These revised recommendations by the Advisory Committee on Immunization Practices concerning prevention of plague update previous recommendations (MMWR 1982;31:301-4). This report includes information and recommendations on vaccination, public health practices, and medical treatment to prevent plague among humans.

/pdf/recommendations-of-the-advisory-committee-on-immunization-3guz7xi9ha.pdf

Recommendations of the Advisory Committee on Immunization Practices (ACIP)

BACKGROUND: Neonatal tetanus remains an important and preventable cause of neonatal mortality globally. Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two trials considered in a Cochrane review. OBJECTIVE: To review the evidence for and estimate the effect on neonatal tetanus mortality of immunization with tetanus toxoid of pregnant women, or women of childbearing age. METHODS: We conducted a systematic review of multiple databases. Standardized abstraction forms were used. Individual study quality and the overall quality of evidence were assessed using an adaptation of the GRADE approach. Meta-analyses were performed. RESULTS: Only one randomised controlled trial (RCT) and one well-controlled cohort study were identified, which met inclusion criteria for meta-analysis. Immunization of pregnant women or women of childbearing age with at least two doses of tetanus toxoid is estimated to reduce mortality from neonatal tetanus by 94% [95% confidence interval (CI) 80-98%]. Additionally, another RCT with a case definition based on day of death, 3 case-control studies and 1 before-and-after study gave consistent results. Based on the consistency of the mortality data, the very large effect size and that the data are all from low/middle-income countries, the overall quality of the evidence was judged to be moderate. CONCLUSION: This review uses a standard approach to provide a transparent estimate of the high impact of tetanus toxoid immunization on neonatal tetanus.

https://www.who.int/immunization/diseases/Article_2010.pdf

Tetanus toxoid immunization to reduce mortality from neonatal tetanus

Every year nearly 11 million children die before reaching their fifth birthday and most of them during their first year of life. Most of these deaths (98% in 2002) are in developing countries; more than half are due to acute respiratory infections diarrhoea measles malaria and HIV/AIDS. In addition malnutrition underlies 54% of all child deaths. Projections based on the 1996 analysis The Global Burden of Disease indicate that these conditions will continue to be major contributors to child deaths in 2020 unless significant efforts are made to control them. In response to this challenge the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) developed the Integrated Management of Childhood Illness (IMCI) strategy which focuses on these five conditions and which includes three main components: Improvements in the case management skills of health workers through the provision of locally adapted guidelines on IMCI and through activities to promote their use. Improvements in the health system that are required for the effective management of childhood illness. Improvements in family and community practices. This paper addresses improvements in family and community practices. More specifically it presents the evidence for twelve key practices (see below) identified by UNICEF and WHO to be of key importance in providing good home-care for the child concerning the prevention or treatment of the IMCI conditions in order to ensure survival reduce morbidity and promote healthy growth and development. It does not include the four additional practices added following a meeting of UNICEF the WHO Regional Office for Africa and nongovernmental organizations(NGO) which took place in Durban South Africa in June 2000 as these practices will need additional work to reach a specificity whose impact can be measured. (excerpt)

Family and community practices that promote child survival growth and development. A review of the evidence.

Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis.

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guerin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality.

/pdf/vaccination-and-all-cause-child-mortality-from-1985-to-2011-33xg9zopcr.pdf

Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys

OBJECTIVES: Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. METHODS: A randomized, double-blind cholera vaccine trial of 41,571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. RESULTS: Children of women who received either 1 or 2 injections of tetanus toxoid experienced 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. CONCLUSIONS: The data demonstrate that...

Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.

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Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.