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IN SAFE MALE CIRCUMCISION SERVICE
Ugandan Perspective
Dr.Kyambadde Peter
MINISTRY OF HEALTH
TETANUS TOXOID VACCINATION
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PRESENTATION OUTLINE1. Introduction2. Rationale for TT in SMC3. Introduction of TT in SMC4. Sero-prevalence of protective tetanus antibodies and
immunological response following TTcV among clients seeking MC services in Uganda.
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Percent of men age 15-49 who are circumcised
Male Circumcision by Region- 2011
West Nile28%
Mid Northern2%
North East7%
Mid Eastern53%
EastCentral
42%
Central 226%
Central 129%
SouthWestern
10%
MidWestern
30%
Kampala35%
Uganda26%
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• The TT vaccination was based on an understanding at the time that Tetanus posed a significant threat to the success of the SMC program in Uganda based on the cases that were reported and associated with SMC
• Since SMC roll out in 2010, No deaths were reported until 4 incident cases were reported between 2012 and 2014
• Two of the fatalities were associated with elastic collar devices and two with conventional surgical circumcision.
• The cases of Tetanus identified in the SMC program probably served to unmask the general burden
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Why TT in SMC program? (1)
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• At that time the UNEPI program provided TT only to children and women of childbearing age
• Besides, the 3 doses in infancy are not adequate to protect the SMC clients after 10 years of age and it was felt better to assume an SMC client population non-primed to TT and there the TT in SMC
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Why TT in SMC program? (2)
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• In March 2015, WHO recommended VMMC programs to adopt the Dual approach (Clean care and TT vaccination to safe levels) to help mitigate Tetanus risk.
• Uganda MoH & partners adopted the recommendation for its SMC program for males who seek the service
• The SMC service has also provided an opportunity for vaccination of men, who are also at risk for Tetanus as general population
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Why TT in SMC program? (3)
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• “To reduce tetanus-related morbidity and mortality among
males seeking SMC”
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Purpose of integrating TT in SMC program
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– MoH Uganda, recommended that all potential SMC clients be vaccinated before the service with at least two doses (at least 28 days apart):• First dose -Day 0• Second dose -Day 28 and then circumcise.
– The recommendation was that SMC clients should be given information to complete the remaining 3 doses to get life long protection against Tetanus
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Prevention of Tetanus in SMC- Tetanus vaccination (1)
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Trend in No of VMMC done between 2010-2016
2010 – 9,052 2011 – 57,132 2012 – 368,490 2013 – 801,678 2014 – 878,109 2015 – 497,978 2016--411,459
(Reduction in numbers attributed to TT)
905257132
368490
801678
878109
497978
411459
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
2010 2011 2012 2013 2014 2015 2016
No.VMMC done annually
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The TT Study 2016
The objective of the study was:“To determine the Sero-prevalence of protectivetetanus antibodies and immunological responsefollowing TT Vaccination among clients seekingMC services in Uganda”.
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Current status
• Still implementing the 2 TT dose recommendation before SMC ( TT 1 on day 0 and TT 2 on day 28 then circumcise on that same day)
• Plans underway to review the evidence available and the new WHO guidance on TT in SMC and then as a country come up with recommendations
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THANK YOU
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