Tetanus vaccine "catch- up" through VMMC

Updated recommendations on tetanus vaccination, published in a position paper in the Weekly Epidemiological Record of the World Health Organization (WHO) on 10 February 2017, address a gap in immunity among boys and men identified in part through safety monitoring of voluntary medical male circumcision (VMMC) programmes. A WHO-led review reported that 15 cases of tetanus identified by August 2016, after more than 12 million VMMCs, were due primarily to an increased risk of tetanus with use of an elastic collar compression method of circumcision or application to circumcision wounds of substances that may contain C tetani spores. It also revealed that adolescent boys in African countries are less likely than girls to have received the booster doses of tetanus toxoid-containing vaccine needed for lifelong protection against tetanus.

In response, WHO issued recommendations to prevent rare but potentially fatal cases of tetanus following VMMC and worked with the Strategic Advisory Group of Experts on Immunization on recommendations for increasing tetanus booster coverage among girls and boys. This guidance (see pp. 72-73 of the position paper) includes recommendations for providing “catch-up” tetanus immunisations to adolescent and adult VMMC clients prior to or at the time of VMMC and to adolescent girls and boys during delivery of HPV vaccinations. Three routine tetanus boosters are now recommended at 12 to 23 months, 4 to 7 years, and 9 to 15 years of age, allowing for the flexibility to provide these vaccinations with other services (WHO Weekly Epidemiological Record, 10 February 2017).