Ridpath Alison Delano, Scobie Heather Melissa, Shibeshi Messeret Eshetu, Yakubu Ahmadu, Zulu Flint, Raza Azhar Abid, Masresha Balcha, Tohme Rania
Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA, USA.
World Health Organization, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe.
Pan Afr Med J. 2017 Jun 22;27(Suppl 3):24. doi: 10.11604/pamj.supp.2017.27.3.11783. eCollection 2017.
Despite the availability of effective tetanus prevention strategies, as of 2016, Maternal and Neonatal Tetanus Elimination (MNTE) has not yet been achieved in 18 countries globally. In this paper, we review the status of MNTE in the World Health Organization African Region (AFR),and provide recommendations for achieving and maintaining MNTE in AFR. As of November 2016, 37 (79%) AFR countries have achieved MNTE, with 10 (21%) countries remaining. DTP3 coverage increased from 52% in 2000 to 76% in 2015. In 2015, coverage with at least 2 doses of tetanus containing vaccine (TT2+) and proportion of newborns protected at birth (PAB) were 69% and 77%, compared with 44% and 62% in 2000, respectively. Since 1999, over 79 million women of reproductive age (WRA) have been vaccinated with TT2+ through supplementary immunization activities (SIAs). Despite the progress, only 54% of births were attended by skilled birth attendants (SBAs), 5 (11%) countries provided the 3 WHO-recommended booster doses to both sexes, and about 5.5 million WRA still need to be reached with SIAs. Coverage disparities still exist between countries that have achieved MNTE and those that have not. In 2015, coverage with DTP3 and PAB were higher in MNTE countries compared with those yet to achieve MNTE: 84% vs. 68% and 86% vs. 69%, respectively. Challenges to achieving MNTE in the remaining AFR countries include weak health systems, competing priorities, insufficient funding, insecurity, and sub-optimal neonatal tetanus (NT) surveillance. To achieve and maintain MNTE in AFR, increasing SBAs and tetanus vaccination coverage, integrating tetanus vaccination with other opportunities (e.g., polio and measles campaigns, mother and child health days), and providing appropriately spaced booster doses are needed. Strengthening NT surveillance and conducting serosurveys would ensure appropriate targeting of MNTE activities and high-quality information for validating the achievement and maintenance of elimination.
尽管有有效的破伤风预防策略，但截至2016年，全球仍有18个国家尚未实现消除孕产妇和新生儿破伤风（MNTE）。在本文中，我们回顾了世界卫生组织非洲区域（AFR）的MNTE状况，并为在AFR实现和维持MNTE提供建议。截至2016年11月，AFR的37个（79%）国家已实现MNTE，仍有10个（21%）国家尚未实现。三联疫苗第三剂（DTP3）的覆盖率从2000年的52%提高到了2015年的76%。2015年，至少接种两剂含破伤风疫苗（TT2+）的覆盖率和出生时得到保护的新生儿比例（PAB）分别为69%和77%，而2000年分别为44%和62%。自1999年以来，超过7900万育龄妇女通过补充免疫活动（SIA）接种了TT2+。尽管取得了进展，但只有54%的分娩由熟练的助产士（SBA）接生，5个（11%）国家为男女两性提供了世界卫生组织推荐的3剂加强疫苗，仍有约550万育龄妇女需要通过SIA接种疫苗。已实现MNTE的国家和尚未实现的国家之间仍然存在覆盖率差距。2015年，MNTE国家的DTP3覆盖率和PAB高于尚未实现MNTE的国家：分别为84%对68%和86%对69%。在AFR其余国家实现MNTE面临的挑战包括卫生系统薄弱、优先事项相互竞争、资金不足、不安全以及新生儿破伤风（NT）监测不理想。为在AFR实现和维持MNTE，需要增加SBA和破伤风疫苗接种覆盖率，将破伤风疫苗接种与其他机会（如脊髓灰质炎和麻疹运动、母婴健康日）相结合，并提供间隔适当的加强剂量。加强NT监测并开展血清学调查将确保MNTE活动的目标定位准确，并提供高质量信息以验证消除目标的实现和维持情况。
