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Schenk J, Abrams S, Litzroth A, Cornelissen L, Grammens T, Theeten H, Hens N. Identifying immunity gaps for measles using Belgian serial serology data. Vaccine 2022; 40:3676-3683. [PMID: 35589453 PMCID: PMC9108896 DOI: 10.1016/j.vaccine.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
Vaccine-preventable diseases, such as measles, have been re-emerging in countries with moderate to high vaccine uptake. It is increasingly important to identify and close immunity gaps and increase coverage of routine childhood vaccinations, including two doses of the measles-mumps-rubella vaccine (MMR). Here, we present a simple cohort model relying on a Bayesian approach to evaluate the evolution of measles seroprevalence in Belgium using the three most recent cross-sectional serological survey data collections (2002, 2006 and 2013) and information regarding vaccine properties. We find measles seroprevalence profiles to be similar for the different regions in Belgium. These profiles exhibit a drop in seroprevalence in birth cohorts that were offered vaccination at suboptimal coverages in the first years after routine vaccination has been started up. This immunity gap is observed across all cross-sectional survey years, although it is more pronounced in survey year 2013. At present, the COVID-19 pandemic could negatively impact the immunization coverage worldwide, thereby increasing the need for additional immunization programs in groups of children that are impacted by this. Therefore, it is now even more important to identify existing immunity gaps and to sustain and reach vaccine-derived measles immunity goals.
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Affiliation(s)
- Julie Schenk
- Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), UHasselt, Diepenbeek, Belgium.
| | - Steven Abrams
- Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), UHasselt, Diepenbeek, Belgium,Global Health Institute (GHI), Family Medicine and Population Health (FAMPOP), University of Antwerp, Wilrijk, Belgium
| | - Amber Litzroth
- Service of Epidemiology of Infectious Diseases, Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laura Cornelissen
- Service of Epidemiology of Infectious Diseases, Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Tine Grammens
- Service of Epidemiology of Infectious Diseases, Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Heidi Theeten
- Centre for Evaluation of Vaccination (CEV), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium,Public Health and Surveillance Department, Zorg en Gezondheid Vlaanderen, Belgium
| | - Niel Hens
- Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), UHasselt, Diepenbeek, Belgium,Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
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2
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Sunarno, Asri F, Subangkit, Mursinah, Herna, Nike S, Kambang S, Widoretno, Dwi F, Tati F, Dian SR, Nelly P. Diphtheria serology in adults in Central Java and East Java, Indonesia: the importance of continuous diphtheria vaccination. Afr Health Sci 2021; 21:1148-1154. [PMID: 35222577 PMCID: PMC8843289 DOI: 10.4314/ahs.v21i3.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Vaccination increase immunity against diphtheria, yet will decrease by aging. Therefore, boosters are needed to be done regularly. Objectives This study aims to determine the immunity to diphtheria for the population of 16 years old and above. Methods The sample of study were 295 collected blood serums by Riskesdas project in 2013, the criteria was above 15 years of age and originating from the Provinces of Central Java or East Java inclusively. Immunity assessment was based on antibody titer (IgG) against diphtheria using Vero Cell cytotoxicity test. Statistical analysis was performed using the X2 test. Results The full protective IgG titer (>0.1 IU/ml) at the age of 16–20 years included 75% sample with a geometric mean titer (GMT) of 0.19 IU/ml. Yet, at the age of 21–60 years and > 60 years, full protective IgG titers only cover 45.5% and 33.3% sample with GMT respectively 0.06 IU / ml. Statistical analysis showed the relationship between age and immune status with p-value 0.003. Otherwise, no relationship between the status of immunity with sex and residency with p-values of 0.16 and 0.43. Conclusions The immune status against diphtheria at the age of above 15 years decreases with aging.
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Affiliation(s)
- Sunarno
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Febriyani Asri
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Subangkit
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Mursinah
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Herna
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Susanti Nike
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Sariadji Kambang
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Widoretno
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Febriyana Dwi
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Febrianti Tati
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Saraswati Ratih Dian
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Puspandari Nelly
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
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3
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Friedrich N, Poethko-Müller C, Kuhnert R, Matysiak-Klose D, Koch J, Wichmann O, Santibanez S, Mankertz A. Seroprevalence of Measles-, Mumps-, and Rubella-specific antibodies in the German adult population - cross-sectional analysis of the German Health Interview and Examination Survey for Adults (DEGS1). THE LANCET REGIONAL HEALTH. EUROPE 2021; 7:100128. [PMID: 34557838 PMCID: PMC8454806 DOI: 10.1016/j.lanepe.2021.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The WHO European Region targets the elimination of measles, rubella, and the congenital rubella syndrome and welcomes mumps elimination via the joint MMR vaccine. In a push towards this elimination goal, Germany introduced a recommendation on MMR vaccination for adults in 2010 to prevent increasing numbers of measles cases among adults and to strengthen herd immunity. METHODS The prevalence of anti-measles, -mumps, and -rubella IgG antibodies was analysed in 7,115 participants between the ages of 18 and 79 years in the German Health Interview and Examination Survey. Risk factors of seronegativity of adults born 1970 or later were determined. FINDINGS The seroprevalence of anti-measles IgG antibodies was more than 97% in adults born before 1965 and less than 90% in adults born afterwards. Prevalence and GMTs declined with later years of birth. Seronegativity was associated with two-sided migration background and region of residence in East Germany. For anti-mumps IgG antibodies, the seroprevalence was less than 90% in almost all age groups. Prevalence and GMTs declined with later years of birth. Seronegativity was not associated with any socio-demographic factor. Anti-rubella IgG seropositivity was found in more than 90% of adults born before 1985. GMTs declined in younger age groups. Seronegativity was associated with birth between 1980 and 1993 and male gender. High socio-economic status lowered the odds of being seronegative. INTERPRETATION These data reinforce the implementation of the vaccination recommendation for adults and provide the basis for further evaluation of this measure. FUNDING The Federal Ministry of Health, Germany.
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Affiliation(s)
- Nicole Friedrich
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | | | - Ronny Kuhnert
- Epidemiological Data Centre, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany
| | | | - Judith Koch
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Sabine Santibanez
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Annette Mankertz
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
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4
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Liu D, Cheng X, Wei S, Yuan L, Chen C, Yao K. Decline of serologic immunity to diphtheria, tetanus and pertussis with age suggested a full life vaccination in mainland China. Hum Vaccin Immunother 2021; 17:1757-1762. [PMID: 33517831 DOI: 10.1080/21645515.2020.1840253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Diphtheria-tetanus-pertussis (DTP) vaccine has already been involved in national vaccination program for several decades in China. The immunity against these diseases in the people of all ages is not well investigated.Materials and methods: Serum samples were tested for IgG antibodies to diphtheria toxoid (DT), tetanus toxoid (TT) and pertussis toxin (PT) by using commercial ELISA kits.Results: A total of 666 sera of patients from 1 day to 89 years of age was collected from 2018 to 2019. The protective rates of diphtheria, tetanus and pertussis were 45.5%, 54.4% and 4.7%, respectively. Only 4.7% of the study population had seropositivity against three of the diseases. Young infant (<3 m) and adult (>18y) were generally lack of protective antibody against diphtheria (81.7% and 58.3%) and tetanus (91.5% and 86.2%). An obvious increase in immunity level of diphtheria and tetanus was observed at 3 m-3y, but there was no significant increase of immunity to pertussis at any age group. All age groups showed low immunity to pertussis.Conclusions: The present results revealed the susceptibility to diphtheria and tetanus in young infants and adults, and the susceptibility to pertussis over the ages, which highlight the need to improve the current vaccination program.
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Affiliation(s)
- Dandan Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoping Cheng
- Clinical Laboratory, Youyang County People's Hospital, Chongqing, China
| | - Shi Wei
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | - Changhui Chen
- Department of Pediatrics, Youyang County People's Hospital, Chongqing, China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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5
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Gobert C, Van Hauwermeiren C, Quoidbach C, Reschner A, Necsoi C, Benslimane A, Nagant C, Van den Wijngaert S, Delforge M, Corazza F, De Wit S, Dauby N. Tetanus seroprotection in people living with HIV: Risk factors for seronegativity, evaluation of medical history and a rapid dipstick test. Vaccine 2021; 39:1963-1967. [PMID: 33715902 DOI: 10.1016/j.vaccine.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Tetanus is a vaccine-preventable disease. Booster immunization is required in order to induce long-lived tetanus-toxoid (TT) specific antibody response. We investigated the prevalence and risk factors of TT seronegativity in a cohort of people living with HIV (PWH) in Belgium along with the respective performance of vaccine history and a rapid dipstick test (Tetanus Quick Stick ® or TQS) compared to ELISA testing. METHODS PWH were prospectively enrolled and answered a questionnaire. ELISA was performed on serum or plasma using a commercial kit. A TT antibody level ≥ 0.15 IU / mL was considered protective. The TQS test was performed on a limited number of subjects. RESULTS Three-hundred forty-four subjects were included. The prevalence of tetanus seroprotection was 84,9%. Median age was 46.7 and 68% were born outside Belgium. Antiretroviral therapy coverage was almost universal (98.5%). After multivariable analysis, two risk factors were independently associated with TT seronegativity: an education level equivalent or below than secondary school and being born outside Europe. Vaccine history was shown to be unreliable (sensitivity: 43.8%; specificity: 76.5%; positive predictive value: 91.4% and negative predictive value :19.3%). The correlation between vaccine history and tetanus seroprotection was low (kappa coefficient = 0.09). The TQS performances were good (sensitivity 86.4%, specificity 96.0%, positive predictive value 99.3%, negative predictive value 52.17%). The correlation between TQS and tetanus seroprotection was substantial (kappa coefficient = 0.61). CONCLUSIONS In this cohort of PWH with a high proportion of migrants, socio-demographic and educational factors were associated with TT seronegativity while HIV-related factors were not, indicating that vaccine information should be tailored to cultural and educational background. As vaccine history is not reliable, TQS could represent an efficient tool for screening of TT-seronegativity.
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Affiliation(s)
- Cathy Gobert
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Celine Van Hauwermeiren
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Catherine Quoidbach
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anca Reschner
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Coca Necsoi
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Asma Benslimane
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Carole Nagant
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Sigi Van den Wijngaert
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Marc Delforge
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francis Corazza
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium; Centre for Environmental Health and Occupational Health, School of Public Health, Université libre de Bruxelles (ULB), Belgium.
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6
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Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients. Vaccines (Basel) 2021; 9:vaccines9010018. [PMID: 33406698 PMCID: PMC7824683 DOI: 10.3390/vaccines9010018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.
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7
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Ho E, Schenk J, Hutse V, Suin V, Litzroth A, Blaizot S, Herzog SA, Verburgh V, Jacques M, Rahman A, Michielsen P, Van Damme P, Van Gucht S, Theeten H, Hens N, Vanwolleghem T. Stable HEV IgG seroprevalence in Belgium between 2006 and 2014. J Viral Hepat 2020; 27:1253-1260. [PMID: 32564516 DOI: 10.1111/jvh.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/15/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Recent European studies suggest an emergence of hepatitis E virus (HEV) infection. We evaluated trends in birth cohort-specific HEV seroprevalence and regional differences in Belgium. HEV IgG seroprevalence was analysed on national serum banks (1579 and 2087 samples for 2006 and 2014, respectively. Hepatitis E virus antigen was tested on positive samples. Observed data were modelled using a generalized additive model with a complementary log-log link. No significant differences between birth cohorts or sexes were found. Modelling identified the individual's age and province as relevant factors. The probability of HEV seropositivity increases significantly with age. An estimated total of 434 819 (yearly rate of 54,352) (sero-)infections were found between 2006 and 2014. Overall, HEV IgG seroprevalences were 4.1% (64/1579, 95% CI 3.1-5.1) and 5.8% (121/2087, CI 4.8-6.9) in 2006 and 2014, respectively. Observed HEV antigen seroprevalence was 0.027% (1/3666) for the entire cohort. These results show stable HEV IgG seroprevalence in Belgium.
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Affiliation(s)
- Erwin Ho
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Julie Schenk
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Veronik Hutse
- Scientific Directorate Infectious Diseases in Humans, National Reference Centre for Hepatitis Viruses, Sciensano, Belgium
| | - Vanessa Suin
- Scientific Directorate Infectious Diseases in Humans, National Reference Centre for Hepatitis Viruses, Sciensano, Belgium
| | - Amber Litzroth
- Scientific Directorate Epidemiology and Public Health, Sciensano, Belgium
| | - Stéphanie Blaizot
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sereina A Herzog
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vera Verburgh
- Scientific Directorate Infectious Diseases in Humans, National Reference Centre for Hepatitis Viruses, Sciensano, Belgium
| | - Marjorie Jacques
- Scientific Directorate Infectious Diseases in Humans, National Reference Centre for Hepatitis Viruses, Sciensano, Belgium
| | - Abbas Rahman
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Van Gucht
- Scientific Directorate Infectious Diseases in Humans, National Reference Centre for Hepatitis Viruses, Sciensano, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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8
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Xu Y, Liu Y, Du J, Zheng W, Liu S, Zhang X, Zhang X, Wang J, Che X, Gu W, Jiang W. Seroepidemiology of tetanus in Hangzhou from 2009 to 2018. Hum Vaccin Immunother 2020; 16:2670-2676. [DOI: 10.1080/21645515.2020.1738170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yuyang Xu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Zheng
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Shijun Liu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xuechao Zhang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jun Wang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Jiang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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9
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Martini H, Soetens O, Litt D, Fry NK, Detemmerman L, Wybo I, Desombere I, Efstratiou A, Piérard D. Diphtheria in Belgium: 2010-2017. J Med Microbiol 2019; 68:1517-1525. [PMID: 31418673 DOI: 10.1099/jmm.0.001039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In Western Europe, the incidence of both respiratory and cutaneous diphtheria, caused by toxin-producing Corynebacterium diphtheriae, Corynebacterium ulcerans or Corynebacterium pseudotuberculosis, has been low over the past few decades thanks to the use of an effective vaccine and a high level of vaccination coverage. However, the disease has still not been eradicated and continues to occur in all of Europe. In order to prevent sequelae or a fatal outcome, diphtheria antitoxin (DAT) should be administered to suspected diphtheria patients as soon as possible, but economic factors and issues concerning regulations have led to poor availability of DAT in many countries. The European Centre for Disease Prevention and Control and World Health Organization have called for European Union-wide solutions to this DAT-shortage. In order to illustrate the importance of these efforts and underline the need for continued diphtheria surveillance, we present data on all registered cases of toxigenic and non-toxigenic C. diphtheriae, C. ulcerans and C. pseudotuberculosis in Belgium during the past decade, up to and including 2017.
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Affiliation(s)
- Helena Martini
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Oriane Soetens
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England - National Infection Service, London, UK
| | - Norman K Fry
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK.,Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England - National Infection Service, London, UK
| | - Liselot Detemmerman
- Present address: LaCAR MDx Technologies, Liège, Belgium.,Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Wybo
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Isabelle Desombere
- Present address: LaCAR MDx Technologies, Liège, Belgium.,SD Infectious Diseases in Humans, Service Immune Response, National Reference Centre for toxigenic corynebacteria, Sciensano (Public Health Belgium), Brussels, Belgium
| | - Androulla Efstratiou
- WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections, Public Health England - National Infection Service, London, UK
| | - Denis Piérard
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
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10
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Funk S, Knapp JK, Lebo E, Reef SE, Dabbagh AJ, Kretsinger K, Jit M, Edmunds WJ, Strebel PM. Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination. BMC Med 2019; 17:180. [PMID: 31551070 PMCID: PMC6760101 DOI: 10.1186/s12916-019-1413-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns. METHODS We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination. RESULTS We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5-9-year-olds than established previously. CONCLUSIONS The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5-9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.
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Affiliation(s)
- Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Jennifer K. Knapp
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Emmaculate Lebo
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Susan E. Reef
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Alya J. Dabbagh
- World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | | | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, 61 Colindale Avenue, London, UK
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Hong Kong SAR, China
| | - W. John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Peter M. Strebel
- GAVI Alliance, Chemin du Pommier 40, Le Grand-Saconnex, Switzerland
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Vermeire T, Barbezange C, Francart A, Hamouda A, Litzroth A, Hutse V, Martens L, Vandermarliere E, Van Gucht S. Sera from different age cohorts in Belgium show limited cross-neutralization between the mumps vaccine and outbreak strains. Clin Microbiol Infect 2019; 25:907.e1-907.e6. [DOI: 10.1016/j.cmi.2018.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/05/2018] [Accepted: 11/10/2018] [Indexed: 11/30/2022]
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12
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Xu Y, Xu E, Liu S, Zheng W, Zhang X, Du J, Zhang X, Wang J, Che X, Gu W, Liu Y. Seroepidemiology of pertussis in Hangzhou, China, during 2009-2017. Hum Vaccin Immunother 2019; 15:2564-2570. [PMID: 31116637 DOI: 10.1080/21645515.2019.1608130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: To delineate seroepidemiology of pertussis in Hangzhou, to evaluate the protection levels of pertussis among healthy populations, for improving prevention strategy of pertussis.Methods: During 2009-2017, a multistage stratified random sampling method was employed to select participants included via physical examination for subjects in several Community Health Centers in Hangzhou. Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect Immunoglobulin G (IgG) antibodies against pertussis in serum samples. Results were compared among 11 age groups. Univariate and multivariate analysis were used to analyze the associations among the rates of pertussis IgG seropositivity and the geometric mean concentration (GMC) levels of pertussis IgG and the related factors.Results: A total of 3360 subjects with available information were included, with 1745 male and 1615 female. Of these, 59.6% subjects had a clear immunization history of diphtheria-tetanus-pertussis vaccine (DTP). The vaccination rates of DTP had a declined trend with older age. The rate of pertussis IgG seropositivity was 69.9% (95% confidence interval: 68.3-71.5) and the GMC for pertussis IgG was 48.46 U/ml. Significantly higher seropositivity and GMC for pertussis IgG were found in subjects that had inoculation vaccine history or unknown history when compared those without inoculation of vaccine, lower in age groups <10, 20-29, and 30-39 y when compared to the other age groups evaluated.Conclusions: There are different distribution profiles both of the seropositivity and GMC for pertussis IgG for different age groups and immunization history of vaccine groups. In order to prevent pertussis occurrence, it is important to employ a booster dose of pertussis vaccine in adolescents and adults.
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Affiliation(s)
- Yuyang Xu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Erping Xu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Shijun Liu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Zheng
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xuechao Zhang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jun Wang
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Imunoprevention institute, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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The value of seroprevalence data as surveillance tool for Lyme borreliosis in the general population: the experience of Belgium. BMC Public Health 2019; 19:597. [PMID: 31101034 PMCID: PMC6525443 DOI: 10.1186/s12889-019-6914-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Serological surveillance, based on the measurement of the presence of specific antibodies in a given population, can be used in addition to traditional and routine disease surveillance methods. The added value of this has been largely documented for vaccine-preventable diseases, but to a lesser extent for vector-borne diseases. This study aimed to evaluate the utility of seroprevalence data as additional source of information on the epidemiology of Lyme borreliosis in Belgium. METHODS In total, 3215 residual blood samples collected in 2013-2015 were analysed with Liaison® Borrelia IgG kit (DiaSorin S.p.A, Saluggia, Italy). Positive and equivocal results were further examined with immunoblotting (recomLine Borrelia IgG kit, Mikrogen, Neuried, Germany). Crude prevalence estimates of equivocal and seropositive results were calculated and further adjusted accounting for clustered sampling and standardized for age, sex and population per province, according to the Belgian population structure in 2014. The effect of age, sex and region on seropositivity was assessed using log-binomial regression. RESULTS The overall weighted national seroprevalence for Borrelia burgdorferi sensu lato, adjusted for clustered sampling, age, sex and province was 1.06% (95%CI 0.67-1.67). Although not statistically significant, the highest prevalences were observed in men and in those younger than 15 years or older than 59 years of age. At provincial level, the seroprevalence estimates do not follow the geographical distribution of tick bites and diagnoses of Lyme borreliosis as detected through other surveillance systems. CONCLUSIONS Although the use of residual samples for seroprevalence estimates has several advantages, it seems to be a limited tool for serological surveillance of Lyme borreliosis in Belgium, other than follow-up of trends if repeated over time. A population-based sampling strategy might provide a more representative nationwide sample, but would be very time intensive and expensive. Seroprevalence studies within risk groups or risk areas in Belgium could provide a useful alternative approach to complement routine surveillance data of Lyme borreliosis.
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Future Ramifications of Age-Dependent Immunity Levels for Measles: Explorations in an Individual-Based Model. LECTURE NOTES IN COMPUTER SCIENCE 2019. [DOI: 10.1007/978-3-030-22734-0_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Smit GSA, Abrams S, Dorny P, Speybroeck N, Devleesschauwer B, Hutse V, Jansens H, Theeten H, Beutels P, Hens N. The seroprevalence of cytomegalovirus infection in Belgium anno 2002 and 2006: a comparative analysis with hepatitis A virus seroprevalence. Epidemiol Infect 2019; 147:e154. [PMID: 31063104 PMCID: PMC6518518 DOI: 10.1017/s0950268819000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/06/2022] Open
Abstract
Cytomegalovirus (CMV) infection is endemic worldwide but its seroprevalence varies widely. The goal of this study was to estimate the age-specific seroprevalence of CMV infection in Belgium based on two cross-sectional serological datasets from 2002 and 2006. The seroprevalence was estimated relying on diagnostic test results based on cut-off values pre-specified by the manufacturers of the tests as well as relying on mixture models applied to continuous pathogen-specific immunoglobulin G antibody titre concentrations. The age-specific seroprevalence of hepatitis A virus (HAV), based on three Belgian cross-sectional serological datasets from 1993, 2002 and 2006, was used as a comparator since individuals acquire lifelong immunity upon recovery, implying an increasing seroprevalence with age. The age group weighted overall CMV seroprevalence derived from the mixture model was 32% (95% confidence interval (CI) 31-34%) in 2002 and 31% (95% CI 30-32%) in 2006. We demonstrated that CMV epidemiology differs from the immunizing infection HAV. This was the first large-scale study of CMV and HAV serial datasets in Belgium, estimating seroprevalence specified by age and birth cohort.
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Affiliation(s)
- G. S. A. Smit
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - S. Abrams
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - P. Dorny
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - N. Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - B. Devleesschauwer
- Department of Epidemiology and Public Health, sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - V. Hutse
- Scientific Directorate Infectious Diseases in Humans, Service of Viral Diseases, Sciensano, Brussels, Belgium
| | - H. Jansens
- Department of Laboratory Medicine, Antwerp University Hospital, Edegem, Belgium
| | - H. Theeten
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - P. Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - N. Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Tomášková H, Zelená H, Kloudová A, Tomášek I. Serological survey of measles immunity in the Czech Republic, 2013. Cent Eur J Public Health 2018; 26:22-27. [PMID: 29684293 DOI: 10.21101/cejph.a5251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the serological survey of measles was to obtain information on the prevalence of antibodies against measles and to verify the effectiveness of vaccination in the Czech population in order to protect public health. METHODS The serological survey was carried out in the Czech Republic in 2013. Antibodies against measles were tested in 3,111 serum samples of participants aged 1-64 years. Serum samples were tested for the presence of immunoglobulin G (IgG) antibodies by enzyme immunoassay (EIA). The vaccination status assessment was based on the medical documentation. Seroprevalence differences were evaluated by sex and age using the Pearson's χ2 test at 5% significance level. RESULTS The overall seroprevalence reached 93.0% (2,893/3,111) (95% CI 92.0-93.9). No statistically significant difference was found between men and women (p=0.724). A lower seroprevalence was identified in the first age group (1-year old children) 62% (62/100), as the vaccination has not yet been completed in this age group. The second lowest seroprevalence 80.4% (160/199) was identified in the age group of 35-44 years. The highest seroprevalence 97.7% (387/396) (95% CI 95.7-99.0) was in the population with naturally-induced immunity (age above 45 years). In the individuals with two doses seroprevalence reached 94.1% (2,081/2,212) (95% CI 93.0-95.0). The level of IgG antibodies decreased in persons above 7 years of age. CONCLUSIONS Based on the results of the serological survey carried out in 2013 in the Czech Republic, it has been decided to postpone the second MMR (measles, mumps and rubella) dose to the age of 5-6 years.
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Affiliation(s)
- Hana Tomášková
- Public Health Institute Ostrava, Ostrava, Czech Republic.,Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Hana Zelená
- Public Health Institute Ostrava, Ostrava, Czech Republic
| | - Alena Kloudová
- Public Health Institute Ostrava, Ostrava, Czech Republic
| | - Ivan Tomášek
- Public Health Institute Ostrava, Ostrava, Czech Republic
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Abstract
Increased measles immunization has led to a significant decline in measles incidence and mortality. During 2016 it is estimated that fewer than 100,000 died from measles for the first time in recorded history. In highly immunized countries measles epidemiology has changed. Threats to national elimination goals and public health include aging cohorts of naïve people that exist from imperfect vaccination rates during the early years of immunization programs. This may be complemented by some loss of immunity in vaccinated populations. While childhood immunization must remain a focus for control efforts, due to higher mortality in the very young, these naïve adolescents and adults also accumulate as they age and add to the pool of susceptible people, perhaps beyond the view of those that are focused on childhood immunization. Here, features of measles epidemiology and control in highly immunized populations are reviewed, providing global data where necessary, to highlight why countries with high immunization coverage are still threatened by measles outbreaks and how changing dynamics may alter disease control.
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Affiliation(s)
- David T S Hayman
- a Molecular Epidemiology and Public Health Laboratory (mEpiLab), Infectious Disease Research Centre (IDReC), Hopkirk Research Institute , Massey University , Palmerston North , New Zealand
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18
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Dauby N, Martin C, Hainaut M, Grammens T, Van den Wijngaert S, Delforge M, De Wit S. Prevalence and risk factors of measles seronegativity in a cohort of HIV-positive subjects: a retrospective study. HIV Med 2018; 19:426-429. [PMID: 29573535 DOI: 10.1111/hiv.12610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Measles infection is a vaccine-preventable disease currently resurging in Europe. HIV-infected subjects are at higher risk of complications following measles infection. We investigated the risk factors associated with being seronegative in a cohort of HIV-infected subjects. METHODS All HIV-infected subjects in our cohort who had a measles serological test performed between December 2005 and May 2017 were retrospectively identified. A measles immunoglobulin G (IgG) titre > 275 mIU/mL was considered protective. Risk factors were analysed using logistic regression. RESULTS Measles serology was available in 273 of 3124 subjects in active follow-up (8.7%). The prevalence of measles seronegativity was 21.6% (59 of 273). In the univariate analysis, being born after 1970 and HIV infection by vertical transmission were both associated with a higher risk of measles seronegativity, while a nadir CD4 T-cell count < 200 cells/μL was associated with a lower risk of measles seronegativity. In the multivariate analysis, only being born after 1970 [odds ratio (OR) 4.9; 95% confidence interval (CI) 1.3-18.7] and vertical transmission (OR 7.7; 95% CI 3.3-18.3) were significantly associated with seronegativity. Among the vertically infected subjects with measles-mumps-rubella (MMR) immunization documentation, the median number of doses of vaccine received before testing was 2 (range 1-3). CONCLUSIONS HIV-infected subjects born after 1970 and vertically infected subjects should be screened for measles seropositivity.
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Affiliation(s)
- N Dauby
- Infectious Diseases Department, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - C Martin
- Infectious Diseases Department, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - M Hainaut
- Pediatrics Department, CHU Saint-Pierre, Brussels, Belgium
| | - T Grammens
- Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - S Van den Wijngaert
- Microbiology Department, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - M Delforge
- Infectious Diseases Department, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - S De Wit
- Infectious Diseases Department, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Gidding HF, Quinn HE, Hueston L, Dwyer DE, McIntyre PB. Declining measles antibodies in the era of elimination: Australia's experience. Vaccine 2017; 36:507-513. [PMID: 29269156 DOI: 10.1016/j.vaccine.2017.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Australia is one of only a few countries with a long-standing and consistent serosurveillance program. We conducted a national serosurvey in 2012-2013 to estimate population seroprevalence of measles-specific IgG and the effective reproduction number, R, and compare the results with the three previous serosurveys (1996-1999, 2002 and 2007) to examine trends following a decade of sustained measles control. METHODS 2729 residual sera from 1 to 49 year olds were tested using the Enzygnost anti-measles IgG enzyme immunoassay (EIA). All sera in the equivocal range by EIA on re-testing and a random sample of low positive and negative sera were later tested by a microneutralisation assay. R was calculated from weighted estimates of the proportion seronegative by age using a previously developed contact matrix. RESULTS In the 2012-13 serosurvey, anti-measles IgG seropositivity for 1-49 year olds was 80.8% (95% CI: 79.4-82.3%) and 8.9% (95% CI: 7.8-10.0%) had equivocal antibody levels. The increasing proportion of seronegative and equivocal individuals in age groups 10-39 years continued a trend seen in previous serosurveys. There was also an increase in equivocal results among 2-4 and 5-9 year old children, >90% of whom were recently vaccinated. R increased from 0.57 in 1999 to above the epidemic threshold of 1 in 2012-13 (R = 1.7). All 20 EIA negative sera, 238/241 (98.8%) equivocal sera, and 89/92 (96.7%) low positive sera had a titre <10 (negative) in the measles microneutralisation assay. CONCLUSIONS A number of countries with sustained measles control have now demonstrated that measles-specific IgG antibodies decline with time since vaccination. As there is good epidemiologic evidence of population-level protection, the implications of declining measles-specific IgG antibody levels for maintaining measles elimination are unclear. Novel studies to determine correlates of protection against measles transmission and disease in the post-elimination era are needed to help answer this question.
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Affiliation(s)
- Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
| | - Helen E Quinn
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
| | - Linda Hueston
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.
| | - Dominic E Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
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Abrams S, Kourkouni E, Sabbe M, Beutels P, Hens N. Inferring rubella outbreak risk from seroprevalence data in Belgium. Vaccine 2016; 34:6187-6192. [PMID: 27840011 DOI: 10.1016/j.vaccine.2016.10.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks.
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Affiliation(s)
- Steven Abrams
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, UHasselt (Hasselt University), Diepenbeek, Belgium.
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Martine Sabbe
- Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute for Public Health, Brussels, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, UHasselt (Hasselt University), Diepenbeek, Belgium; Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium; Department of Epidemiology and Social Medicine, University of Antwerp, Wilrijk, Belgium
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21
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Al-Mekaini LA, Kamal SM, Al-Jabri O, Soliman M, Alshamsi H, Narchi H, Souid AK, Alsuwaidi AR. Seroprevalence of vaccine-preventable diseases among young children in the United Arab Emirates. Int J Infect Dis 2016; 50:67-71. [PMID: 27457919 DOI: 10.1016/j.ijid.2016.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES In the United Arab Emirates (UAE), many vaccine-preventable diseases are notifiable and are often reported despite high estimated immunization coverage. The serological assessment of immunity against these infections (serosurveillance) complements disease surveillance (notification). This study aimed to assess the yet unmeasured serological immunities to nine vaccine-preventable infections among vaccinated Emirati children. METHODS This cross-sectional study involved children who attended the Well-Child Care Programme of the Ambulatory Healthcare Services (Al-Ain, UAE) between July 2014 and September 2015. Serological testing was performed in 227 Emirati children (49% females); subjects were aged (mean±standard deviation) 45±14 months (median 43, range 23-71 months). RESULTS The seroprevalence rates varied markedly among the studied vaccine-preventable diseases, ranging from 39.2% (pertussis) to 98.3% (rubella). Other high seroprevalence rates were noted for measles (98.2%) and poliovirus (92%). The seroprevalence rate for mumps was 82.8%, for varicella was 68.3%, for diphtheria was 86.4%, for tetanus was 89.9%, and for Haemophilus influenzae type B was 84.1%. CONCLUSIONS A large number of the studied children had low seroprevalence rates against pertussis, varicella, and mumps. Studies are needed to explore whether modifying the national immunization programme could improve these low seroprevalence estimates.
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Affiliation(s)
- Lolowa A Al-Mekaini
- Department of Paediatrics, United Arab Emirates University, PO Box 17666, Al Ain, UAE
| | - Salwa M Kamal
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Omer Al-Jabri
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Maher Soliman
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Huda Alshamsi
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Hassib Narchi
- Department of Paediatrics, United Arab Emirates University, PO Box 17666, Al Ain, UAE
| | - Abdul-Kader Souid
- Department of Paediatrics, United Arab Emirates University, PO Box 17666, Al Ain, UAE
| | - Ahmed R Alsuwaidi
- Department of Paediatrics, United Arab Emirates University, PO Box 17666, Al Ain, UAE.
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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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Huygen K. Development of human monoclonal antibodies to diphtheria toxin: A solution for the increasing lack of equine DAT for therapeutic use? Virulence 2016; 7:613-5. [PMID: 27196732 DOI: 10.1080/21505594.2016.1190062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kris Huygen
- a Service Immunology, Scientific Institute of Public Health , Brussels , Belgium
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Caboré RN, Piérard D, Huygen K. A Belgian Serosurveillance/Seroprevalence Study of Diphtheria, Tetanus and Pertussis Using a Luminex xMAP Technology-Based Pentaplex. Vaccines (Basel) 2016; 4:vaccines4020016. [PMID: 27171114 PMCID: PMC4931633 DOI: 10.3390/vaccines4020016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
Serosurveillance and seroprevalence studies are an essential tool to monitor vaccine-preventable diseases. We have developed a magnetic bead-based pentaplex immunoassay (MIA) for the simultaneous detection of IgG antibodies against diphtheria toxin (DT), tetanus toxin (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (Prn). The in-house pentaplex MIA showed a good correlation with commercial ELISAs with correlation coefficients between 0.89 for PT and 0.98 for TT. Intra- and inter-assay variability was <10%. A total of 670 anonymized serum samples collected in 2012 in Belgian adults (ages 20–29.9 years) were analyzed. Geometric mean concentrations (GMC) were 0.2 (0.13–0.29) IU/mL for DT, 0.63 (0.45–0.82) IU/mL for TT, 3.9 (2.6–5.8) IU/mL for PT, 16.3 (11.7–22.7) IU/mL for FHA and 15.4 (10.1–23.6) IU/mL for Prn. Antibody concentrations were below the protective level of 0.1 IU/mL in 26.4% of the sera for DT and in 8.6% of the sera for TT. Anti-PT IgG concentrations indicative of recent pertussis infection (>125 IU/mL) were detected in 1.2% of the subjects. High anti-PT antibodies were not correlated with high antibodies against any of the four other vaccine antigens. This pentaplex MIA will be used for a new large-scale Belgian serosurveillance/seroprevalence study of diphtheria, tetanus and pertussis.
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Affiliation(s)
- Raissa Nadège Caboré
- National Reference Centre Bordetella and Toxigenic Corynebacteria, Service Immunology, Scientific Institute of Public Health (WIV-ISP, Site Ukkel), 1180 Brussels, Belgium.
| | - Denis Piérard
- National Reference Centre Bordetella and Toxigenic Corynebacteria, University Hospital VUB, UZ Brussels, 1090 Jette, Belgium.
| | - Kris Huygen
- National Reference Centre Bordetella and Toxigenic Corynebacteria, Service Immunology, Scientific Institute of Public Health (WIV-ISP, Site Ukkel), 1180 Brussels, Belgium.
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Gonçalves G, Frade J, Nunes C, Mesquita JR, Nascimento MSJ. Persistence of measles antibodies, following changes in the recommended age for the second dose of MMR-vaccine in Portugal. Vaccine 2015; 33:5057-63. [PMID: 26319061 DOI: 10.1016/j.vaccine.2015.08.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
In populations vaccinated with two doses of combined measles-mumps-rubella vaccine (MMR), the serum levels of antibodies against measles depend on the vaccination schedule, time elapsed from the last dose and the area-specific epidemiological situation. Variables measuring "schedule" are age at first and second doses of MMR and intervals derived from that. Changes in vaccination schedules have been made in Portugal. The specific objectives of this study were to measure the association between those potential determinants and the concentration of measles-specific IgG antibodies, after the second dose of MMR. Convenience samples of three Portuguese birth cohorts were selected for this study (41, 66 and 60 born, respectively, in 2001-2003, 1990-1993 and 1994-1995). Geometric mean concentrations (GMC) for measles IgG were, respectively, 934, 251 and 144mIU/ml; p<0.001). Anti-measles-IgG serum concentration decreased with time since last vaccination (waning immunity) and was not influenced by any other component of vaccination schedule, namely age at vaccination with the second dose of MMR. Waning levels of measles antibodies have been observed elsewhere but not as fast as it was observed in Portuguese birth cohorts in this study. Changes in the vaccination schedules might have to be considered in the future.
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Affiliation(s)
- Guilherme Gonçalves
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto Rua de Jorge Viterbo Ferreira, no. 228, Porto 4050-313, Portugal; Unit for Multidisciplinary Biomedical Research (UMIB) Rua de Jorge Viterbo Ferreira, no 228, Porto 4050-313, Portugal.
| | - João Frade
- School of Health Sciences, Polytechnic Institute of Leiria Campus 2 - Morro do Lena - Alto do Vieiro, Apartado 4137, Leiria 2411-901, Portugal; National School of Public Health, Universidade Nova de Lisboa Avenida Padre Cruz, Lisboa 1600-560, Portugal.
| | - Carla Nunes
- National School of Public Health, Universidade Nova de Lisboa Avenida Padre Cruz, Lisboa 1600-560, Portugal; Centro de Investigação em Saúde Pública (CISP) Avenida Padre Cruz, Lisboa 1600-560, Portugal.
| | - João Rodrigo Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu Quinta da Alagoa - Estrada de Nelas, Ranhados, Viseu 3500-606, Portugal.
| | - Maria São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto Rua de Jorge Viterbo Ferreira, no. 228, Porto 4050-313, Portugal.
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Hens N, Abrams S, Santermans E, Theeten H, Goeyvaerts N, Lernout T, Leuridan E, Van Kerckhove K, Goossens H, Van Damme P, Beutels P. Assessing the risk of measles resurgence in a highly vaccinated population: Belgium anno 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.1.20998] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - S Abrams
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - E Santermans
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - N Goeyvaerts
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - T Lernout
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - K Van Kerckhove
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Beutels
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
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27
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Ogunjimi B, Hens N, Pebody R, Jansens H, Seale H, Quinlivan M, Theeten H, Goossens H, Breuer J, Beutels P. Cytomegalovirus seropositivity is associated with herpes zoster. Hum Vaccin Immunother 2015; 11:1394-9. [PMID: 25905443 PMCID: PMC4514428 DOI: 10.1080/21645515.2015.1037999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/12/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022] Open
Abstract
Herpes zoster (HZ) is caused by VZV reactivation that is facilitated by a declined immunity against varicella-zoster virus (VZV), but also occurs in immunocompetent individuals. Cytomegalovirus (CMV) infection is associated with immunosenescence meaning that VZV-specific T-cells could be less responsive. This study aimed to determine whether CMV infection could be a risk factor for the development of HZ. CMV IgG serostatus was determined in stored serum samples from previously prospectively recruited ambulatory adult HZ patients in the UK (N = 223) in order to compare the results with those from UK population samples (N = 1545) by means of a logistic regression (controlling for age and gender). Furthermore, we compared the UK population CMV seroprevalence with those from population samples from other countries (from Belgium (N1 = 1741, N2 = 576), USA (N = 5572) and Australia (N = 2080)). Furthermore, CMV IgG titers could be compared between UK HZ patients and Belgium N2 population samples because the same experimental set-up for analysis was used. We found UK ambulatory HZ patients to have a higher CMV seroprevalence than UK population samples (OR 1.56 [1.11 2.19]). CMV IgG seropositivity was a significant risk factor for HZ in the UK (OR 3.06 [1.32 7.04]. Furthermore, high CMV IgG titers (exceeding the upper threshold) were less abundant in CMV-seropositive Belgian N2 population samples than in CMV-seropositive UK HZ patients (OR 0.51 [0.31 0.82]. We found CMV-seroprevalence to increase faster with age in the UK than in other countries (P < 0.05). We conclude that CMV IgG seropositivity is associated with HZ. This finding could add to the growing list of risk factors for HZ.
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Affiliation(s)
- Benson Ogunjimi
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID); Vaccine & Infectious Disease Institute (VAXINFECTIO); University of Antwerp; Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT); Hasselt University; Hasselt, Belgium
| | - Niel Hens
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID); Vaccine & Infectious Disease Institute (VAXINFECTIO); University of Antwerp; Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT); Hasselt University; Hasselt, Belgium
| | - Richard Pebody
- Respiratory Diseases Department; Public Health England; London, UK
| | - Hilde Jansens
- Department of Laboratory Medicine; Antwerp University Hospital; Edegem, Belgium
| | - Holly Seale
- School of Public Health and Community Medicine; The University of New South Wales; Sydney, Australia
| | - Mark Quinlivan
- Division of Infection and Immunity; University College London; London, UK
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Disease Institute (VAXINFECTIO); University of Antwerp; Antwerp, Belgium
| | - Herman Goossens
- Department of Laboratory Medicine; Antwerp University Hospital; Edegem, Belgium
- Laboratory of Medical Microbiology; Vaccine & Infectious Disease Institute (VAXINFECTIO); University of Antwerp; Antwerp, Belgium
| | - Judy Breuer
- Division of Infection and Immunity; University College London; London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID); Vaccine & Infectious Disease Institute (VAXINFECTIO); University of Antwerp; Antwerp, Belgium
- School of Public Health and Community Medicine; The University of New South Wales; Sydney, Australia
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Braeye T, Linina I, De Roy R, Hutse V, Wauters M, Cox P, Mak R. Mumps increase in Flanders, Belgium, 2012–2013: Results from temporary mandatory notification and a cohort study among university students. Vaccine 2014; 32:4393-4398. [DOI: 10.1016/j.vaccine.2014.06.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/03/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
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Abrams S, Beutels P, Hens N. Assessing mumps outbreak risk in highly vaccinated populations using spatial seroprevalence data. Am J Epidemiol 2014; 179:1006-17. [PMID: 24573540 DOI: 10.1093/aje/kwu014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks.
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THEETEN H, HUTSE V, HOPPENBROUWERS K, BEUTELS P, VAN DAMME P. Universal hepatitis B vaccination in Belgium: impact on serological markers 3 and 7 years after implementation. Epidemiol Infect 2014; 142:251-61. [PMID: 23689103 PMCID: PMC9151132 DOI: 10.1017/s0950268813001064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/15/2013] [Accepted: 04/15/2013] [Indexed: 11/06/2022] Open
Abstract
Hepatitis B virus (HBV) can be eliminated by effective universal vaccination. In Belgium, a free-of-charge HBV vaccination programme in infants with catch-up in adolescents was introduced in 1999. To evaluate the effects in <20-year-olds, seroprotection (anti-HBs >11 mIU/ml, according to the assay) and markers of infection (anti-HBc, HBsAg) were assessed in 2443 residual sera collected 7-8 years after implementation of the programme. The maximal prevalence of a solely anti-HBs seroprotective ('vaccinated') serostatus was 82·9% at age 1 year and 60·5% at age 13 years. A clear increase was found in age cohorts targeted by the campaign after a similar serosurvey conducted 4 years earlier. The prevalence of HBV infection remained unchanged at a low level (1·8% in 2006) similar to pre-vaccination data (1993-1994). We conclude that universal HBV vaccination has achieved overall high levels of vaccine-induced immunity, despite regional variations, which may give rise to pockets of susceptible young adults in the future.
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Affiliation(s)
- H. THEETEN
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
| | - V. HUTSE
- Scientific Institute of Public Health, Virology Section, Brussels, Belgium
| | | | - P. BEUTELS
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
| | - P. VAN DAMME
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
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Khetsuriani N, Zakikhany K, Jabirov S, Saparova N, Ursu P, Wannemuehler K, Wassilak S, Efstratiou A, Martin R. Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: nationwide population-based survey, 2010. Vaccine 2013; 31:4917-22. [PMID: 23859842 PMCID: PMC10507670 DOI: 10.1016/j.vaccine.2013.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/26/2013] [Accepted: 07/02/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tajikistan had a major diphtheria outbreak (≈ 10,000 cases) in the 1990 s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus. METHODS Residents of all regions of Tajikistan aged 1-24 years were included in the serosurvey implemented during September-October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥ 0.1 IU/mL were considered seropositive. RESULTS Overall, 51.4% (95% CI, 47.1%-55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%-82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10-19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%-43.7%) among 10-14 year-olds, and 35.3% (95% CI, 29.9%-41.1%) among 15-19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%-71.6%) and 70.1% (95% CI, 64.5%-75.2%). CONCLUSIONS Population immunity for diphtheria in Tajikistan is low, particularly among 10-19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10-19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1-19 years in 2010 (3-21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.
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Affiliation(s)
- Nino Khetsuriani
- Centers for Disease Control and Prevention (CDC), Atlanta, United States.
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Abstract
SUMMARY The last report on pertussis seroprevalence in Belgium concerned samples collected during 1993-1994. In the context of the Eupert-Labnet WP6 seroprevalence study (comparing sera from 16 European member states), 1500 anonymized leftover diagnostic samples were collected randomly during the second semester of 2012 by the clinical chemistry laboratories of six participating Belgian centres, distributed equally between Flanders, Wallonia and Brussels Capital Region. As suggested by the WP6 organizers, a total of 750 samples (125/centre) were selected from subjects in the 20-29 years age group and 750 samples (125/centre) from subjects in the 30-39 years age group. Anti-PT IgG levels were measured using Virion-Serion ELISA and analysed using predefined cut-off levels. Sixty-one (4%) sera were indicative of an infection in the past 2 years (between 50 and 100 IU/ml) and another 61 (4%) sera had anti-PT IgG antibodies reflecting acute infection (>100 IU/ml). These results highlight the presence of a Bordetella pertussis reservoir in the adult 'healthy' Belgian population.
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High risk of a large measles outbreak despite 30 years of measles vaccination in The Netherlands. Epidemiol Infect 2013; 142:1100-8. [PMID: 23915981 DOI: 10.1017/s0950268813001532] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our aim was to assess progress towards measles elimination from The Netherlands by studying humoral measles immunity in the Dutch population. A population-based seroepidemiological study was conducted in 2006-2007 (N = 7900). Serum samples were analysed by a bead-based multiplex immunoassay. IgG levels ⩾0·2 IU/ml were considered protective. The overall seroprevalence in the Dutch population was 96%. However, 51% of socio-geographically clustered orthodox Protestant individuals aged <10 years were susceptible. Infants might be susceptible to measles between ages 4 months and 14 months, the age at which maternal antibodies have disappeared and the first measles, mumps, rubella (MMR) vaccination is administered, respectively. Waning of antibody concentrations was slower after the second MMR vaccination than after the first. The Netherlands is at an imminent risk of a measles outbreak in the orthodox Protestant minority. To prevent subsequent transmission to the general population, efforts to protect susceptible age groups are needed.
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Braeye T, Sabbe M, Hutse V, Flipse W, Godderis L, Top G. Obstacles in measles elimination: an in-depth description of a measles outbreak in Ghent, Belgium, spring 2011. ACTA ACUST UNITED AC 2013; 71:17. [PMID: 23834074 PMCID: PMC3716678 DOI: 10.1186/0778-7367-71-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/24/2013] [Indexed: 12/03/2022]
Abstract
Background From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions. Methods Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database ‘Vaccinnet’. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center. Results A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0–9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated). Conclusions Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed.
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Affiliation(s)
- Toon Braeye
- Scientific Institute of Public Health, Brussels, Belgium.
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González-Escalada A, García-García L, Viguera-Ester P, Marín-García P, García J, Gil-de-Miguel A, Gil-Prieto R. Seroprevalence of antibodies against measles, rubella, mumps, varicella-zoster, and B. Pertussis in young adults of Madrid, Spain. Hum Vaccin Immunother 2013; 9:1918-25. [PMID: 23793571 DOI: 10.4161/hv.25127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In recent years, there has been an increase in the number of cases of certain immunopreventable diseases in our country. A high proportion of these have been recorded among the young adult population. The aim of this study was to determine the seroprevalence of antibodies against immunopreventable diseases with the greatest health impacts on the young adult population (19-39 y of age) in Madrid. We collected a total of 1,153 serum samples from healthy volunteers undergoing routine medical visits and used ELISA to determine the presence of IgG antibodies against measles, rubella, mumps, and varicella zoster, as well as Bordetella pertussis. The Pearson's χ(2) test was used to compare prevalences, the Mann-Whitney U test was used to compare means, and the Kruskal-Wallis test was applied for variables with more than 2 categories. Statistical significance was achieved with p values of<0.05. The global prevalence of antibodies was 92.1% for measles, 94.4% for rubella, 88.3% for mumps, 92.8% for varicella zoster, and 70.2% for B. pertussis. No statistically significant differences were found between genders. The prevalence of antibodies against measles was more than 95% in the group of individuals born after 1986, and the percentage of individuals susceptible to rubella was less than 5% in women born after 1986. In spite of adequate vaccination coverage, in our region, a population of young adults exists who have not achieved the objectives of the WHO for the elimination of measles and congenital rubella syndrome.
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Affiliation(s)
- Alba González-Escalada
- Departments of Preventive Medicine and Public Health and Medical Immunology and Microbiology; University Rey Juan Carlos; Madrid, Spain
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Immunity to tetanus and diphtheria in the UK in 2009. Vaccine 2012; 30:7111-7. [PMID: 23022148 DOI: 10.1016/j.vaccine.2012.09.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/14/2012] [Accepted: 09/14/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study aimed to estimate the immunity of the UK population to tetanus and diphtheria, including the potential impact of new glycoconjugatate vaccines, and the addition of diphtheria to the school leaver booster in 1994. METHODS Residual sera (n=2697) collected in England in 2009/10 were selected from 18 age groups and tested for tetanus and diphtheria antibody. Results were standardised by testing a panel of sera (n=150) to enable comparison with a previously (1996) published serosurvey. Data were then standardised to the UK population. RESULTS In 2009, 83% of the UK population were protected (≥0.1 IU/mL) against tetanus compared to 76% in 1996 (p=0.079), and 75% had at least basic protection against diphtheria (≥0.01 IU/mL) in 2009 compared to 60% in 1996 (p<0.001). Higher antibody levels were observed in those aged 1-3 years in 2009 compared to 1996 for both tetanus and diphtheria. Higher diphtheria immunity was observed in those aged 16-34 years in 2009 compared to 1996 (geometric mean concentration [GMC] 0.15 IU/mL vs. 0.03 IU/mL, p<0.001). Age groups with the largest proportion of susceptible individuals to both tetanus and diphtheria in 2009 were <1 year old (>29% susceptible), 45-69 years (>20% susceptible) and 70+ years (>32% susceptible). Low immunity was observed in those aged 10-11 years (>19% susceptible), between the scheduled preschool and school leaver booster administration. DISCUSSION The current schedule appears to induce protective levels; increases in the proportions protected/GMCs were observed for the ages receiving vaccinations according to UK policy. Glycoconjugate vaccines appear to have increased immunity, in particular for diphtheria, in preschool age groups. Diphtheria immunity in teenagers and young adults has increased as a result of the addition of diphtheria to the school leaver booster. However, currently older adults remain susceptible, without any further opportunities for immunisations planned according to the present schedule.
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Poethko-Müller C, Mankertz A. Seroprevalence of measles-, mumps- and rubella-specific IgG antibodies in German children and adolescents and predictors for seronegativity. PLoS One 2012; 7:e42867. [PMID: 22880124 PMCID: PMC3412821 DOI: 10.1371/journal.pone.0042867] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022] Open
Abstract
We have undertaken a seroprevalence study with more than 13,000 children, who had been included in the German KIGGS survey, a representative sample of children and adolescents 0-17 years of age. The IgG titres against measles, mumps and rubella were determined in 1 to 17 year olds While 88.8% of the children were MMR-vaccinated at least once, 76.8% of children aged 1 to 17 years showed prevalence of antibodies to MMR. The highest seronegativity was seen with respect to mumps. Gender differences were most pronounced with regard to rubella IgG titres: girls aged 14 to 17 years were best protected, although seronegativity in 6.8% of this vulnerable group still shows the need of improvement. Search for predictors of missing seroprevalence identified young age to be the most important predictor. Children living in the former West and children born outside of Germany had a higher risk of lacking protection against measles and rubella, while children with a migration background but born in Germany were less often seronegative to measles antibodies than their German contemporaries. An association of seronegativity and early vaccination was seen for measles but not for mumps and rubella. A high maternal educational level was associated with seronegativity to measles and rubella. In vaccinated children, seronegativity was highest for mumps and lowest for rubella. For mumps, high differences were observed for seronegativity after one-dose and two-dose vaccination, respectively. Seronegativity increases as time since last vaccination passes thus indicating significant waning effects for all three components of MMR.
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Leuridan E, Goeyvaerts N, Hens N, Hutse V, Van Damme P. Maternal mumps antibodies in a cohort of children up to the age of 1 year. Eur J Pediatr 2012; 171:1167-73. [PMID: 22395563 DOI: 10.1007/s00431-012-1691-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED The duration of the presence of maternal mumps antibodies in a prospective cohort study is presented. Immunoglobulin G against mumps was portioned with a commercial ELISA test (Euroimmun® anti-mumps Virus AT ELISA, Germany) on samples from 213 mother-child pairs at seven time points between pregnancy and 12 months of age. Non-linear mixed models were used to model maternal antibody decay in infants. The model-based median time to loss of antibodies was 3.6 months. The median child-specific time to loss of antibodies in children of naturally immune women (3.8 months) and children of vaccinated women (2.4 months) differed significantly (p = 0.025). The log antibody level of the mother and the log birth weight were correlated with the duration of maternal antibodies in infants (p < 0.0001). CONCLUSION Children of vaccinated women loose maternal mumps antibodies significantly earlier in life compared to children of naturally infected women. If early administration (<12 months) of the combined measles, mumps, and rubella vaccine is needed, maternal mumps antibodies are not expected to interfere with infant humoral vaccine responses.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, WHO Collaborating Centre for Control and Prevention of Infectious Diseases, University of Antwerp, UA-CDE-R 2.13, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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Zakikhany K, Efstratiou A. Diphtheria in Europe: current problems and new challenges. Future Microbiol 2012; 7:595-607. [DOI: 10.2217/fmb.12.24] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, is an ancient disease with high incidence and mortality that has always been characterized by epidemic waves of occurrence. Whilst towards the beginning of the 1980s, many European countries were progressing towards the elimination of diphtheria, an epidemic re-emergence of diphtheria in the Russian Federation and the Newly Independent States of the former Soviet Union demonstrated a continuous threat of the disease into the 1990s. At present, the epidemic is under control and only sporadic cases are observed in Europe. However, the circulation of toxigenic strains is still observed in all parts of the world, posing a constant threat to the population with low levels of seroprotection. More recently, Corynebacterium ulcerans has been increasingly isolated as emerging zoonotic agent of diphtheria from companion animals such as cats or dogs, indicating the enduring threat of this thought-to-be controlled disease.
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Affiliation(s)
- Katherina Zakikhany
- The European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Androulla Efstratiou
- Health Protection Agency (HPA), Microbiology Services Divison: Colindale, Respiratory & Systemic Infection Laboratory (RSIL), WHO Global Collaborating Centre for Diphtheria, London, UK
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