Duke Global Health Institute, Duke University, Durham, NC, USA.
Health Section, UNICEF, New York, USA.
Vaccine. 2020 Feb 24;38(9):2241-2249. doi: 10.1016/j.vaccine.2019.11.052. Epub 2020 Jan 21.
Globally, 13 countries have yet to eliminate maternal and neonatal tetanus. While efforts have improved access to tetanus toxoid containing vaccines (TTCVs) and increased clean delivery practices, reaching elimination targets (<1 case of neonatal tetanus per 1000 live births per district per year) may require significant resources to reach the remaining high risk and hard-to-reach districts.
We estimated the cost to achieve maternal and neonatal tetanus elimination (MNTE) in three years in the remaining 13 countries: Afghanistan, Angola, Central African Republic, Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan, and Yemen. Costs were estimated for: (1) vaccination campaigns using standard TTCVs and TT-Uniject™ targeting women of reproductive age in high risk areas, (2) additional vaccinations delivered to pregnant women at antenatal care (ANC) clinics, (3) clean delivery and umbilical cord care promotion, (4) neonatal tetanus surveillance strengthening, and (5) validation activities. We forecasted the averted mortality to assess the cost-effectiveness of achieving MNTE.
It will cost an estimated US$197.7 million to realize MNTE over three years. These costs include $161.4 million for vaccination campaigns, $6.1 million for routine vaccination during ANC, $23.3 million for promotion of clean delivery practices, $4 million for surveillance, and $3 million for validation of MNTE. Achieving MNTE will avert approximately 70,000 neonatal deaths over ten years of vaccine protection, resulting in approximately 4.4 million life years gained. It will cost $2,900 per death averted and $45 per life year gained.
Maternal and neonatal tetanus can be eliminated with significant financial investment, high prioritization, and strong political will. While substantial costs must be incurred to reach hard-to-reach populations, MNTE should be accomplished as a matter of health equity, and will significantly contribute to reaching the United Nations' Sustainable Development Goals.
在全球范围内，仍有 13 个国家尚未消除孕产妇和新生儿破伤风。虽然在获得含破伤风类毒素疫苗（TTCV）和增加清洁分娩做法方面已经取得了进展，但要实现消除目标（每个区每年每 1000 例活产中新生儿破伤风病例<1 例），可能需要大量资源来覆盖剩余的高风险和难以到达的地区。
我们估计了在未来三年内，在剩余的 13 个国家（阿富汗、安哥拉、中非共和国、刚果民主共和国、几内亚、马里、尼日利亚、巴基斯坦、巴布亚新几内亚、索马里、南苏丹、苏丹和也门）实现孕产妇和新生儿破伤风消除（MNTE）的成本。成本估计包括：（1）在高风险地区针对育龄妇女使用标准 TTCV 和 TT-UnijectTM 的疫苗接种运动，（2）在产前保健（ANC）诊所为孕妇提供的额外疫苗接种，（3）清洁分娩和脐带护理促进，（4）新生儿破伤风监测加强，以及（5）验证活动。我们预测了避免的死亡人数，以评估实现 MNTE 的成本效益。
在三年内实现 MNTE 需要估计 1.977 亿美元。这些成本包括疫苗接种运动的 1.614 亿美元，ANC 期间常规疫苗接种的 610 万美元，清洁分娩做法促进的 2330 万美元，监测的 400 万美元和 MNTE 验证的 300 万美元。在十年的疫苗保护期内，实现 MNTE 将避免约 70000 例新生儿死亡，从而获得约 440 万生命年。它将花费 2900 美元来避免每例死亡，花费 45 美元来获得每例生命年。
通过大量资金投入、高度优先考虑和强烈政治意愿，可以消除孕产妇和新生儿破伤风。虽然要覆盖难以到达的人群需要承担巨大的成本，但 MNTE 应该作为健康公平的问题来完成，这将对实现联合国可持续发展目标做出重大贡献。
