Nepal has sustained the elimination status of maternal and neonatal tetanus, a milestone it first achieved in 2005.

Officials from the Ministry of Health and Population confirmed that a recent assessment conducted by a team of experts from the World Health Organisation headquarters, WHO South-East Asia Regional Office (SEARO), WHO country office, and UNICEF reconfirmed the country’s elimination status.

“The expert panel's report has validated Nepal’s sustained elimination of maternal and neonatal tetanus,” said Dr Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division under the Department of Health Services. “This success indicates the effectiveness of our immunisation programme and its coverage.”

Tetanus is a severe nervous system disorder caused by a toxin-producing bacterium, leading to muscle contractions and, in severe cases, life-threatening complications. There is no cure for tetanus.

The United Nations health body has noted that maternal and neonatal tetanus has historically been one of the most deadly consequences of unclean delivery practices and improper umbilical cord care. It is also a key indicator of inequality in access to immunisation and maternal, newborn, and child health services. When untreated, tetanus has an extremely high mortality rate, mainly when medical care is unavailable.

Doctors explain that neonatal tetanus can occur when unhygienic birth practices allow tetanus spores to contaminate the umbilical cord. Symptoms typically appear within three days after birth and include the baby’s inability to nurse, increasing rigidity, body arching, and painful convulsions, with a fatality rate of 70–100 percent.

Maternal tetanus is caused by contamination from tetanus spores, often linked to unsafe or unclean abortions and deliveries. Its symptoms mirror those of neonatal tetanus and include a tight jaw, stiff neck and muscles, difficulty swallowing, and convulsions. These cases usually occur 2–21 days after the injury, with most occurring within the first 14 days.

According to Gautam, a post-validation assessment was carried out in December last year, which showed that the country continues to maintain less than one case in every 1,000 live births. Three districts—Tanahun, Makawanpur and Udayapur—were selected for a joint-risk assessment. Officials say that the evaluation aligns with the South-East Asia Regional Vaccine Implementation Plan(2022-2026) recommendations from the National Immunisation Advisory Committee and the South-East Asia Regional Immunisation Advisory Group. Development partners, including WHO Nepal and UNICEF, have provided technical and financial support for the assessment.

As part of the evaluation, the expert team visited health facilities in select districts, interviewed women who had given birth in the past two years. The team also assessed immunisation service delivery, cold chain management, surveillance system, antenatal care and safe delivery practices.

The team has also recommended introducing a booster dose of the tetanus vaccine in the second year of life, integrating neonatal tetanus death reporting into the existing maternal and perinatal death surveillance system and strengthening community awareness on antenatal care services, clean delivery practices among others for the long-term sustainability of elimination status.