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Tetanus Toxoid Immunization to Reduce Mortality from Neonatal Tetanus

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More Intervention Effect Estimate Summaries

Blencowe H, Lawn J, Vandelaer J, Roper M, Cousens S.  Tetanus toxoid immunization to reduce mortality from neonatal tetanus. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i102-i109.


  • Despite progress, approximately 130,000 babies died from neonatal tetanus around 2004. (1)
  • Absent medical treatment, case fatality approaches 100%; with hospital care 10-60% of neonatal tetanus cases die. (2)
  • Tetanus toxoid vaccination of pregnant women was included in the WHO’s Expanded Program on Immunization in the mid-1970’s. (3)

Intervention Effect

Tetanus toxoid immunization of pregnant women or women of childbearing age on mortality from neonatal tetanus

  • Tetanus toxoid dosage was at least 2 doses given at least 4 weeks apart 94% (95% CI: 80-98%) reduction in mortality from neonatal tetanus   
  • Despite only have data from one RCT and one cohort study, the quality of data was upgraded from low to moderate because:
    • All data are from low/middle-income countries
    • Very large effect size
    • Mortality data are consistent

Intervention Recommendation

  • Given the low additional cost of immunization at around 60 cents per dose, including full operational costs and the feasibility of reaching high coverage, global elimination of tetanus should be achievable.

References from Blencowe Paper Cited Here

  1. WHO. The Global Burden of Disease 2004 Update. Available at _report_update/en/index.html (12 May 2009, date last accessed).
  2. Roper MH, Vandelaer JH, Gasse FL. Maternal and neonatal tetanus. Lancet 2007; 370: 1947-59.
  3. Plotkin. In: Plotkin S, Orenstein W, Offit P (eds). Vaccines. 5th edition. Philadelphia: WB Saunders Company, 2008, pp. 805-40

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