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Dhalaria P, Kumar P, Verma A, Priyadarshini P, Kumar Singh A, Tripathi B, Taneja G. Exploring landscape of measles vaccination coverage: A step towards measles elimination goal in India. Vaccine 2024; 42:3637-3646. [PMID: 38704248 PMCID: PMC11165302 DOI: 10.1016/j.vaccine.2024.04.075] [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: 12/07/2023] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Measles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24-35 months. DATA SOURCES AND METHODOLOGY The National Family Health Survey 2019-21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24-35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression. RESULTS The study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India. DISCUSSION Measles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal.
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Affiliation(s)
- Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi 110070, India
| | - Pawan Kumar
- Immunization Division, Ministry of Health & Family Welfare, New Delhi 110011, India
| | - Ajay Verma
- Department of Economics, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Pretty Priyadarshini
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi 110070, India
| | - Ajeet Kumar Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi 110070, India.
| | | | - Gunjan Taneja
- Bill & Melinda Gates Foundation, New Delhi 110067, India
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Mutwadi AM, Madinga JN, Vanlerberghe V, Mbala PK, van der Sande MAB. Geospatial and multilevel clustering of zero-dose children in Kikwit, Democratic Republic of the Congo in 2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002617. [PMID: 38422098 PMCID: PMC10903790 DOI: 10.1371/journal.pgph.0002617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/03/2024] [Indexed: 03/02/2024]
Abstract
Zero-dose children remain highly vulnerable to vaccine-preventable diseases and can sustain transmission even in highly vaccinated populations. The WHO Immunization Agenda 2030 has prioritised reaching out to these children. We assessed the spatial distribution of zero-dose children together with the associated risk factors in a provincial capital in the Democratic Republic of Congo. A cross sectional survey was conducted in the city of Kikwit between September 28 and October 14, 2022. Data were collected both at household and health area level. QGIS and SATscan were used to describe and identify hotspots among zero-dose children, and a mixed effect logistic regression model was used to identify risk factors. Overall, 1,863 children aged 12-23 months were enrolled. Kikwit city had a 16.3% zero-dose prevalence, with significant variation between and within health zones. Two hotspots were identified through geospatial analysis, each spanning multiple health areas. Multilevel analysis revealed significant clustering at health area level and found six associated risk factors. These include the absence of home visits by community health workers (aOR = 1.90), living more than a kilometre from a health centre (aOR = 1.95), the mother's lack of tetanus vaccination (aOR = 3.16), and inability to name a vaccine-preventable disease (aOR = 3.20). However, secondary (aOR = 0.56) or tertiary (aOR = 0.21) education of mothers/guardians and belonging to Bunda (aOR = 0.36) or Mbala (aOR = 0.52) ethnicity reduced the risk of zero-dose. We observed a high prevalence of zero-dose children with a heterogeneous spatial distribution of epidemiological importance. Due to sub-zonal diversity, a health zone approach to reduce zero-dose immunization appears very limited. Zero-dose prevalence was related to the community health workers' home visit, to the distance of residence to a health centre and to household-level factors. Geospatial results could help in targeting priority health areas and communities for vaccination.
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Affiliation(s)
- Armand Malembe Mutwadi
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Epidemiology and Global Health Department, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joule Ntwan Madinga
- Epidemiology and Global Health Department, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Veerle Vanlerberghe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Placide K. Mbala
- Epidemiology and Global Health Department, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Marianne A. B. van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Global Public Health Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Biks GA, Shiferie F, Tsegaye DA, Asefa W, Alemayehu L, Wondie T, Zelalem M, Lakew Y, Belete K, Gebremedhin S. High prevalence of zero-dose children in underserved and special setting populations in Ethiopia using a generalize estimating equation and concentration index analysis. BMC Public Health 2024; 24:592. [PMID: 38395877 PMCID: PMC10893596 DOI: 10.1186/s12889-024-18077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Globally, according to the World Health Organization (WHO) 2023 report, more than 14.3 million children in low- and middle-income countries, primarily in Africa and South-East Asia, are not receiving any vaccinations. Ethiopia is one of the top ten countries contributing to the global number of zero-dose children. OBJECTIVE To estimate the prevalence of zero-dose children and associated factors in underserved populations of Ethiopia. METHODS A cross-sectional vaccine coverage survey was conducted in June 2022. The study participants were mothers of children aged 12-35 months. Data were collected using the CommCare application system and later analysed using Stata version 17. Vaccination coverage was estimated using a weighted analysis approach. A generalized estimating equation model was fitted to determine the predictors of zero-dose children. An adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p-value of 0.05 or less was considered statistically significant. RESULTS The overall prevalence of zero-dose children in the study settings was 33.7% (95% CI: 34.9%, 75.7%). Developing and pastoralist regions, internally displaced peoples, newly formed regions, and conflict-affected areas had the highest prevalence of zero-dose children. Wealth index (poorest [AOR = 2.78; 95% CI: 1.70, 4.53], poorer [AOR = 1.96; 95% CI: 1.02, 3.77]), single marital status [AOR = 2.4; 95% CI: 1.7, 3.3], and maternal age (15-24 years) [AOR = 1.2; 95% CI: 1.1, 1.3] were identified as key determinant factors of zero-dose children in the study settings. Additional factors included fewer than four Antenatal care visits (ANC) [AOR = 1.3; 95% CI: 1.2, 1.4], not receiving Postnatal Care (PNC) services [AOR = 2.1; 95% CI: 1.5, 3.0], unavailability of health facilities within the village [AOR = 3.7; 95% CI: 2.6, 5.4], women-headed household [AOR = 1.3; 95% CI:1.02, 1.7], low gender empowerment [AOR = 1.6; 95% CI: 1.3, 2.1], and medium gender empowerment [AOR = 1.7; 95% CI: 1.2, 2.5]. CONCLUSION In the study settings, the prevalence of zero-dose children is very high. Poor economic status, disempowerment of women, being unmarried, young maternal age, and underutilizing antenatal or post-natal services are the important predictors. Therefore, it is recommended to target tailored integrated and context-specific service delivery approach. Moreover, extend immunization sessions opening hours during the evening/weekend in the city administrations to meet parents' needs.
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Affiliation(s)
| | | | | | | | | | - Tamiru Wondie
- Project HOPE, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Meseret Zelalem
- Maternal and Child Health, Minister of Health, Addis Ababa, Ethiopia
| | - Yohannes Lakew
- Maternal and Child Health, Minister of Health, Addis Ababa, Ethiopia
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Aheto JMK, Olowe ID, Chan HMT, Ekeh A, Dieng B, Fafunmi B, Setayesh H, Atuhaire B, Crawford J, Tatem AJ, Utazi CE. Geospatial Analyses of Recent Household Surveys to Assess Changes in the Distribution of Zero-Dose Children and Their Associated Factors before and during the COVID-19 Pandemic in Nigeria. Vaccines (Basel) 2023; 11:1830. [PMID: 38140234 PMCID: PMC10747017 DOI: 10.3390/vaccines11121830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The persistence of geographic inequities in vaccination coverage often evidences the presence of zero-dose and missed communities and their vulnerabilities to vaccine-preventable diseases. These inequities were exacerbated in many places during the coronavirus disease 2019 (COVID-19) pandemic, due to severe disruptions to vaccination services. Understanding changes in zero-dose prevalence and its associated risk factors in the context of the COVID-19 pandemic is, therefore, critical to designing effective strategies to reach vulnerable populations. Using data from nationally representative household surveys conducted before the COVID-19 pandemic, in 2018, and during the pandemic, in 2021, in Nigeria, we fitted Bayesian geostatistical models to map the distribution of three vaccination coverage indicators: receipt of the first dose of diphtheria-tetanus-pertussis-containing vaccine (DTP1), the first dose of measles-containing vaccine (MCV1), and any of the four basic vaccines (bacilli Calmette-Guerin (BCG), oral polio vaccine (OPV0), DTP1, and MCV1), and the corresponding zero-dose estimates independently at a 1 × 1 km resolution and the district level during both time periods. We also explored changes in the factors associated with non-vaccination at the national and regional levels using multilevel logistic regression models. Our results revealed no increases in zero-dose prevalence due to the pandemic at the national level, although considerable increases were observed in a few districts. We found substantial subnational heterogeneities in vaccination coverage and zero-dose prevalence both before and during the pandemic, showing broadly similar patterns in both time periods. Areas with relatively higher zero-dose prevalence occurred mostly in the north and a few places in the south in both time periods. We also found consistent areas of low coverage and high zero-dose prevalence using all three zero-dose indicators, revealing the areas in greatest need. At the national level, risk factors related to socioeconomic/demographic status (e.g., maternal education), maternal access to and utilization of health services, and remoteness were strongly associated with the odds of being zero dose in both time periods, while those related to communication were mostly relevant before the pandemic. These associations were also supported at the regional level, but we additionally identified risk factors specific to zero-dose children in each region; for example, communication and cross-border migration in the northwest. Our findings can help guide tailored strategies to reduce zero-dose prevalence and boost coverage levels in Nigeria.
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Affiliation(s)
- Justice Moses K. Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; (I.D.O.); (H.M.T.C.); (A.J.T.); (C.E.U.)
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra P.O. Box LG13, Ghana
| | - Iyanuloluwa Deborah Olowe
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; (I.D.O.); (H.M.T.C.); (A.J.T.); (C.E.U.)
| | - Ho Man Theophilus Chan
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; (I.D.O.); (H.M.T.C.); (A.J.T.); (C.E.U.)
- School of Mathematical Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | | | | | | | | | - Brian Atuhaire
- Gavi, The Vaccine Alliance, Geneva, Switzerland; (H.S.); (B.A.); (J.C.)
| | - Jessica Crawford
- Gavi, The Vaccine Alliance, Geneva, Switzerland; (H.S.); (B.A.); (J.C.)
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; (I.D.O.); (H.M.T.C.); (A.J.T.); (C.E.U.)
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; (I.D.O.); (H.M.T.C.); (A.J.T.); (C.E.U.)
- School of Mathematical Sciences, University of Southampton, Southampton SO17 1BJ, UK
- Department of Statistics, Nnamdi Azikiwe University, Awka PMB 5025, Nigeria
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Wariri O, Utazi CE, Okomo U, Metcalf CJE, Sogur M, Fofana S, Murray KA, Grundy C, Kampmann B. Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study. Vaccine 2023; 41:5696-5705. [PMID: 37563051 DOI: 10.1016/j.vaccine.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants. METHODS We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km2 pixel. We utilized cluster-level childhood vaccination data from The Gambia 2019-20 Demographic and Health Survey. We adopted a fully Bayesian geostatistical model incorporating publicly available geospatial covariates to aid predictive accuracy. The model was implemented using the integrated nested Laplace approximation-stochastic partial differential equation (INLA-SPDE) approach. RESULTS We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants. CONCLUSIONS Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Jessica E Metcalf
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health, Charité Universitatsmedizin, Berlin, Germany
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Haeuser E, Nguyen JQ, Rolfe S, Nesbit O, Fullman N, Mosser JF. Assessing Geographic Overlap between Zero-Dose Diphtheria–Tetanus–Pertussis Vaccination Prevalence and Other Health Indicators. Vaccines (Basel) 2023; 11:vaccines11040802. [PMID: 37112714 PMCID: PMC10144604 DOI: 10.3390/vaccines11040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The integration of immunization with other essential health services is among the strategic priorities of the Immunization Agenda 2030 and has the potential to improve the effectiveness, efficiency, and equity of health service delivery. This study aims to evaluate the degree of spatial overlap between the prevalence of children who have never received a dose of the diphtheria–tetanus–pertussis-containing vaccine (no-DTP) and other health-related indicators, to provide insight into the potential for joint geographic targeting of integrated service delivery efforts. Using geospatially modeled estimates of vaccine coverage and comparator indicators, we develop a framework to delineate and compare areas of high overlap across indicators, both within and between countries, and based upon both counts and prevalence. We derive summary metrics of spatial overlap to facilitate comparison between countries and indicators and over time. As an example, we apply this suite of analyses to five countries—Nigeria, Democratic Republic of the Congo (DRC), Indonesia, Ethiopia, and Angola—and five comparator indicators—children with stunting, under-5 mortality, children missing doses of oral rehydration therapy, prevalence of lymphatic filariasis, and insecticide-treated bed net coverage. Our results demonstrate substantial heterogeneity in the geographic overlap both within and between countries. These results provide a framework to assess the potential for joint geographic targeting of interventions, supporting efforts to ensure that all people, regardless of location, can benefit from vaccines and other essential health services.
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Affiliation(s)
- Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Jason Q. Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Sam Rolfe
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Olivia Nesbit
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Nancy Fullman
- Department of Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA
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Tohme RA, Scobie HM, Okunromade O, Olaleye T, Shuaib F, Jegede T, Yahaya R, Nnaemeka N, Lawal B, Egwuenu A, Parameswaran N, Cooley G, An Q, Coughlin M, Okposen BB, Adetifa I, Bolu O, Ihekweazu C. Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children? Vaccines (Basel) 2023; 11:vaccines11030663. [PMID: 36992247 DOI: 10.3390/vaccines11030663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | | | - Faisal Shuaib
- National Primary Healthcare Development Agency, Area 11, Garki, Abuja 900247, Nigeria
| | - Tunde Jegede
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Ridwan Yahaya
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Ndodo Nnaemeka
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Bola Lawal
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | | | - Nishanth Parameswaran
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Qian An
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Melissa Coughlin
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Bassey B Okposen
- National Primary Healthcare Development Agency, Area 11, Garki, Abuja 900247, Nigeria
| | | | - Omotayo Bolu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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