Abstract

Tetanus remains a considerable cause of mortality among undervaccinated mothers and their infants following unhygienic deliveries, especially in low-income countries.Strategies of the maternal and neonatal tetanus elimination (MNTE) initiative, which targets 59 priority countries, include strengthening antenatal immunization of pregnant women with tetanus toxoid-containing vaccines (TTCVs); conducting TTCV supplementary immunization activities among women of reproductive age in high-risk districts; optimizing access to skilled birth attendants to ensure clean deliveries and umbilical cord care practices; and identifying and investigating suspected neonatal tetanus cases.This report updates a previous report and describes progress toward MNTE during 2000-2022.By December 2022, 47 (80%) of 59 priority countries were validated to have achieved MNTE.In 2022, among the 50 countries that reported coverage with ≥2 doses of TTCV among pregnant women, 16 (32%) reported coverage of ≥80%.In 2022, among 47 validated countries, 26 (55%) reported that ≥70% of births were assisted by skilled birth attendants.Reported neonatal tetanus cases worldwide decreased 89%, from 17,935 in 2000 to 1,995 in 2021; estimated neonatal tetanus deaths decreased 84%, from 46,898 to 7,719.However, the global disruption of routine immunization caused by the COVID-19 pandemic impeded MNTE progress.Since 2020, reported neonatal tetanus cases have increased in 18 (31%) priority countries.Integration of MNTE strategies into priority countries' national postpandemic immunization recovery activities is needed to achieve and sustain global elimination.