Yemen, the Ministry of Health plans to eradicate neonatal tetanus and measles by 2010 and immunization campaigns are already under way.Yemen must reduce its under-five mortality rate by two thirds between 1990 and 2015 to reach the United Nation’s (UN) fourth Millennium Development Goal (MDG). Although the country’s under-five mortality rate has dropped by over a half since 1990, it must be reduced by a further 30 per 1,000 in the next six years to reach this health-related goal on time.Yemen’s under-five mortality rate stood at 73 per 1,000 in 2007, according to UNICEF.The country’s neonatal mortality rate –the probability of death within the first 28 days of a baby’s life- was 41 per 1,000 in 2004, the third highest in the Middle East after Iraq and Afghanistan.While neonatal tetanus is a particular threat to babies delivered without professional medical assistance, measles can cause serious complications in malnourished children. The Ministry of Health is actively setting out to prevent both these diseases through immunization.

Neonatal tetanus

Neonatal tetanus, or “lockjaw,” develops when a bacterium, Clostridium tetani, infects a cut or wound. Unclean delivery or abortion practices can result in maternal tetanus, while neonatal tetanus occurs when a newly born infant’s umbilical cord is cut with a non-sterile instrument. In the absence of intensive hospital care, neonatal tetanus is nearly always fatal, according to the UN Children’s Fund’s (UNICEF) 2009 State of the World’s Children report.Globally, tetanus was directly responsible for up to seven percent of neonatal deaths in 2000, and was the second leading cause of deaths from vaccine-preventable diseases in 1999, according to UNICEF and the World Health Organization (WHO). Once a baby is infected, the bacteria produce an extremely potent toxin, or poison, which attacks the nervous system causing spasms and tightening of muscles in the newborn’s jaw and neck and later, in the back and abdomen. The baby’s mouth grows so rigid that it becomes “locked” the child will no longer be able to breastfeed, or ultimately, breathe, according to UNICEF.Although the true extent of the tetanus death toll is not known as many newborns and mothers die at home and neither the birth nor the death is reported, UNICEF estimated the global fatality rate in 2000 between 70 and 100 percent. In Yemen, a country where up to 64 percent of births take place at home without the presence of a skilled attendant, the risk for neonatal tetanus is far higher than in countries where pregnant women have better access to professional healthcare. And if a hygienic delivery using clean instruments cannot be guaranteed, the best method of prevention against maternal and neonatal tetanus is immunization.For this, tetanus toxoid has proven to be an effective vaccine against the disease. Given towomen of childbearing age, two doses a month apart are an effective prevention method in most cases. Once a mother is immunized, her baby acquires passive immunity from her.“In the 16 governorates, we aim to vaccinate 2,167,000 women between the ages of 15 and 45, and have so far insured 70 percent coverage of the targeted governorates” said Dr. Eissa Mohammad, director of the expanded immunization program at the Ministry of Health and assistant professor of Pediatrics at Sana’a University. The six-day campaign was successful in 15 of the 16 governorates, but in Hadramout the immunization teams were unable to access targeted areas because of heavy rain. The campaign started in the governorate last Saturday and is expected to come to its conclusion soon.The immunization campaign, which was launched with two vaccinations to women of child-bearing age in Al-Dhale’, Lahj, Al-Hodeidah and Ibb between May and June 2008, is a progressive one. In a month’s time, a second vaccination will be administered to the women in all of the country’s 16 remaining governorates, thereby completing the second phase of the program nationwide. In September 2009, the campaign will continue in all governorates with the third vaccination.“The third vaccine provides immunization for five years, the fourth for ten years and the fifth provides immunization for life,” explained Mohammad.The global rate of vaccination against tetanus has risen from 9 percent to at least 81 percent globally since 1980, according to UNICEF, but this still leaves one in five infants worldwide at risk of infection. “The rate of vaccination against neonatal tetanus in Yemen had reached 17 percent by mid-2007,” said Mohammad, explaining that this rate is still low compared to the rest of the world.

Measles

But Yemen’s battle against measles is a more successful story. From 2007 to 2006, reported cases of measles nationwide plummeted from 30,000 cases, 5,000 of which were fatal, to 13 cases only.“In 2008, there were three reported cases of measles, and no fatalities,” said Mohammad.“[This year] we vaccinated over 667, 000 children between the age of nine months and five years in the governorates of Mahara, Al-Hodeidah and Hadramout, achieving 85 percent coverage in all three governorates,” he added, explaining that the campaign was still ongoing in Hadramout because of the rain.Measles is a highly contagious viral disease, which affects mostly children, according to WHO. It is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear eight to12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. There is no specific treatment for measles and most people recover within 2–3 weeks. But, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhea, ear infection and pneumonia. In a country where up to 42 percent of children under five years-old are underweight according to the latest WHO statistics, immunization is importantMeasles deaths worldwide fell by 74 per cent between 2000 and 2007, according to UNICEF, and Yemen’s successful vaccination campaign will have contributed, at least in part, to the UN’s Global Immunization Goal and Strategy of reducing measles mortality by 90 percent by 2010.In view of Yemen’s triumph over measles in the last few years and the success of its ongoing campaign against neonatal tetanus, Mohammad is optimistic that the country will reach the UN’s fourth MDG by 2015.“We will reduce under-five mortality by two thirds by 2015 thanks to the departments of family health, basic health care and immunization at the Ministry of Health,” he concluded.