Progress toward elimination of neonatal tetanus–Egypt, 1988-1994

Neonatal tetanus (NT) is a leading cause of neonatal mortality in many parts of the world and, of vaccine-preventable diseases, is second only to measles worldwide as a cause of childhood mortality (1). In Egypt, although tetanus toxoid (TT) vaccination for pregnant women was introduced in 1973, a nationwide survey in 1986 estimated that the NT mortality risk was seven per 1000 live births (2); in 1987, only 9% of pregnant women received at least two doses of TT (TT2+) through the routine vaccination program. Consequently, in 1988, the Ministry of Health initiated an aggressive NT elimination program; this program included 1) annual nationwide TT vaccination campaigns during 1988-1993 targeting pregnant women, and 2) supplementary campaigns during 1992-1994 targeting all women of childbearing age in districts where NT rates were highest. This report describes efforts to eliminate NT in Egypt that resulted in an 85% decline in reported cases during 1988-1994.