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  • Title: Neonatal tetanus: countdown to 1995.
    Author: da Silveira CM, de Quadros CA.
    Journal: World Health Forum; 1991; 12(3):289-96. PubMed ID: 1777017.
    Abstract:
    Progress in the campaign against neonatal tetanus in South and Central America and the Caribbean is reviewed. The main emphasis is on immunizing women of childbearing age who live in high-risk areas, although importance also attaches to routine tetanus toxoid treatment, adequate care during the prenatal period and delivery, and epidemiological surveillance. In 1990, the Pan American Health Organization (PAHO) announced its strategy to reduce neonatal tetanus: immunize all 12-44 year old women in high risk areas with the tetanus toxoid. As of mid-1991, health workers in Bolivia, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, and Venezuela systematically reported neonatal tetanus cases. Only Guatemala had not yet began case investigations. Workers in Argentina, Brazil, Haiti, and Paraguay did not report neonatal tetanus cases. In fact, hospital searches were the only means to detect tetanus cases in Haiti. The number of reported cases/year fluctuated between 1300-1500 between 1985-90. PAHO defined a high risk area as an area that has a neonatal tetanus morbidity or mortality rate higher than the national average for the last 3-5 years. PAHO found 50% of all cases occurred in 5% of municipios. El Salvador, however, case occurrence did not differ from 1 region to another, PAHO proposed training traditional midwives how to vaccinate women with the tetanus toxoid and children with other vaccines as has been done in Bolivia's Department of Santa Cruz. They can also report tetanus cases and refer women to health facilities if they cannot vaccinate the women themselves. Before 1990, 78% of recorded neonatal tetanus cases occurred to women with at least 2 other children. This represented at least 2 missed opportunities for vaccination/woman. In 1990, only 17 of the 212 reported tetanus cases in the Americas were born in a hospital. In 1988, the incidence rate for deliveries in hygienic conditions averaged .11/1000 compared with .5 for all deliveries. 90% of mothers who had infants with tetanus in 1990 had not received any tetanus toxoid vaccinations, and only 22% of all mothers had received the 2nd dose. In addition to prenatal and delivery care, PAHO promoted effective epidemiological surveillance systems.
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