Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2012-2015

Abstract : Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60 percent, and the Presidents Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.During April 2012November 2015, PEPFARs VMMC program reported 12 tetanus cases in five sub-Saharan African countries. Three cases occurred in 20122013 (one in Uganda and two in Zambia), six in 2014 (one each in Kenya, Rwanda, and Tanzania and three in Uganda), and three in 2015 (one in Rwanda and two in Uganda). Eight patients received conventional VMMC surgery, and four received PrePex, a nonsurgical male circumcision device. No other VMMC-related tetanus cases had been previously reported. Intensified adverse event and death monitoring and reporting were instituted in July 2014 in all 14 PEPFAR-supported countries providing VMMC for HIV prevention.