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Chellamuthu P, Angel AN, MacMullan MA, Denny N, Mades A, Santacruz M, Lopez R, Bagos C, Casian JG, Trettner K, Lopez L, Nirema N, Brobeck M, Kojima N, Klausner JD, Turner F, Slepnev V, Ibrayeva A. SARS-CoV-2 Specific IgG Antibodies Persist Over a 12-Month Period in Oral Mucosal Fluid Collected From Previously Infected Individuals. Front Immunol 2021; 12:777858. [PMID: 34956206 PMCID: PMC8697108 DOI: 10.3389/fimmu.2021.777858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/22/2021] [Indexed: 01/12/2023] Open
Abstract
Background Developing an understanding of the antibody response, seroprevalence, and seroconversion from natural infection and vaccination against SARS-CoV-2 will give way to a critical epidemiological tool to predict reinfection rates, identify vulnerable communities, and manage future viral outbreaks. To monitor the antibody response on a larger scale, we need an inexpensive, less invasive, and high throughput method. Methods Here we investigate the use of oral mucosal fluids from individuals recovered from SARS-CoV-2 infection to monitor antibody response and persistence over a 12-month period. For this cohort study, enzyme-linked immunosorbent assays (ELISAs) were used to quantify anti-Spike(S) protein IgG antibodies in participants who had prior SARS-CoV-2 infection and regularly (every 2-4 weeks) provided both serum and oral fluid mucosal fluid samples for longitudinal antibody titer analysis. Results In our study cohort (n=42) with 17 males and 25 females with an average age of 45.6 +/- 19.3 years, we observed no significant change in oral mucosal fluid IgG levels across the time course of antibody monitoring. In oral mucosal fluids, all the participants who initially had detectable antibodies continued to have detectable antibodies throughout the study. Conclusions Based on the results presented here, we have shown that oral mucosal fluid-based assays are an effective, less invasive tool for monitoring seroprevalence and seroconversion, which offers an alternative to serum-based assays for understanding the protective ability conferred by the adaptive immune response from viral infection and vaccination against future reinfections.
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Affiliation(s)
- Prithivi Chellamuthu
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Aaron N. Angel
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Melanie A. MacMullan
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
- Mork Family Department of Chemical Engineering and Materials Science, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Nicholas Denny
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Aubree Mades
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Marilisa Santacruz
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Ronell Lopez
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Cedie Bagos
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Joseph G. Casian
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Kylie Trettner
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
- Mork Family Department of Chemical Engineering and Materials Science, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Lauren Lopez
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Nina Nirema
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Matthew Brobeck
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Noah Kojima
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Fred Turner
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Vladimir Slepnev
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Albina Ibrayeva
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
- Eli and Edythe Broad Center for Regenerative Medicine at the University of Southern California, William Myron Keck School of Medicine, Los Angeles, CA, United States
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
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2
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Casian JG, Angel AN, Lopez R, Bagos C, MacMullan MA, Bui ML, Chellamathu P, Das S, Turner F, Slepnev V, Ibrayeva A. Saliva-Based ELISAs for Effective SARS-CoV-2 Antibody Monitoring in Vaccinated Individuals. Front Immunol 2021; 12:701411. [PMID: 34539632 PMCID: PMC8446671 DOI: 10.3389/fimmu.2021.701411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
In March 2020, the World Health Organization (WHO) declared a global health emergency-the coronavirus disease 2019 (COVID-19) pandemic. Since then, the development and implementation of vaccines against the virus amidst emerging cases of re-infection has prompted researchers to work towards understanding how immunity develops and is sustained. Serological testing has been instrumental in monitoring the development and persistence of antibodies against SARS-CoV-2 infection, however inconsistencies in detection have been reported by different methods. As serological testing becomes more commonplace, it is important to establish widespread and repeatable processes for monitoring vaccine efficacy. Therefore, we present enzyme linked immunosorbent assays (ELISAs) compatible for antibody detection in saliva as highly accurate, efficacious, and scalable tools for studying the immune response in individuals vaccinated against SARS-CoV-2.
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Affiliation(s)
- Joseph G Casian
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Aaron N Angel
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Ronell Lopez
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Cedie Bagos
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Melanie A MacMullan
- Department of Serology Research and Development, Curative, Monrovia, CA, United States.,Mork Family Department of Chemical Engineering and Materials Science, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Mindy L Bui
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Prithivi Chellamathu
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Sudipta Das
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Fred Turner
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Vladimir Slepnev
- Department of Serology Research and Development, Curative, Monrovia, CA, United States
| | - Albina Ibrayeva
- Department of Serology Research and Development, Curative, Monrovia, CA, United States.,Eli and Edith Broad Center for Regenerative Medicine & Stem Cell Research at the University of Southern California, Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine, Los Angeles, CA, United States.,Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
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3
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Carcelen AC, Mutembo S, Matakala KH, Chilumba I, Mulundu G, Monze M, Mwansa FD, Moss WJ, Hayford K. Impact of a Measles and Rubella Vaccination Campaign on Seroprevalence in Southern Province, Zambia. Am J Trop Med Hyg 2021; 104:2229-2232. [PMID: 33939639 PMCID: PMC8176503 DOI: 10.4269/ajtmh.20-1669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/05/2021] [Indexed: 11/07/2022] Open
Abstract
Zambia conducted a measles and rubella (MR) vaccination campaign targeting children 9 months to younger than 15 years of age in 2016. This campaign was the first introduction of a rubella-containing vaccine in Zambia. To evaluate the impact of the campaign, we compared the MR seroprevalence estimates from serosurveys conducted before and after the campaign in Southern Province, Zambia. The measles seroprevalence increased from 77.8% (95% confidence interval [CI], 73.2-81.9) to 96.4% (95% CI, 91.7-98.5) among children younger than 15 years. The rubella seroprevalence increased from 51.3% (95% CI, 45.6-57.0) to 98.3% (95% CI, 95.5-99.4). After the campaign, slightly lower seroprevalence remained for young adults 15 to 19 years old, who were not included in the campaign because of their age. These serosurveys highlighted the significant impact of the vaccination campaign and identified immunity gaps for those beyond the targeted vaccination age. Continued monitoring of population immunity can signal the need for future targeted vaccination strategies.
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Affiliation(s)
- Andrea C Carcelen
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,2Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - Gina Mulundu
- 5University of Zambia School of Medicine, Lusaka, Zambia.,6University Teaching Hospital, Lusaka, Zambia
| | - Mwaka Monze
- 5University of Zambia School of Medicine, Lusaka, Zambia
| | - Francis D Mwansa
- 2Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - William J Moss
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyla Hayford
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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4
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Cutts FT, Dansereau E, Ferrari MJ, Hanson M, McCarthy KA, Metcalf CJE, Takahashi S, Tatem AJ, Thakkar N, Truelove S, Utazi E, Wesolowski A, Winter AK. Using models to shape measles control and elimination strategies in low- and middle-income countries: A review of recent applications. Vaccine 2020; 38:979-992. [PMID: 31787412 PMCID: PMC6996156 DOI: 10.1016/j.vaccine.2019.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/30/2023]
Abstract
After many decades of vaccination, measles epidemiology varies greatly between and within countries. National immunization programs are therefore encouraged to conduct regular situation analyses and to leverage models to adapt interventions to local needs. Here, we review applications of models to develop locally tailored interventions to support control and elimination efforts. In general, statistical and semi-mechanistic transmission models can be used to synthesize information from vaccination coverage, measles incidence, demographic, and/or serological data, offering a means to estimate the spatial and age-specific distribution of measles susceptibility. These estimates complete the picture provided by vaccination coverage alone, by accounting for natural immunity. Dynamic transmission models can then be used to evaluate the relative impact of candidate interventions for measles control and elimination and the expected future epidemiology. In most countries, models predict substantial numbers of susceptible individuals outside the age range of routine vaccination, which affects outbreak risk and necessitates additional intervention to achieve elimination. More effective use of models to inform both vaccination program planning and evaluation requires the development of training to enhance broader understanding of models and where feasible, building capacity for modelling in-country, pipelines for rapid evaluation of model predictions using surveillance data, and clear protocols for incorporating model results into decision-making.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - E Dansereau
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - M Hanson
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - K A McCarthy
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA
| | - C J E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - S Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - N Thakkar
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA
| | - S Truelove
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Utazi
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - A Wesolowski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A K Winter
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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5
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Gong W, Hayford K, Taighoon Shah M, Iqbal J, Moss WJ, Moulton LH, Chandir S, O'Brien KL. Using Serosurvey Data Triangulation for More Accurate Estimates of Vaccine Coverage: Measured and Modeled Coverage From Pakistan Household Surveys. Am J Epidemiol 2019; 188:1849-1857. [PMID: 31318424 DOI: 10.1093/aje/kwz161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Household surveys remain an essential method for estimating vaccine coverage in developing countries. However, the resulting estimates have inevitable and currently unmeasurable information biases due to inaccuracies in recall, low retention of home-based records (HBRs; i.e., vaccination cards), and inaccurate recording of vaccination on HBRs. We developed an innovative method with which to overcome these biases, enhance the validity of survey results, and estimate true vaccine coverage using nested serological assessments of immune markers. We enrolled children aged 12-23 months in vaccine coverage surveys in Karachi, Pakistan, from January to December 2016. Vaccination history was collected through verbal recall by the caregiver and, when available, by HBR. One-third of survey participants were randomly enrolled for serological testing for anti-measles virus immunoglobulin G antibody. We applied Bayesian latent class models to evaluate the misalignment among measles vaccination histories derived by recall, HBRs, and measles serology and estimated true measles vaccine coverage. The model-based estimate of true measles vaccine coverage was 61.1% (95% credible interval: 53.5, 69.4) among all survey participants. The standard estimate of 73.2% (95% confidence interval: 71.3, 75.1) defined by positive recall or HBR documentation substantially overestimated the vaccine coverage. Researchers can correct for information biases using serological assessments in a subsample of survey participants and latent class analytical approaches.
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6
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Poletti P, Parlamento S, Fayyisaa T, Feyyiss R, Lusiani M, Tsegaye A, Segafredo G, Putoto G, Manenti F, Merler S. The hidden burden of measles in Ethiopia: how distance to hospital shapes the disease mortality rate. BMC Med 2018; 16:177. [PMID: 30333039 PMCID: PMC6193289 DOI: 10.1186/s12916-018-1171-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A sequence of annual measles epidemics has been observed from January 2013 to April 2017 in the South West Shoa Zone of the Oromia Region, Ethiopia. We aimed at estimating the burden of disease in the affected area, taking into account inequalities in access to health care due to travel distances from the nearest hospital. METHODS We developed a dynamic transmission model calibrated on the time series of hospitalized measles cases. The model provided estimates of disease transmissibility and incidence at a population level. Model estimates were combined with a spatial analysis to quantify the hidden burden of disease and to identify spatial heterogeneities characterizing the effectiveness of the public health system in detecting severe measles infections and preventing deaths. RESULTS A total of 1819 case patients and 36 deaths were recorded at the hospital. The mean age was 6.0 years (range, 0-65). The estimated reproduction number was 16.5 (95% credible interval (CI) 14.5-18.3) with a cumulative disease incidence of 2.34% (95% CI 2.06-2.66). Three thousand eight hundred twenty-one (95% CI 1969-5671) severe cases, including 2337 (95% CI 716-4009) measles-related deaths, were estimated in the Woliso hospital's catchment area (521,771 inhabitants). The case fatality rate was found to remarkably increase with travel distance from the nearest hospital: ranging from 0.6% to more than 19% at 20 km. Accordingly, hospital treatment prevented 1049 (95% CI 757-1342) deaths in the area. CONCLUSIONS Spatial heterogeneity in the access to health care can dramatically affect the burden of measles disease in low-income settings. In sub-Saharan Africa, passive surveillance based on hospital admitted cases might miss up to 60% of severe cases and 98% of related deaths.
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Affiliation(s)
- Piero Poletti
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy.
| | - Stefano Parlamento
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy
| | - Tafarraa Fayyisaa
- South West Shoa Zone Health Office, P.O. Box 253, Woliso, Oromia, Ethiopia
| | - Rattaa Feyyiss
- South West Shoa Zone Health Office, P.O. Box 253, Woliso, Oromia, Ethiopia
| | - Marta Lusiani
- Doctors with Africa CUAMM, Woliso Hospital, P.O. Box 250, Woliso, Oromia, Ethiopia
| | - Ademe Tsegaye
- Doctors with Africa CUAMM, Woliso Hospital, P.O. Box 250, Woliso, Oromia, Ethiopia
| | - Giulia Segafredo
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Giovanni Putoto
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Fabio Manenti
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Stefano Merler
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy
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7
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Winter AK, Wesolowski AP, Mensah KJ, Ramamonjiharisoa MB, Randriamanantena AH, Razafindratsimandresy R, Cauchemez S, Lessler J, Ferrari MJ, Metcalf CJE, Héraud JM. Revealing Measles Outbreak Risk With a Nested Immunoglobulin G Serosurvey in Madagascar. Am J Epidemiol 2018; 187:2219-2226. [PMID: 29878051 PMCID: PMC6166215 DOI: 10.1093/aje/kwy114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/25/2018] [Indexed: 12/28/2022] Open
Abstract
Madagascar reports few measles cases annually and high vaccination campaign coverage. However, the underlying age profile of immunity and risk of a measles outbreak is unknown. We conducted a nested serological survey, testing 1,005 serum samples (collected between November 2013 and December 2015 via Madagascar’s febrile rash surveillance system) for measles immunoglobulin G antibody titers. We directly estimated the age profile of immunity and compared these estimates with indirect estimates based on a birth cohort model of vaccination coverage and natural infection. Combining these estimates of the age profile of immunity in the population with an age-structured model of transmission, we further predicted the risk of a measles outbreak and the impact of mitigation strategies designed around supplementary immunization activities. The direct and indirect estimates of age-specific seroprevalence show that current measles susceptibility is over 10%, and modeling suggests that Madagascar may be at risk of a major measles epidemic.
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Affiliation(s)
- Amy K Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy P Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keitly J Mensah
- Princeton Environmental Institute, Princeton University, Princeton, New Jersey
| | | | | | | | - Simon Cauchemez
- Mathematical Modeling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matt J Ferrari
- Intercollege Graduate Degree Program in Ecology, Pennsylvania State University, University Park, Pennsylvania
| | - C Jess E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
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8
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Winter AK, Martinez ME, Cutts FT, Moss WJ, Ferrari MJ, McKee A, Lessler J, Hayford K, Wallinga J, Metcalf CJE. Benefits and Challenges in Using Seroprevalence Data to Inform Models for Measles and Rubella Elimination. J Infect Dis 2018; 218:355-364. [PMID: 29562334 PMCID: PMC6049004 DOI: 10.1093/infdis/jiy137] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background Control efforts for measles and rubella are intensifying globally. It becomes increasingly important to identify and reach remaining susceptible populations as elimination is approached. Methods Serological surveys for measles and rubella can potentially measure susceptibility directly, but their use remains rare. In this study, using simulations, we outline key subtleties in interpretation associated with the dynamic context of age-specific immunity, highlighting how the patterns of immunity predicted from disease surveillance and vaccination coverage data may be misleading. Results High-quality representative serosurveys could provide a more accurate assessment of immunity if challenges of conducting, analyzing, and interpreting them are overcome. We frame the core disease control and elimination questions that could be addressed by improved serological tools, discussing challenges and suggesting approaches to increase the feasibility and sustainability of the tool. Conclusions Accounting for the dynamical context, serosurveys could play a key role in efforts to achieve and sustain elimination.
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Affiliation(s)
- Amy K Winter
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
| | - Micaela E Martinez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Felicity T Cutts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matt J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, Pennsylvania
| | - Amalie McKee
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, Pennsylvania
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jacco Wallinga
- Netherlands National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Leiden University Medical Center, Leiden, Netherlands
| | - C Jess E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
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9
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Wanjiku HW, Adetifa IM. Serological Surveys for complementing assessments of vaccination coverage in sub-Saharan Africa: A systematic review. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.13880.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Serosurveys of biomarkers of infection/vaccination are widely used for evaluating vaccine-induced immunity and monitoring the effectiveness of immunisation programmes in developed countries. In sub-Saharan Africa (sSA) where vaccination coverage (VC) estimates are often incomplete, inaccurate and overestimate effective population immunity, the use of serosurveys is limited. Methods: We conducted a review of the use of serosurveys to assess/complement assessments of VC in sSA by searching electronic databases (PubMed, Embase, Web of Science, Popline, Ovid and Africa Wide Information) for English language articles published from 1st January 1940 to 31st January 2017. We also searched the references of retrieved articles. SSA was defined as all of Africa excluding the countries in North Africa. We included only articles that measured VC and assessed the quality of these studies using the Newcastle-Ottawa Scale. Results: We found 1056 unique records, reviewed 20 eligible studies of which just 12 met our inclusion criteria. These 12 studies were serosurveys of measles, tetanus, polio and yellow fever. Antibodies induced by natural infection confounded serological test results and there was significant discordance between vaccination history and the presence of antibodies in all except for tetanus vaccine. No study looked at Hepatitis B. Conclusions: Serosurveys for tetanus or tetanus containing vaccines may be directly useful for ascertainment of vaccination exposure or reliably complement current survey methods that measure VC. Given the limited experience in using serosurveys for this purpose in sSA, well-designed serosurveys of tetanus and possibly hepatitis B are required to further validate/evaluate their performance.
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10
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Hübschen JM, Charpentier E, Weicherding P, Muller CP. IgG antibody prevalence suggests high immunization needs in newcomers to Luxembourg, 2012. Vaccine 2018; 36:899-905. [PMID: 29306505 DOI: 10.1016/j.vaccine.2017.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/30/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Abstract
Vaccine coverage of the general population in Luxembourg is high, but refugees or asylum seekers may be incompletely vaccinated and susceptible to vaccine-preventable diseases. In order to assess protection rates, serum and oral fluid samples were collected from 406 newcomers aged between 13 and 70 years arriving between May and September 2012. Sera were screened for IgG antibodies against measles, rubella, mumps, hepatitis B, tetanus, diphtheria and pertussis. Oral fluid samples were screened for antibodies against measles, mumps and rubella virus to investigate their suitability for antibody prevalence studies. More than 90% of the participants had IgG antibodies against rubella, 73% against measles and 56% against mumps. Less than 19% had anti-HBs antibodies. Nearly 84% of the participants had an adequate protection against tetanus, 73% against diphtheria and 40% had pertussis antibodies. 93%, 95% and 78% of the measles, rubella and mumps test results obtained with serum and oral fluid were concordant. The majority of the participants lacked antibodies against at least one of the measles/mumps/rubella (58%) and diphtheria/tetanus/pertussis (72%) vaccine components and against hepatitis B virus (82%) and might thus profit from vaccination. Oral fluid is a suitable alternative and non-invasive specimen for measles/rubella antibody prevalence studies.
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Affiliation(s)
- Judith M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette and Laboratoire National de Santé, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg.
| | - Emilie Charpentier
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette and Laboratoire National de Santé, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg.
| | - Pierre Weicherding
- Direction de la Santé, Division de l'Inspection Sanitaire, 20 rue de Bitbourg, L-1273 Luxembourg-Hamm, Luxembourg.
| | - Claude P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette and Laboratoire National de Santé, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg.
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Thompson KM, Odahowski CL. Systematic Review of Measles and Rubella Serology Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1459-1486. [PMID: 26077609 DOI: 10.1111/risa.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Serological tests provide information about individual immunity from historical infection or immunization. Cross-sectional serological studies provide data about the age- and sex-specific immunity levels for individuals in the studied population, and these data can provide a point of comparison for the results of transmission models. In the context of developing an integrated model for measles and rubella transmission, we reviewed the existing measles and rubella literature to identify the results of national serological studies that provided cross-sectional estimates of population immunity at the time of data collection. We systematically searched PubMed, the Science Citation Index, and references we identified from relevant articles published in English. We extracted serological data for comparison to transmission model outputs. For rubella, serological studies of women of child-bearing age provide information about the potential risks of infants born with congenital rubella syndrome. Serological studies also document the loss of maternal antibodies, which occurs at different rates for the different viruses and according to the nature of the induced immunity (i.e., infection or vaccine). The serological evidence remains limited for some areas, with studies from developed countries representing a disproportionate part of the evidence. The collection and review of serological evidence can help program managers identify immunity gaps in the population, which may help them better understand the characteristics of individuals within their populations who may participate in transmission and manage risks.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Cutts FT, Hanson M. Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries. Trop Med Int Health 2016; 21:1086-98. [PMID: 27300255 DOI: 10.1111/tmi.12737] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries.
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Affiliation(s)
- Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Matt Hanson
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
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A 16-year review of seroprevalence studies on measles and rubella. Vaccine 2016; 34:4110-4118. [PMID: 27340097 DOI: 10.1016/j.vaccine.2016.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 05/15/2016] [Accepted: 06/01/2016] [Indexed: 01/31/2023]
Abstract
The determination of the seroprevalence of vaccine-preventable diseases is critical in monitoring the efficacy of vaccination programmes and to assess the gaps in population immunity but requires extensive organisation and is time and resource intensive. The results of the studies are frequently reported in peer-reviewed scientific, government and non-government publications. A review of scientific literature was undertaken to advise the development of WHO guidelines for the assessment of measles and rubella seroprevalence. A search of the National Library of Medicine's PubMed online publications using key words of 'measles', 'rubella', combined with 'serosurvey', 'seroprevalence', 'immunity' and 'population immunity' was conducted. A total of 97 articles published between January 1998 and June 2014 were retrieved, 68 describing serosurveys for measles and 58 serosurveys for rubella, conducted in 37 and 36 different countries respectively. Only 13 (19%) and 8 (14%) respectively were UN classified "least developed countries". The study sample varied markedly and included combinations of male and female infants, children, adolescents and adults. The study sizes also varied with 28% and 33% of measles and rubella studies respectively, having greater than 2000 participants. Microtitre plate enzyme immunoassays were used in 52 (76%) measles studies and 40 (69%) rubella studies. A total of 39 (57%) measles and 44 (76%) rubella studies reported quantitative test results. Seroprevalence ranged from 60.8% to 95.9% for measles and 53.0% to 99.3% for rubella studies. The review highlighted that infants lost maternally-acquired immunity within 9months of birth and were unprotected until vaccination. Two groups at higher risk of infection were identified: young adults between the ages of 15 and 30years and immigrants.
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Dimech W, Mulders MN. A review of testing used in seroprevalence studies on measles and rubella. Vaccine 2016; 34:4119-4122. [PMID: 27340096 DOI: 10.1016/j.vaccine.2016.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/15/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022]
Abstract
Seroprevalence studies are an essential tool to monitor the efficacy of vaccination programmes, to understand population immunity and to identify populations at higher risk of infection. An overarching review of all aspects of seroprevalence studies for measles and rubella published between 1998 and June 2014 was undertaken and the findings reported elsewhere. This paper details the considerable variation in the testing formats identified in the review. Apart from serum/plasma samples, testing of oral fluid, breast milk, dry blood spots and capillary whole blood were reported. Numerous different commercial assays were employed, including microtitre plate assays, automated immunoassays and classical haemagglutination inhibition and neutralisation assays. A total of 29 of the 68 (43%) measles and 14 of the 58 (24%) rubella studies reported qualitative test results. Very little information on the testing environment, including quality assurance mechanisms used, was provided. Due to the large numbers of testing systems, the diversity of sample types used and the difficulties in accurate quantification of antibody levels, the results reported in individual studies were not necessarily comparable. Further efforts to standardise seroprevalence studies may overcome this deficiency.
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Affiliation(s)
- Wayne Dimech
- NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia.
| | - Mick N Mulders
- World Health Organization, Global VPD Laboratory Networks, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Travassos MA, Beyene B, Adam Z, Campbell JD, Mulholland N, Diarra SS, Kassa T, Oot L, Sequeira J, Reymann M, Blackwelder WC, Wu Y, Ruslanova I, Goswami J, Sow SO, Pasetti MF, Steinglass R, Kebede A, Levine MM. Immunization Coverage Surveys and Linked Biomarker Serosurveys in Three Regions in Ethiopia. PLoS One 2016; 11:e0149970. [PMID: 26934372 PMCID: PMC4774907 DOI: 10.1371/journal.pone.0149970] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/07/2016] [Indexed: 01/24/2023] Open
Abstract
Objective Demographic and health surveys, immunization coverage surveys and administrative data often divergently estimate vaccination coverage, which hinders pinpointing districts where immunization services require strengthening. We assayed vaccination coverage in three regions in Ethiopia by coverage surveys and linked serosurveys. Methods Households with children aged 12–23 (N = 300) or 6–8 months (N = 100) in each of three districts (woredas) were randomly selected for immunization coverage surveys (inspection of vaccination cards and immunization clinic records and maternal recall) and linked serosurveys. IgG-ELISA serologic biomarkers included tetanus antitoxin ≥ 0.15 IU/ml in toddlers (receipt of tetanus toxoid) and Haemophilus influenzae type b (Hib) anti-capsular titers ≥ 1.0 mcg/ml in infants (timely receipt of Hib vaccine). Findings Coverage surveys enrolled 1,181 children across three woredas; 1,023 (87%) also enrolled in linked serosurveys. Administrative data over-estimated coverage compared to surveys, while maternal recall was unreliable. Serologic biomarkers documented a hierarchy among the districts. Biomarker measurement in infants provided insight on timeliness of vaccination not deducible from toddler results. Conclusion Neither administrative projections, vaccination card or EPI register inspections, nor parental recall, substitute for objective serological biomarker measurement. Including infants in serosurveys informs on vaccination timeliness.
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Affiliation(s)
- Mark A. Travassos
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Berhane Beyene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zenaw Adam
- JSI Research & Training Institute Inc., Arlington, Virginia, United States of America
| | - James D. Campbell
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Seydou S. Diarra
- Centre pour le Développement des Vaccins, Mali (CVD-Mali), Bamako, Mali
| | - Tassew Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lisa Oot
- JSI Research & Training Institute Inc., Arlington, Virginia, United States of America
| | - Jenny Sequeira
- JSI Research & Training Institute Inc., Arlington, Virginia, United States of America
| | - Mardi Reymann
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Blackwelder
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yukun Wu
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Inna Ruslanova
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jaya Goswami
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Mali (CVD-Mali), Bamako, Mali
| | - Marcela F. Pasetti
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Robert Steinglass
- JSI Research & Training Institute Inc., Arlington, Virginia, United States of America
| | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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MacNeil A, Lee CW, Dietz V. Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys. Vaccine 2014; 32:4893-900. [PMID: 25045821 PMCID: PMC10721341 DOI: 10.1016/j.vaccine.2014.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 06/18/2014] [Accepted: 07/08/2014] [Indexed: 01/12/2023]
Abstract
Accurate estimates of vaccination coverage are crucial for assessing routine immunization program performance. Community based household surveys are frequently used to assess coverage within a country. In household surveys to assess routine immunization coverage, a child's vaccination history is classified on the basis of observation of the immunization card, parental recall of receipt of vaccination, or both; each of these methods has been shown to commonly be inaccurate. The use of serologic data as a biomarker of vaccination history is a potential additional approach to improve accuracy in classifying vaccination history. However, potential challenges, including the accuracy of serologic methods in classifying vaccination history, varying vaccine types and dosing schedules, and logistical and financial implications must be considered. We provide historic and scientific context for the potential use of serologic data to assess vaccination history and discuss in detail key areas of importance for consideration in the context of using serologic data for classifying vaccination history in household surveys. Further studies are needed to directly evaluate the performance of serologic data compared with use of immunization cards or parental recall for classification of vaccination history in household surveys, as well assess the impact of age at the time of sample collection on serologic titers, the predictive value of serology to identify a fully vaccinated child for multi-dose vaccines, and the cost impact and logistical issues on outcomes associated with different types of biological samples for serologic testing.
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Affiliation(s)
- Adam MacNeil
- Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health, The Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-04, Atlanta, GA 30333, USA.
| | - Chung-Won Lee
- Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health, The Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-04, Atlanta, GA 30333, USA
| | - Vance Dietz
- Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health, The Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-04, Atlanta, GA 30333, USA
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Cutts FT, Lessler J, Metcalf CJE. Measles elimination: progress, challenges and implications for rubella control. Expert Rev Vaccines 2014; 12:917-32. [DOI: 10.1586/14760584.2013.814847] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England. Vaccine 2013; 32:1213-7. [PMID: 23871823 PMCID: PMC3969712 DOI: 10.1016/j.vaccine.2013.06.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/20/2013] [Accepted: 06/25/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the UK, primary varicella is usually a mild infection in children, but can cause serious illness in susceptible pregnant women and adults. The UK Joint Committee on Vaccination and Immunisation is considering an adolescent varicella vaccination programme. Cost-effectiveness depends upon identifying susceptibles and minimising vaccine wastage, and chickenpox history is one method to screen for eligibility. To inform this approach, we estimated the proportion of adolescents with varicella antibodies by reported chickenpox history. METHODS Recruitment occurred through secondary schools in England from February to September 2012. Parents were asked about their child's history of chickenpox, explicitly setting the context in terms of the implications for vaccination. 247 adolescents, whose parents reported positive (120), negative (77) or uncertain (50) chickenpox history provided oral fluid for varicella zoster virus-specific immunoglobulin-G (VZV-IgG) testing. RESULTS 109 (90.8% [85.6-96.0%]) adolescents with a positive chickenpox history, 52 (67.5% [57.0-78.1%]) with a negative history and 42 (84.0% [73.7-94.3%]) with an uncertain history had VZV-IgG suggesting prior infection. Combining negative and uncertain histories, 74% had VZV-IgG (best-case). When discounting low total-IgG samples and counting equivocals as positive (worst-case), 84% had VZV-IgG. We also modelled outcomes by varying the negative predictive value (NPV) for the antibody assay, and found 74-87% under the best-case and 84-92% under the worst-case scenario would receive vaccine unnecessarily as NPV falls to 50%. CONCLUSION Reported chickenpox history discriminates between varicella immunity and susceptibility in adolescents, but significant vaccine wastage would occur if this approach alone were used to determine vaccine eligibility. A small but important proportion of those with positive chickenpox history would remain susceptible. These data are needed to determine whether reported history, with or without oral fluid testing in those with negative and uncertain history, is sufficiently discriminatory to underpin a cost-effective adolescent varicella vaccination programme.
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Cutts FT, Izurieta HS, Rhoda DA. Measuring coverage in MNCH: design, implementation, and interpretation challenges associated with tracking vaccination coverage using household surveys. PLoS Med 2013; 10:e1001404. [PMID: 23667334 PMCID: PMC3646208 DOI: 10.1371/journal.pmed.1001404] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a child's vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardian's recall of vaccination for children without a written record. There has been substantial reliance on the guardian's recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis.
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Levine MM. “IDEAL” vaccines for resource poor settings. Vaccine 2011; 29 Suppl 4:D116-25. [DOI: 10.1016/j.vaccine.2011.11.090] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 12/22/2022]
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Sheikh S, Ali A, Zaidi AKM, Agha A, Khowaja A, Allana S, Qureshi S, Azam I. Measles susceptibility in children in Karachi, Pakistan. Vaccine 2011; 29:3419-23. [PMID: 21396902 PMCID: PMC3082702 DOI: 10.1016/j.vaccine.2011.02.087] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/19/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
Measles, despite being vaccine preventable is still a major public health problem in many developing countries. We estimated the proportion of measles susceptible children in Karachi, the largest metropolitan city of Pakistan, one year after the nationwide measles supplementary immunization activity (SIA) of 2007-2008. Oral fluid specimens of 504 randomly selected children from Karachi, aged 12-59 months were collected to detect measles IgG antibodies. Measles antibodies were detected in only 55% children. The proportion of children whose families reported receiving a single or two doses of measles vaccine were 78% and 12% respectively. Only 3% of parents reported that their child received measles vaccine through the SIA. Among the reported single dose measles vaccine recipients, 58% had serologic immunity against measles while among the reported two dose measles vaccine recipients, 64% had evidence of measles immunity. Urgent strengthening of routine immunization services and high quality mass vaccination campaigns against measles are recommended to achieve measles elimination in Pakistan.
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Affiliation(s)
- Sana Sheikh
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K. M. Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ajmal Agha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Asif Khowaja
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Salim Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Prickett JR, Johnson J, Murtaugh MP, Puvanendiran S, Wang C, Zimmerman JJ, Opriessnig T. Prolonged Detection of PCV2 and Anti-PCV2 Antibody in Oral Fluids Following Experimental Inoculation. Transbound Emerg Dis 2011; 58:121-7. [DOI: 10.1111/j.1865-1682.2010.01189.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The development of oral fluid-based diagnostics and applications in veterinary medicine. Anim Health Res Rev 2010; 11:207-16. [PMID: 20202287 DOI: 10.1017/s1466252310000010] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this review was to discuss the history of the development and implementation of oral fluid diagnostics for infectious diseases of humans and domestic animals. The use of oral fluid for the assessment of health and diagnosis of disease in humans and animals has a surprisingly long history. As early as 1909, Pollaci and Ceraulo reported sensitive and specific agglutination of 'Micrococcus melitensis' (Brucella melitensis) by oral fluid from patients diagnosed with Malta Fever. A 1986 report of the detection of antibodies against human immunodeficiency virus (HIV) in oral fluid from patients with acquired immunodeficiency syndrome (AIDS) marked the start of a remarkably rapid series of developments in oral fluid-based assays. Cumulatively, the literature strongly supports implementation of oral fluid-based diagnostics in veterinary diagnostic medicine. Pathogen-specific IgA, IgM and IgG antibodies have all been demonstrated in oral fluid collected from diverse domestic animal species in response to infection. A variety of infectious agents, both local and systemic, are shed in oral fluid, including some of the most economically significant pathogens of production animals (e.g. foot-and-mouth disease virus, classical swine fever virus and porcine reproductive and respiratory syndrome virus) Ultimately, point-of-care rapid assays (i.e. cow-side, sow-side or pen-side tests) and access to real-time infectious disease data will revolutionize our delivery of health management services.
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Lowther SA, Curriero FC, Kalish BT, Shields TM, Monze M, Moss WJ. Population immunity to measles virus and the effect of HIV-1 infection after a mass measles vaccination campaign in Lusaka, Zambia: a cross-sectional survey. Lancet 2009; 373:1025-32. [PMID: 19211140 DOI: 10.1016/s0140-6736(09)60142-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Measles control efforts are hindered by challenges in sustaining high vaccination coverage, waning immunity in HIV-1-infected children, and clustering of susceptible individuals. Our aim was to assess population immunity to measles virus after a mass vaccination campaign in a region with high HIV prevalence. METHODS 3 years after a measles supplemental immunisation activity (SIA), we undertook a cross-sectional survey in Lusaka, Zambia. Households were randomly selected from a satellite image. Children aged 9 months to 5 years from selected households were eligible for enrolment. A questionnaire was administered to the children's caregivers to obtain information about measles vaccination history and history of measles. Oral fluid samples were obtained from children and tested for antibodies to measles virus and HIV-1 by EIA. FINDINGS 1015 children from 668 residences provided adequate specimens. 853 (84%) children had a history of measles vaccination according to either caregiver report or immunisation card. 679 children (67%) had antibodies to measles virus, and 64 (6%) children had antibodies to HIV-1. Children with antibodies to HIV-1 were as likely to have no history of measles vaccination as those without antibodies to HIV-1 (odds ratio [OR] 1.17, 95% CI 0.57-2.41). Children without measles antibodies were more likely to have never received measles vaccine than those with antibodies (adjusted OR 2.50, 1.69-3.71). In vaccinated children, 33 (61%) of 54 children with antibodies to HIV-1 also had antibodies to measles virus, compared with 568 (71%) of 796 children without antibodies to HIV-1 (p=0.1). INTERPRETATION 3 years after an SIA, population immunity to measles was insufficient to interrupt measles virus transmission. The use of oral fluid and satellite images for sampling are potential methods to assess population immunity and the timing of SIAs.
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Affiliation(s)
- Sara A Lowther
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Affiliation(s)
- Robin J Biellik
- Immunization Solutions, PATH, 01210 Ferney-Voltaire, France.
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Lim SS, Stein DB, Charrow A, Murray CJL. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. Lancet 2008; 372:2031-46. [PMID: 19070738 DOI: 10.1016/s0140-6736(08)61869-3] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substantial resources have been invested in increasing childhood immunisation coverage through global initiatives such as the Universal Childhood Immunisation (UCI) campaign and the Global Alliance on Vaccines and Immunisations (GAVI). There are longstanding concerns that target-oriented and performance-oriented initiatives such as UCI and GAVI's immunisation services support (ISS) might encourage over-reporting. We estimated the coverage of three doses of diphtheria, tetanus, and pertussis vaccine (DTP3) based on surveys using all available data. METHODS We estimated DTP3 coverage by analysing unit record data from surveys and supplemented this with reported coverage from other surveys and administrative data. We used bidirectional distance-dependent regression to estimate trends in survey-based coverage in 193 countries during 1986-2006. We used standard time-series cross-sectional analysis to investigate any association in the difference between countries' official reports and survey-based coverage as the dependent variable and the presence of GAVI ISS as the independent variable, controlling for country and time effects. FINDINGS Crude coverage of DTP3 based on surveys increased from 59% (95% uncertainty interval 51-65) in 1986 to 65% (60-68) in 1990, 70% (65-74) in 2000, and 74% (70-77) in 2006. There were substantial differences between officially reported and survey-based coverage during UCI. GAVI ISS significantly increased the difference between officially reported coverage and survey coverage. Up to 2006, in 51 countries receiving GAVI ISS payments, 7.4 million (5.7 million to 9.2 million) additional children were immunised with DTP3 based on surveys compared with officially reported estimates of 13.9 million. On the basis of the number of additional children immunised from surveys at a rate of US$20 each, GAVI ISS payments are estimated at $150 million (115 million to 184 million) compared with actual disbursements of $290 million. INTERPRETATION Survey-based DTP3 immunisation coverage has improved more gradually and not to the level suggested by countries' official reports or WHO and UNICEF estimates. There is an urgent need for independent and contestable monitoring of health indicators in an era of global initiatives that are target-oriented and disburse funds based on performance.
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Affiliation(s)
- Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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