. Yet three doses of the tetanus toxoid vaccine one of the worlds safest and least expensive vaccines protects almost 100 per cent of recipients from the disease. Additionally, children born to immunized women are protected from the disease for the first two months of life. Since UNICEF re-launched its MNT Elimination Initiative in 1999, at least 20 countries have achieved the goal of eliminating MNT, and since 2006, private-sector partner Pampers has donated funds for 300 million vaccines. In D. R. Congo, this initiative is promoting vaccination among girls and women of child-bearing age, particularly in southern provinces where health infrastructure is weak and vaccine shortages are common. The goal of the initiative is to eliminate cases of MNT from the world by 2015.

In October 2010, UNICEF and partners helped organizing a vaccination campaign in Bossangoa to immunize children against polio, tetanus, hepatitis B and diphtheria - among other diseases. On the day it started, women and children danced and chanted near the health care centre to call all the community members to ing their children to be vaccinated. Afterwards, long queues were formed with mothers and their children to make sure every child was covered.

The countries that have eliminated MNT are: Bangladesh; Benin; Burkina Faso; Burundi; Cameroon; China; Comoros; Congo (Republic of); Cote d' Ivoire; Egypt; Eritrea; Ghana; Guinea Bissau; Iraq; Liberia; Malawi; Mozambique; Myanmar; Namibia; Nepal; Rwanda; Senegal; South Africa; Tanzania; Timor Leste; Turkey; Togo; Uganda; Vietnam; Zimbabwe and Zambia.

The countries that are still working toward elimination include Afghanistan; Angola; Cambodia; Central African Republic; Chad; Congo DR; Equatorial Guinea; Ethiopia; Gabon; Guinea; Haiti; India; Indonesia; Kenya; Lao People's Democratic Republic; Madagascar; Mali; Mauritania; Niger; Nigeria; Pakistan; Papua New Guinea; Philippines; Sierra Leone; Somalia; Sudan; South Sudan; and Yemen.