INTRODUCTION Globally, 13 countries have yet to eliminate maternal and neonatal tetanus. While efforts have improved access to tetanus toxoid containing vaccines (TTCVs) and increased clean delivery practices, reaching elimination targets (<1 case of neonatal tetanus per 1000 live births per district per year) may require significant resources to reach the remaining high risk and hard-to-reach districts. METHODS We estimated the cost to achieve maternal and neonatal tetanus elimination (MNTE) in three years in the remaining 13 countries: Afghanistan, Angola, Central African Republic, Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan, and Yemen. Costs were estimated for: (1) vaccination campaigns using standard TTCVs and TT-Uniject™ targeting women of reproductive age in high risk areas, (2) additional vaccinations delivered to pregnant women at antenatal care (ANC) clinics, (3) clean delivery and umbilical cord care promotion, (4) neonatal tetanus surveillance strengthening, and (5) validation activities. We forecasted the averted mortality to assess the cost-effectiveness of achieving MNTE. RESULTS It will cost an estimated US$197.7 million to realize MNTE over three years. These costs include $161.4 million for vaccination campaigns, $6.1 million for routine vaccination during ANC, $23.3 million for promotion of clean delivery practices, $4 million for surveillance, and $3 million for validation of MNTE. Achieving MNTE will avert approximately 70,000 neonatal deaths over ten years of vaccine protection, resulting in approximately 4.4 million life years gained. It will cost $2,900 per death averted and $45 per life year gained. CONCLUSION Maternal and neonatal tetanus can be eliminated with significant financial investment, high prioritization, and strong political will. While substantial costs must be incurred to reach hard-to-reach populations, MNTE should be accomplished as a matter of health equity, and will significantly contribute to reaching the United Nations' Sustainable Development Goals.

中文翻译：

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消除产妇和新生儿破伤风的投资案例。

引言在全球范围内，尚未有13个国家消除母婴破伤风。尽管努力改善了获得包含破伤风类毒素疫苗（TTCV）的途径并提高了清洁分娩实践，但要达到消灭目标（每区每年每千名活产婴儿中破伤风<1例），可能需要大量资源才能达到仍然存在的高风险和高难度。到达区域。方法我们估算了剩余13个国家在三年内实现母婴破伤风（MNTE）的成本：阿富汗，安哥拉，中非共和国，刚果民主共和国，几内亚，马里，尼日利亚，巴基斯坦，巴布亚新几内亚，索马里，南苏丹，苏丹和也门。估计费用：（1）针对高危地区育龄妇女的标准TTCV和TT-Uniject™疫苗接种运动；（2）在产前保健（ANC）诊所为孕妇提供额外的疫苗接种；（3）清洁分娩和促进脐带护理，（4）加强新生儿破伤风监测，以及（5）验证活动。我们预测了避免的死亡率，以评估实现MNTE的成本效益。结果在三年内实现MNTE估计需要花费1.977亿美元。这些费用包括用于疫苗接种运动的1.614亿美元，在ANC期间进行常规疫苗接种的610万美元，用于推广清洁交付实践的2,330万美元，用于监视的400万美元以及用于MNTE验证的300万美元。在十年的疫苗保护中，实现MNTE可以避免约70,000例新生儿死亡，导致大约440万生命年。避免每例死亡的费用为2,900美元，每生命年增加45美元。结论母婴破伤风可以通过大量的财政投入，高优先级和强大的政治意愿来消除。虽然必须付出巨大的代价才能惠及难以到达的人口，但MNTE应从卫生公平的角度来实现，并将为实现联合国的可持续发展目标做出重大贡献。