In order to assess the effect of the neonatal tetanus elimination program in Turkey, tetanus antibody prevalence among women of childbearing age from three selected provinces was evaluated in relation to vaccination doses of the single-type tetanus vaccine. A combined method of in-house enzyme-linked immunosorbent assay and particle agglutination test was used to determine tetanus antibody titers. Among 205 women aged 20-39 years, the tetanus antibody level was higher in women with 1-3 children than those without children. The geometric mean of the log antibody titer was increased proportionally with a slope of 0.405 +/- 0.174 per dose between 0 and 3 doses (P > 0.05). However, the proportion of 20-39-year-old women with the protective antibody in the provinces ranged from 54.8 to 86.6%. Diyarbakir had the lowest immunity with a larger number of children in the household, and a lower educational level. The results of our serological study demonstrated that the neonatal tetanus elimination program in Turkey is effectively promoting immunity against tetanus in pregnant women. However, the study also revealed that the tetanus immunity among women of childbearing age was still insufficient. Intensive implementation of the supplemental immunization activities and encouraging vaccinations through neonatal care services will improve the situation.
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