Bibliographic Info
GuidelineWHO recommendations on antenatal care for a positive pregnancy experience
Year of Publication2016
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended
Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.
Notes and Remarks
- 1.This recommendation is consistent with recommendations from the 2006 WHO guideline on Maternal immunization against tetanus. The GDG endorses the 2006 guideline approach, which recommends the following.
- – If a pregnant woman has not previously been vaccinated, or if her immunization status is unknown, she should receive two doses of a tetanus toxoid-containing vaccine (TT-CV) one month apart with the second dose given at least two weeks before delivery. Two doses protect against tetanus infection for 1–3 years in most people. A third dose is recommended six months after the second dose, which should extend protection to at least five years.
- – Two further doses for women who are first vaccinated against tetanus during pregnancy should be given after the third dose, in the two subsequent years or during two subsequent pregnancies.
- – If a woman has had 1–4 doses of a TT-CV in the past, she should receive one dose of a TT-CV during each subsequent pregnancy to a total of five doses (five doses protects throughout the childbearing years).
- 2.Tetanus vaccination and clean delivery practices are major components of the strategy to eradicate maternal and neonatal tetanus globally.
- 3.Effective surveillance is critical for identifying areas or populations at high risk of neonatal tetanus and for monitoring the impact of interventions.
- 4.A monitoring system should include an immunization register, personal vaccination cards and maternal health records, which should be held by the woman.
- 5.For effective implementation, ANC health-care providers need to be trained in tetanus vaccination and the vaccine, equipment and supplies (refrigerator, needles and syringes) need to be readily available at ANC services.
- 6.Policy-makers in low prevalence/high-income settings may choose not to include tetanus vaccination among ANC interventions if effective tetanus immunization programmes and good post-exposure prophylaxis exist outside of pregnancy.
- 7.ANC contacts should be used to verify the vaccination status of pregnant women, and administer any vaccines that are recommended in the national immunization schedule. ANC contacts are also opportunities to explain the importance of infant vaccination and communicate the infant/child vaccination schedule to pregnant women.
- 8.Further information can be found in the WHO guidance, available at: http://www.who.int/ reproductivehealth/publications/maternal_perinatal_health/immunization_tetanus.pdf; and in WHO’s vaccine position papers, available at: http://www.who.int/immunization/documents/positionpapers/en