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

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 toroid 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 toroid provided significant protection for subsequent durations of up to 12 or 13 years. Conclusions. The data demonstrate that a limited-dose regimen of maternal tetanus toroid provides significant and extended protection against the risk of neonatal tetanus death.