ABSTRACT
Maternal immunization with tetanus toxoid [TT] is the most effective was to prevent neonatal tetanus. In Duhok, Iraq data indicate low vaccination coverage. This study assessed TT immunization status among 600 randomly selected pregnant women attending Azadi teaching hospital, Duhok for delivery, by both tetanus antibody seroprevalence and TT history. WHO criteria for protective levels were used for seroprevalence and vaccination history. Overall, 90% of the women at delivery had protective tetanus antitoxin titres compared to only 55% considered protected according to their vaccination history. Immunity rates for women who had received no TT vaccination, 1 dose, 2 doses and >/= 3 doses were 28.0%, 92.6%, 100.0% and 99.0% respectively. Groups with lower serological immunity levels were women aged less than 25 years, those reporting no history of vaccination and those living in Akre, Bardarash or Shekhan districts of Duhok. Tetanus immunity determined by seroprevalence of tetanus antitoxin levels exceeded that estimated by vaccination history, and serological markers should be used instead of vaccination history in determining immunity status